Weil syndrome is a triad of jaundice, renal impairment, and hemorrhage. Weil's disease is caused due to contaminated fresh water. Read about Weil's disease symptoms at Meri Sehat.

Weil's Syndrome

Online Consultation

Ismail Munir

Overview

Weil&#39;s syndrome, also known as Icteric leptospirosis, is an infection spread by animals. It is an extremely serious form of leptospirosis because of its potential to escalate to multiorgan failure and death. It was reported for the first time in 1886 by a German physician, Adolf Weil.

&nbsp;

The condition is the most common zoonosis (an infectious disease that is transmitted from animals to humans) in the world, linked to poor sanitation and agricultural activities.

Therefore, it&rsquo;s most likely to affect rural subsistence farmers and urban slum residents in low- middle income countries. The risk is greater with occupational exposures, aquatic sports, and flooding in these regions. Rates are higher in tropical places during the rainy season and in temperate areas in late summer.

&nbsp;

Along with Icteric Leptospirosis, Weil&rsquo;s syndrome is also known as:

<ul>
	<li>Fiedler Disease</li>
	<li>Icterohemorrhagic&nbsp;</li>
	<li>Infectious <a href="https://merisehat.pk/disease/jaundice-65">Jaundice</a></li>
	<li>Lancereaux-Mathieu-Weil Spirochetosis</li>
	<li>Leptospiral Jaundice</li>
	<li>Spirochetal Jaundice 
	&nbsp;</li>
</ul>

Weil&#39;s disease is distinguished by multisystem dysfunction and presents with high fever, severe jaundice, renal failure, hepatic necrosis, lung involvement, cardiovascular collapse, neurologic abnormalities, and hemorrhagic diathesis.

&nbsp;

Low-middle income countries bear the most of the disease&#39;s burden, with half a million cases recorded each year and a mortality rate ranging from 5-10%<a href="#accordion">[1]</a>. The Global Burden of Disease regions with the highest estimates of disease morbidity and death are South and Southeast Asia, Oceania, the Caribbean, Andean, Central and Tropical Latin America, and East Sub-Saharan Africa<a href="#accordion">[2]</a>. It causes roughly 1.03 million cases and 58,900 fatalities worldwide each year. Overall, adult males aged 20-49 years account for a high number of cases and fatalities. 
&nbsp;

&nbsp;
<quillbot-extension-portal></quillbot-extension-portal>

Weil&rsquo;s syndrome may occur in 2 phases: The septicemic (acute) phase of leptospirosis followed by the immune (delayed) phase. During the septicemic phase, the individual may experience minor or no symptoms. In contrast, during the immune phase, the individual may experience severe symptoms. 
&nbsp;

<h5>Septicemic Phase</h5>

You may suffer a sudden onset of flu-like symptoms during this phase. This usually begins 2-14 days following a Leptospira infection.

Symptoms usually appear 5-14 days after infection and include:

<ul>
	<li>Fever</li>
	<li>Chills</li>
	<li>Red eyes (typically on 3rd or 4th day)</li>
	<li>Cough with blood</li>
	<li>Sore throat</li>
	<li>Severe muscular pain in the calves and back</li>
	<li>Chest pain</li>
	<li><a href="https://merisehat.pk/disease/migraines-73">Headache</a></li>
</ul>

&nbsp;

At this stage, there&rsquo;s bacteria inside the host body and spreading through the bloodstream to organs. The infection can be detected through blood tests. A vast majority of people recover within 7 days. 
&nbsp;

<h5>Immune Phase</h5>

Symptoms may reappear a few days later in some persons. This is due to the inflammation that&rsquo;s triggered when the immune system is working to remove the microorganisms from the body. The fever returns and the meninges (tissues that coat the brain and spinal cord) may become inflamed as a result of which the individual experiences stiffness in the neck and a headache. The lungs sustain significant damage, too.

Leptospira bacteria have now attacked the organs. Kidneys have the highest concentration of microorganisms so urine tests can reveal the bacterial infection. 
&nbsp;

During this phase, symptoms of Weil&rsquo;s syndrome include:

<ul>
	<li><a href="https://merisehat.pk/disease/anemia">Anemia</a></li>
	<li>Internal bleeding within tissues in the skin, lungs and, less frequently, the digestive tract</li>
	<li>Nosebleeds</li>
	<li>Coughing up of blood</li>
	<li>Renal damage</li>
	<li>Extreme yellowing of skin and eyes 
	&nbsp;</li>
</ul>

Although the liver and kidneys are the most usually damaged organs, the lungs and heart can also suffer significant damage. 
&nbsp;

Signs and Symptoms

According to the New York State Department of Health<a href="#accordion">[7]</a>, the incubation period is anywhere from 2-30 days following the initial encounter.

