Differential Diagnosis

  • Influenza
  • Legionellosis
  • Leptospirosis
  • Malaria     
Fever, Chills, Dry Cough, and Myalgia


This patient was diagnosed with leptospirosis, a bacterial zoonotic infection caused by any of the serovarieties of the spirochetes from the Leptospira species. There is an incubation period of 5 to 14 days. The geographic distribution is worldwide, but it is endemic in tropical climates and sporadic in temperate climates. It is more common in summer and after floods (ie, hurricanes).

Learnings/What to Look for

  • Leptospirosis may be difficult to diagnose because its initial symptoms (remittent fever, chills or rigors, myalgia, headache, low back pain, and conjunctivitis/uveitis) are similar to other diseases. Some cases have few to no symptoms. However, early diagnosis is crucial as successful treatment should be initiated, ideally, within the first 4 days of illness
  • Conjunctival suffusion (conjunctival redness without inflammatory exudate) is a classic clinical sign. Some cases may also demonstrate a dry cough, nausea, vomiting, diarrhea, abdominal pain, and a pretibial rash of erythematous papules
  • Leptospirosis may progress to Weil disease, a more severe form, which includes jaundice, kidney and/or liver failure, meningitis, pneumonitis with hemoptysis, acute respiratory distress, hemorrhage, shock, and death.

Pearls for Urgent Care Management

  • Leptospirosis is treated with antibiotics (ie, doxycycline or azithromycin) which should be given early in the course of the disease
  • Intravenous antibiotics may be required for persons with more severe symptoms

Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/JUCM).

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A 13-Year-Old Girl with Fever, Chills, Dry Cough, and Myalgia
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