Differential Diagnosis

The patient's symptoms and epidemiological history suggest a severe infection. Here's a breakdown of the differential diagnosis:

• Single most likely diagnosis

  • Leptospirosis, jaundice form, severe course. Complication: Acute renal damage, oliguric stage.
    • Justification: The patient's symptoms, such as pronounced weakness, increased body temperature with chills, pain in the lumbar region, and lack of urine, are consistent with leptospirosis. The patient's occupation as a swimming pool trainer increases the risk of exposure to Leptospira bacteria. The presence of jaundice, enlarged liver and spleen, and positive lumbar tapping symptom further support this diagnosis. The oliguric stage of acute renal damage is also consistent with the patient's lack of urine production.

• Other Likely diagnoses

  • Leptospirosis, jaundice form, severe course. Complication: DIC syndrome.
    • Justification: While the patient's symptoms are consistent with leptospirosis, the presence of micro polyadenitis and injected sclerae vessels could suggest a coagulopathy, such as DIC syndrome.
  • Leptospirosis, jaundice form, severe course. Complication: Infectious-toxic shock, 1st or 2nd stage.
    • Justification: The patient's severe condition, hyperemic face, and puffy appearance could indicate infectious-toxic shock. However, the absence of specific symptoms such as hypotension or decreased peripheral circulation makes this diagnosis less likely.

• Do Not Miss

  • Sepsis due to other bacterial infections (e.g., E. coli, Klebsiella pneumoniae).
    • Justification: While leptospirosis is a strong consideration, other bacterial infections could present with similar symptoms and should not be missed.
  • Viral hemorrhagic fevers (e.g., dengue fever, yellow fever).
    • Justification: Although less likely, viral hemorrhagic fevers could present with similar symptoms, such as jaundice and hemorrhaging, and should be considered in the differential diagnosis.

• Rare diagnoses

  • Hantavirus infection.
    • Justification: While rare, hantavirus infection could present with similar symptoms, such as renal failure and hemorrhaging.
  • Rickettsial infections (e.g., Rocky Mountain spotted fever).
    • Justification: Although less likely, rickettsial infections could present with similar symptoms, such as fever, headache, and rash, and should be considered in the differential diagnosis.