Leptospirosis presents itself in a variety of ways. In most cases of leptospirosis, the symptoms are minor. For instance: 
&nbsp;

<ul>
	<li>Vomiting</li>
	<li>Fever</li>
	<li>Appetite loss</li>
	<li>Chills</li>
	<li>Body pain</li>
	<li>Headaches</li>
	<li>Coughing</li>
	<li>Nausea 
	&nbsp;</li>
</ul>

Weil&#39;s disease, a severe form of leptospirosis, occurs in rare circumstances. Symptoms of Weil&#39;s disease usually appear 1-3 days after milder leptospirosis symptoms have disappeared. Also, symptoms differ depending on which organs are diseased. 
&nbsp;

<h5>Kidney, Heart, &amp; Liver</h5>

The symptoms of liver and renal impairment usually occur in 3-6 days. The liver is normally only slightly damaged and complete healing nearly always happens. The fever also normally goes away on the 7th day, but it can reoccur for weeks.

The prognosis for Weil&rsquo;s syndrome is less favorable after the age of 50.

If the Leptospira bacteria is present in the kidneys, liver, or heart, then the following symptoms can be observed: 
&nbsp;

<ul>
	<li>Jaundice</li>
	<li>Edema</li>
	<li>Nausea</li>
	<li>Weight loss</li>
	<li>Fatigue</li>
	<li>Thrombocytopenia&nbsp;</li>
	<li>Swollen ankles, feet, or hands</li>
	<li>Appetite loss&nbsp;</li>
	<li>Less frequent urination</li>
	<li>Shortness of breath</li>
	<li>Increased heartbeat 
	&nbsp;</li>
</ul>

<h5>Lungs</h5>

Lungs can be affected by this disease, too. In that case, the following symptoms may appear:

<ul>
	<li>Shortness of breath</li>
	<li>High fever</li>
	<li>Coughing up blood 
	&nbsp;</li>
</ul>

<h5>Brain</h5>

If it&rsquo;s the brain that has become infected, then the individual may experience the following symptoms:

<ul>
	<li>Aggressive behavior</li>
	<li>High fever</li>
	<li>Nausea</li>
	<li>Drowsiness and weariness</li>
	<li>Disoriented mental state</li>
	<li>Inability to communicate</li>
	<li>Afraid of lights</li>
	<li>Stiffness or soreness in the neck</li>
	<li>Vomiting</li>
	<li>Failure to regulate movements</li>
	<li>Seizures 
	&nbsp;</li>
</ul>

Causes

Leptospira bacteria causes Weil&#39;s syndrome. If the infection is mild, it is referred to as leptospirosis. Weil&#39;s disease occurs when leptospirosis progresses to a serious infection.

An individual can get infected with the Leptospira bacteria if their eyes, mouth, nose, or open wounds on their skin come into contact with:

<ul>
	<li>The urine of a bacteria-carrying animal</li>
	<li>Soil or freshwater (i.e., water from a river, canal, or lake) containing contaminated pee goes into mouth, eyes, nose, genitals, or a cut frequently as in during swimming or fishing</li>
	<li>An infected animal&#39;s blood or flesh frequently while working with animals or animal parts 
	&nbsp;</li>
</ul>

Getting bitten by a diseased animal as well as consuming contaminated water might also lead to infection.

Farm animals, such as cattle, pigs, and horses, are common carriers of Leptospirosis; wild animals, such as raccoons and porcupines, as well as domesticated dogs can be carriers, too.

However, Leptospirosis outbreaks typically start with exposure to contaminated water, such as floodwaters. Person-to-person transmission is uncommon. 
&nbsp;

<ol>
	<li>Endothelial Biomarkers As Predictors For Hemodialysis Need In Severe Leptospirosis Patients </li>
</ol>

Syndecan-1 (a cell surface heparan sulfate proteoglycan) and angiopoietin-2 (produced by endothelial cells) were linked to the requirement for hemodialysis in patients with severe leptospirosis. This can be used to enhance the therapeutic approach and lower mortality<a href="#accordion">[3]</a>. 
&nbsp;

<ol start="2">
	<li>Host Biomarkers Distinguish Dengue From Leptospirosis </li>
</ol>

9 biomarkers showed significant differences between leptospirosis and dengue fever, with greater levels of sTie-2 in leptospirosis and lower levels of IL-18BP, Angptl3, IP-10/CXCL10, sICAM-1, Platelet Factor 4, Factor D, and sEng in dengue<a href="#accordion">[4]</a>. 
&nbsp;

Diagnosis

It is possible that a mild case of leptospirosis will be difficult to diagnose. The symptoms are similar to those of other illnesses, such as the flu. However, it is easier to identify Weil&#39;s disease as it has severe signs and symptoms.

