LeptospirosisA27.9

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 16.03.2021

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Synonym(s)

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

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HistoryThis section has been translated automatically.

Landouzy, 1883; Mathieu, 1886; Weil, 1886

DefinitionThis section has been translated automatically.

Acute, febrile, phasic spirochete infection (leptospirosis). Obligation to notify in case of proven disease! S.a.u. Infection Protection Act.

PathogenThis section has been translated automatically.

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

Occurrence/EpidemiologyThis section has been translated automatically.

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

EtiopathogenesisThis section has been translated automatically.

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 featuresThis section has been translated automatically.

incubation period 2-30 days.

Then sudden onset of headache and limb pain (often calf pain, myalgias), conjunctivitis (typical, meningismus and fleeting exanthema.

Severe feeling of illness, high fever and drowsiness for 5-10 days. After a short period of fever relief, organ manifestations with renewed fever, leptospiruria (> 90% of patients), jaundice , haemorrhagic diathesis, anaemia, internal organ involvement, meningitis.

Anicteric, mostly benign courses of the disease have been described much more frequently than the severe symptoms. In this case, serous meningitis (30-40% of patients) is often in the foreground. In uncomplicated cases, the patients develop fever after 7-10 days.

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

If untreated, the symptoms of the disease can last 3-4 weeks, but convalescence often takes several months.

LaboratoryThis section has been translated automatically.

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)This section has been translated automatically.

Hepatorenal failure, ARDS, arrhythmia.

Internal therapyThis section has been translated automatically.

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/forecastThis section has been translated automatically.

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

ProphylaxisThis section has been translated automatically.

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.

LiteratureThis section has been translated automatically.

  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

Authors

Last updated on: 16.03.2021

Author: Prof. Dr. med. Peter Altmeyer