Weil's syndrome, is caused by water borne infection by Leptospira icterohemorrhagica and is the most severe form of leptospirosis.
The incubation period is approximately 2 weeks.
The onset of illness is no different from that of less severe leptospirosis
with Leptospirosis may present as an acute influenza-like illness, with
fever, chills, severe headache, nausea, vomiting, and myalgias. Muscle
pain, which especially affects the calves, back, and abdomen, is an important
feature of leptospiral infection. However, unlike milder leptospirosis
after 9 days, jaundice as well as renal and vascular dysfunction generally
develop. Although some degree of defervescence may be noted after the
first week of illness, a biphasic disease pattern like that seen in anicteric
leptospirosis is lacking. The jaundice of Weil's syndrome, which can be
profound and give an orange cast to the skin, is usually not associated
with severe hepatic necrosis. Death is rarely due to liver failure. Hepatomegaly
and tenderness in the right upper quadrant are usually detected. Splenomegaly
is found in 20% of cases.
Renal failure may develop, often during the second week of illness. Hypovolemia and decreased renal perfusion contribute to the development of acute tubular necrosis with oliguria or anuria. Dialysis is sometimes required, although a fair number of cases can be managed without dialysis. Renal function may be completely regained.
Pulmonary involvement occurs frequently, resulting in cough, dyspnea, chest pain, and blood-stained sputum, and sometimes in hemoptysis or even respiratory failure. Hemorrhagic manifestations are seen in Weil's syndrome: epistaxis, petechiae, purpura, and ecchymoses are found commonly, while severe gastrointestinal bleeding and adrenal or subarachnoid hemorrhage are detected rarely.
Rhabdomyolysis, hemolysis, myocarditis, pericarditis, congestive heart failure, cardiogenic shock, adult respiratory distress syndrome, and multiorgan failure have all been described during severe leptospirosis.
A definite diagnosis of leptospirosis is based either on isolation of the organism from the patient or on seroconversion or a rise in antibody titer in the microscopic agglutination test (MAT).
Antimicrobial therapy should be started at once. Intravenous administration of penicillin G, amoxicillin, ampicillin, or erythromycin is recommended.
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.