The doctor begins diagnosis by taking the medical history. It is important for the patient to inform their doctor if they have: 
&nbsp;

<ul>
	<li>Recently traveled</li>
	<li>Engaged in water sports</li>
	<li>Come in contact with a source of freshwater</li>
	<li>A job that entails working with animals or animal care</li>
</ul>

Then the doctor may request blood testing, urine tests, or maybe both if they think the patient has leptospirosis or another bacterial illness. 
&nbsp;

<h5>Blood Test</h5>

Blood testing can also confirm the diagnosis by detecting germs (bacteria) in the bloodstream. The doctors order a simple blood test and look for antibodies to detect leptospirosis.

Antibodies are organisms that the body creates to combat germs. The issue is that the blood test may produce a false positive, i.e., it may show antibodies from a previous infection. As a result, the doctor may proceed to a follow-up test approximately a week later to ensure that the results are correct. 
&nbsp;

<h5>Urine Sample Test</h5>

Typically, this test is used to confirm the diagnosis. The patient is requested to provide a urine sample to be tested for Leptospira. Leptospirosis causes increased potassium excretion in the urine, resulting in low potassium and salt levels in the blood.

Urinalysis can detect protein, white blood cells, and microscopic hematuria. Urine cultures will test positive for leptospirosis after 14 days of bacterial incubation and it will continue to do so for the next 30 days because the bacteria settle in the kidneys. 
&nbsp;

<h5>Liver Function Test </h5>

Transaminases and direct bilirubin levels are higher in people with liver involvement. 
&nbsp;

<h5>Chest X-ray</h5>

A chest X-ray may be used to rule out any lung issues. It may show diffuse alveolar opacities in patients with lung involvement. 
&nbsp;

<h5>Molecular Tests</h5>

Polymerase chain reaction (PCR) can be used to amplify leptospiral DNA from serum, urine, aqueous humor, CSF, and postmortem specimens. It detects the presence of germs within the initial few days of infection without having to wait for the number of antibodies to increase. It can be used even after medications (antibiotics) have killed the bacterium because PCR detects the presence of leptospiral DNA in the blood. 
&nbsp;

Treatment

Leptospirosis treatment should start as soon as possible. The illness may get worse if it is not adequately treated within the first 2-3 days. Weil&#39;s disease, a severe type of leptospirosis, can be lethal with renal failure and lung hemorrhage being the leading causes of mortality. Chemotherapy as well as symptomatic and supportive therapy are now used in treatment.

Leptospires are responsive to several antibiotics in vitro (outside a living organism), including:

<ul>
	<li>Penicillin</li>
	<li>Cephems</li>
	<li>Aminoglycosides</li>
	<li>Tetracyclines</li>
	<li>Macrolides</li>
	<li>Cephaloridine</li>
	<li>Erythromycin</li>
	<li>Gentamicin</li>
	<li>Tobramycin</li>
	<li>Isepamicin 
	&nbsp;</li>
</ul>

Compared to other antibiotics, streptomycin tends to be more efficient against leptospirosis.

Simple leptospirosis typically manifests as a minor, self-limiting illness that goes away independently. The patient may need to stay in the hospital if Weil&#39;s syndrome is diagnosed to provide them with intravenous antibiotics in the hospital. Penicillin and doxycycline are two of the most preferred antibiotics.

In addition to this, medical treatment entails different therapies according to the patient&rsquo;s symptoms and the impacted organs. For instance, if they have breathing problems, they can be connected to a ventilator.; if it&rsquo;s the kidneys that have been harmed and contaminated, then they will need to start dialysis. 
&nbsp;

<h5>Symptomatic &amp; Supportive Treatments </h5>

<ul>
	<li>Analgesics are used to treat headaches and myalgia</li>
	<li>Antipyretics are used for fever</li>
	<li>Diazepam is used intravenously in particular to manage convulsions</li>
	<li>Disturbances in fluid and electrolyte balance should be aggressively handled</li>
	<li>Hepatic and renal failure patients require substantial supportive care 
	&nbsp;</li>
</ul>

Dialysis is considered when the patient&rsquo;s condition worsens due to severe renal failure. Hemodialysis is started as soon as the blood urea nitrogen level (BUN) hits 200 mg/dl, but it is less convenient than peritoneal dialysis. Recurrent dialysis is advised to support renal function until the patient recovers completely. 
&nbsp;

<ol>
	<li>
	<h5>Nervous Complications </h5>
	</li>
</ol>

A small but significant number of cases of benign lymphocytic meningitis are caused by leptospiral infection. According to a study, meningitis, flaccid paralysis of the legs, and alterations in the cerebrospinal fluid were indications of differentiation from usual Weil&#39;s disease<a href="#accordion">[5]</a>.

