Leptospirosis A27.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

leptospirosis icterohaemorrhagica; Swine flock disease; Weil`s disease; Weil's disease

History
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Landouzy, 1883; Mathieu, 1886; Weil, 1886

Definition
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Acute, febrile, phased leptospirosis. Duty to report in case of proven illness! S.a.u. Infection Protection Act.

Pathogen
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Various leptospires. All pathogenic leptospires are grouped under the name Leptospira interrogans with different subtypes (2000 serotypes, 23 serovars). Severe forms of leptospirosis are mostly caused by Leptospira icterohaemorrhagica.

Occurrence/Epidemiology
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Worldwide, in Europe especially in Central and Eastern Europe. Incidence (Federal Republic of Germany): 20-50 diseases/year (higher estimated number of unreported cases).

Etiopathogenesis
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The carriers of leptospires are rats, mice, dogs, pigs, horses and cattle. Inoculation mainly via pre-damaged skin. Transmission is also described by contaminated fruit, soil (urine of infected animals) or contact with contaminated waters (diving, swimming, canoeing).

Clinical features
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Incubation period 7-14 days. Then sudden onset of headache and limb pain (often calf pain, myalgia), conjunctivitis (typical, meningismus and fleeting exanthema. Strong feeling of illness, fever and drowsiness for 5-10 days. After short-term defibrillation, organ manifestations with renewed fever, leptospiruria (> 90% of patients), jaundice , haemorrhagic diathesis, anaemia, involvement of internal organs, meningitis.

Significantly more frequently than the severely pronounced symptoms, anikteric, mostly benign courses of disease were described. Serous meningitis (30-40% of patients) is often the main symptom. Patients with uncomplicated courses of the disease develop fever after 7-10 days.

Severe courses of the disease with high mortality occur mainly in people over 50 years of age.

Untreated, the symptoms of the disease can last 3-4 weeks, but convalescence often lasts several months.

Laboratory
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More than 80% of patients have leptospiruria! Pathogen detection in blood and cerebrospinal fluid (1st week), in urine (2nd week); IgM antibody detection (possible from about the 10th day of illness, e.g. with ELISA) or IgG antibody detection (≥ fourfold increase in titer in two samples).

Complication(s)
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Hepatorenal failure, ARDS, arrhythmia.

Internal therapy
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Severe cases: Early antibiotic therapy with penicillin G in high dosage (starting within the first 48 hours). Thereafter, manifestation of leptospires in the internal organs without access to therapy. Penicillin G/ Benzylpenicillin: 10-20 million IU/day i.v. over 7-14 days. Cave! Risk of Herxheimer's reaction. Prophylaxis of the Herxheimer's reaction with prednisolone 40-60 mg/day for 10-14 days, gradual dosing.

Lighter cases: Tetracyclines (e.g. Achromycin) (only bacteriostatic effect): Adults 3-4 times/day 0.5-1.0 g p.o. Cave! Already existing liver or kidney damage is considered as contraindication.

In case of organ manifestations try haemodialysis.

Progression/forecast
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Fatalities 10-40% (especially in older people), type-specific immunity after infection.

Prophylaxis
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Active vaccination with killed pathogens in persons in endemic areas. For short-term stays in endemic areas chemoprophylaxis with doxycycline (e.g. supracycline) 2 times/day 100 mg p.o.

Literature
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  1. Abdulkader RC et al (2002) Leptospirosis severity may be associated with the intensity of humoral immune response. Rev Inst Med Trop Sao Paulo 44: 79-83
  2. Akiyama K et al (2001) A fatal case of Weil's disease in Miyagi Prefecture. Jpn J Infect Dis 54: 156-157
  3. Landouzy LTJ (1883) Typhoid fever hépatique. Gaz hôp (Paris) 56: 913-914
  4. Mathieu A (1886) Typhoid hépatique benin; rechute, guérison. Revue médicale (Paris) 6: 833-639
  5. Because A (1886) About a peculiar acute infectious disease associated with spleen tumor, icterus and nephritis. Dtsch Arch klin Med (Leipzig) 39: 209-232
  6. Wenz M et al (2001) Weil's syndrome with bone marrow involvement after collecting walnuts. German Med Weekly 126: 1132-1135
  7. Yiu MW et al (2003) High resolution CT of Weil's disease. Lancet 362: 117

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020