Peripheral nerve and plexus injuries, typically to the upper limb, are not unusual. Pain, muscular wasting, and loss of tendon reflexes are clinical signs of Weil&rsquo;s disease, which bear a close resemblance to antecedent poliomyelitis or neuralgic amyotrophy.

On a few occasions, cranial nerve involvement has been detected, leading to facial, transient palatal, or ocular palsies. 
&nbsp;

<ol start="2">
	<li>
	<h5>Ocular Complications </h5>
	</li>
</ol>

Acute conjunctivitis is frequently caused by swimming in contaminated water and, on rare occasions, it can cause ocular, facial, or palate palsy.

According to a case study, no central scotoma was seen in patients who had mild optic neuritis and complained of a little vision loss. Additionally, further probing revealed that the patients have, in fact, suffered from jaundice previously because there was no evident cause for the neuritis.

Although the condition progressed like spirochetosis, the Wassermann reaction was consistently adverse. Unfortunately, there was no attempt to locate the Inada-Ido spirochaete during the acute stage of the sickness to look for it in the urine or cerebrospinal fluid. The test for the spirochaete was only weakly positive in the blood. However, it appears that the eye ailment has no other known cause, leading one to believe that this was its true origin. 
&nbsp;

<ol start="3">
	<li>
	<h5>Thrombocytopenia In Severe Leptospirosis </h5>
	</li>
</ol>

Leptospirosis frequently results in thrombocytopenia, as is evident by the hospitalization of more than half of the patients. Acute renal injury and chronic illness are risk factors for thrombocytopenia. The relationship between thrombocytopenia and death was not statistically significant. 
&nbsp;

Leptospirosis is largely an illness that affects people who operate in close proximity to animals, animal tissues, or animal waste products.

The following animals transmit leptospirosis to people:

<ul>
	<li>Pigs</li>
	<li>Cattle</li>
	<li>Dogs</li>
	<li>Rats and other rodents </li>
	<li>Reptiles and amphibians 
	&nbsp;</li>
</ul>

People who have an increased risk of getting leptospirosis include:

<ul>
	<li>People who engage in watersports, like swimming, rafting, canoeing, or kayaking</li>
	<li>Veterinarians</li>
	<li>Farmers</li>
	<li>Freshwater fishermen</li>
	<li>People who bathe in rivers, lakes, or canals</li>
	<li>Animal butchers and any other person who handles dead animals</li>
	<li>Rodent control workers</li>
	<li>Sewer workers</li>
	<li>Soldiers</li>
	<li>Miners</li>
</ul>

Although leptospirosis and Weil&#39;s disease can be found everywhere, tropical areas tend to have higher rates than temperate ones. 
&nbsp;

<ul>
	<li>Do not drink polluted water. Make sure the water is clean before drinking it. </li>
	<li>It&#39;s also a good idea to steer clear of activities like swimming, waterskiing, sailing, and fishing in freshwater locations since leptospirosis can enter through other bodily openings. In short, saltwater is relatively safer than freshwater.</li>
	<li>Avoid contact with infected animals, particularly wild rats. The primary hosts of the bacterium are rats and other rodents; 20% of wild rats carry it. Anyone who has to handle wild rats or comes into contact with their habitats needs to exercise caution.</li>
	<li>Farm animals are typically immunized in developed countries; thus, there is significantly less risk. Nevertheless, avoid animal bites and bodily fluids, especially if the animal is sick. </li>
	<li>Furthermore, it&rsquo;s important to beware of surroundings while traveling. Leptospirosis is more prevalent and potentially challenging to prevent in countries with poor sanitation. Therefore, pay attention to the conditions and seek medical attention if any symptoms appear.</li>
	<li>Always keep a disinfectant close by for cleanup. The germs are obliterated by iodine, Lysol, bleach, and acidic liquids. 
	&nbsp;</li>
</ul>

<h5>Can Pets Get It?</h5>

Leptospirosis affects all animals. It was previously uncommon in pets, but it has become more prevalent in recent years, especially in dogs. Leptospirosis affects dogs the same way it affects humans: by contact with the urine of diseased animals, which can seep into the water or soil and live for weeks or months. Leptospirosis affects cats very rarely.

It&rsquo;s possible that the pet doesn&rsquo;t display any symptoms that would alert its owner or the vet. Leptospirosis symptoms frequently resemble those of other illnesses, such as:

<ul>
	<li>Fever</li>
	<li>Belly pain</li>
	<li>Vomiting</li>
	<li><a href="https://merisehat.pk/disease/diarrhea">Diarrhea</a></li>
	<li>Pain</li>
	<li>Weakness</li>
	<li>Stiffness 
	&nbsp;</li>
</ul>

In a suspected case, ask the veterinarian to conduct a test since that is the only way to know for sure if the animal is a carrier. This is important because the sick pet can pass the infection to its owner. Veterinarians advise leptospirosis vaccination for any dog that ventures outside at all, even if it&rsquo;s only to use the toilet. 
&nbsp;

<h5>Issues &amp; Challenges </h5>

Leptospirosis is difficult to diagnose because the majority of cases are either mild or asymptomatic. Furthermore, its symptoms coincide with those of malaria, dengue fever, and other febrile illnesses, which means it frequently goes untreated or is misdiagnosed. Although there are many diagnostic tests available, their sensitivity and specificity vary, making it difficult to get reliable results. Then there is also the issue of false positives caused by cross-reactivity and previous infections. An efficient diagnostic test is needed for the quick detection of leptospirosis in order to start prompt antibiotic therapy that is diagnosed quickly. 
&nbsp;

<h5>Methods Of Detection</h5>

Leptospirosis is diagnosed by identification of Leptospira in blood and urine by direct dark-field microscopy (DFM), isolation of Leptospira by culture, genomic DNA identification by molecular techniques, and detection of antibodies by serological assays like the Microscopic Agglutination Test (MAT). However, due to their poor sensitivity or technical restrictions, some of these tests cannot be carried out on a regular basis<a href="#accordion">[8]</a>. 
&nbsp;

<ol>
	<li>Darkfield Microscopy</li>
</ol>

Using Dark Field Microscopy (DFM), it is possible to show that Leptospira is present in bodily fluids, such as serum, blood, urine, and CSF. It is a straightforward, quick diagnostic procedure that needs a concentration of 104 Leptospira/ml in order to make the organisms visible. 
&nbsp;

<ol start="2">
	<li>Polymerase Chain Reaction</li>
</ol>

The highly sensitive enzymatic amplification of DNA in blood, urine, CSF, and other bodily fluids is known as a Polymerase Chain Reaction (PCR). When compared to culture, PCR is found to be more effective and produces findings more quickly. PCR can quickly identify Leptospira in the circulation at the time of symptom onset. 
&nbsp;

Key Points

<ul>
	<li>Weil&#39;s syndrome is an infection spread by animals.</li>
	<li>Weil&#39;s disease is distinguished by multisystem dysfunction and can be expressed as high fever, severe jaundice, renal failure, hepatic necrosis, lung involvement, cardiovascular collapse, neurologic abnormalities, and hemorrhagic diathesis.</li>
	<li>Depending on the causing strains and other variables, the illness may get worse if it is not properly treated within the first 2-3 days. 
	&nbsp;</li>
</ul>

[1] Evangelista K V, Coburn J. Leptospira as an emerging pathogen: a review of its biology, pathogenesis and host immune responses. Future Microbiol. 2010 Sep;5(9):1413–25.

[2] Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis. 2015;9(9):e0003898.

[3] Meneses GC, de Carvalho Gomes PEA, Galdino GS, Bezerra GF, de Souza Santos RS, Martins AMC, et al. Endothelial biomarkers as predictors for haemodialysis need in severe leptospirosis patients (Weil’s disease). Trop Med \& Int Heal. 2022;27(8):727–34.

[4] Conroy AL, Gélvez M, Hawkes M, Rajwans N, Liles WC, Villar-Centeno LA, et al. Host biomarkers distinguish dengue from leptospirosis in Colombia: a case--control study. BMC Infect Dis. 2014;14(1):1–13.

[5] Mortensen V, others. Nervous Complications of Weil’s Disease. Lancet. 1940;117–9.

[7] Leptospirosis (Weil's disease) - New York State Department of Health

[6] Pinto GV, Senthilkumar K, Rai P, Kabekkodu SP, Karunasagar I, Kumar BK. Current methods for the diagnosis of leptospirosis: Issues and challenges. J Microbiol Methods. 2022;195:106438.