Leptospirosis (Weil's disease)
This is an infection caught from water, soil and animals: the leptospira bacterium is shed in the urine of rodents and livestock, reaches fresh water and damp…
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Medicines commonly prescribed for Leptospirosis (Weil's disease)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 100 mgActive substance: doxycyclineManufacturer: Industrial Farmaceutica Cantabria S.A.Prescription requiredDosage form: MODIFIED-RELEASE CAPSULE, 40 mgActive substance: doxycyclineManufacturer: Laboratorios Galderma S.A.Prescription requiredDosage form: CAPSULE, 50 mgActive substance: doxycyclineManufacturer: Industrial Farmaceutica Cantabria S.A.Prescription required
This is an infection caught from water, soil and animals: the leptospira bacterium is shed in the urine of rodents and livestock, reaches fresh water and damp ground, and enters a person through small breaks in the skin or through the linings of the eyes, nose and mouth.
In most people it passes like a long bout of flu that nobody remembers afterwards. In a minority it turns severe, with jaundice, kidney failure and bleeding, and that severe form is what Weil's disease means. It is not a second name for leptospirosis but its worst version, and keeping the two apart is useful, because they call for quite different responses.
How the bacterium reaches people
The carriers are chiefly rats and mice, but also cattle, pigs, horses and dogs. The animal itself may stay perfectly well while shedding the organism in its urine for months. Once in warm fresh water or damp soil, leptospira survives there for weeks.
Infection happens when that water or soil meets broken skin or a mucous membrane:
- swimming, rowing, rafting or fishing in a river, canal, lake or pond, particularly if water gets into the mouth or eyes;
- working in water and mud barefoot or without gloves: fields, irrigation channels, rice paddies, sewers, abattoirs, kennels and farms;
- clearing up after a flood, emptying a soaked cellar, handling rubbish where rats are at home;
- contact with the blood, urine or tissues of an infected animal while butchering it or treating it.
Intact skin is a reasonable barrier, but long soaking makes it permeable, so people who paddle or work knee-deep in water are at greater risk even without visible cuts.
From another person, by contrast, it is not caught, nor through kissing or sex. Pets rarely pass it on, usually via urine from an unwell dog spilt on the floor. Transmission through a bite is unusual.
Who meets it more often
The disease occurs worldwide and is commonest where it is warm and wet. In southern Europe it is no rarity: it is linked to rice fields, to fish farming and to clearing up after heavy rainfall floods. Travel to the tropics is a chapter of its own, with cases after river descents, treks through wet jungle, adventure races and an ordinary swim in a river.
The risk is higher for farmers and vets, abattoir and fish-farm workers, sewer and municipal staff, pest controllers, miners, soldiers, and also for anyone keen on water sports and angling. Outbreaks regularly follow floods, when submerged streets stir everything together.
How the illness unfolds
Between infection and the first symptoms there are usually five to fourteen days, though the range is wide: from two days to a month. That is why people often no longer connect what is happening to that day's fishing.
It begins abruptly, over a few hours: a high temperature with shivering, a severe headache across the forehead, nausea. One characteristic feature is sudden muscle pain, especially in the calves and lower back: the legs hurt so much that standing on them is difficult. The second striking sign is red eyes with no discharge and no sticky lids: the whites fill with blood, but the eyes do not weep and usually do not hurt.
Tummy pain, diarrhoea, vomiting, cough and a rash may follow. At about a week the fever often settles, the person decides they are better, and a day or two later it returns, now with headache and dislike of light, because the membranes around the brain become inflamed. That two-wave course is fairly typical.
For many people it ends there: within a week or two the infection clears on its own. The trouble is that there is no telling in advance which way it will go.
Weil's disease and the other severe forms
In roughly one in ten of those affected the infection takes the severe route. It usually happens in the second week and looks like this:
- jaundice — the skin and the whites of the eyes turn yellow, at times almost orange; on brown or black skin it shows more clearly in the eyes, gums and palms;
- kidney failure — less and less urine is passed, with mounting swelling and weakness;
- a tendency to bleed — bruises without a knock, nosebleeds and bleeding gums, black tarry stools, blood in the phlegm;
- bleeding into the lungs, the most dangerous form: breathlessness, coughing up blood, air hunger that worsens quickly;
- inflammation of the heart muscle with rhythm disturbances and falling blood pressure.
The severe forms kill when help arrives late, and the reckoning is in days. So jaundice, bleeding, confusion, breathlessness or urine that has all but stopped mean an ambulance, not watchful waiting at home. In Spain, Italy, Portugal, Poland and Ukraine the single European emergency number 112 applies.
There is also a delayed complication: weeks or even months after recovery the middle layer of the eye can become inflamed, bringing pain, redness, dislike of light and blurring. Hardly anyone is warned about it, and it needs prompt attention, otherwise sight suffers.
How the diagnosis is confirmed
What settles matters here is not a test but the patient's account. The symptoms pass for flu and the jaundice for hepatitis, so be sure to tell the doctor that you swam in a river, worked in water, cleared up after a flood, butchered an animal or have just come back from the tropics. Without that sentence the diagnosis usually does not even come to mind.
In the first week the organism is looked for in the blood by genetic testing. Later, once it has left the bloodstream, antibody tests do the work, with blood taken twice a week or two apart: it is the rise that confirms things. Culture is possible, but takes weeks to grow and does not change decisions.
Ordinary tests are done alongside to gauge severity: kidney function, bilirubin and liver readings, clotting, a muscle enzyme, the platelet count. Jaundice together with low platelets and a rising creatinine is precisely what separates leptospirosis from viral hepatitis.
How it is treated
Treatment is with antibiotics, started at once without waiting for the laboratory: confirmation comes late, and the gain from an early start is considerable. Mild illness is treated with tablets, usually from the tetracycline group, or from the penicillins and macrolides where there is intolerance or pregnancy. The course is finished in full even if there is clear improvement within two days.
Severe forms are treated only in hospital: antibiotic into a vein, fluid replacement, oxygen, dialysis if the kidneys fail, transfusion if there is bleeding. Kidneys generally recover completely after leptospirosis even when dialysis has been needed, and that is worth knowing in advance: here dialysis is nearly always a temporary measure.
Paracetamol is suitable for fever and pain. Ibuprofen and other anti-inflammatory painkillers are best avoided in this illness: they punish kidneys that are already under strain and add to the tendency to bleed.
Occasionally, in the first hours after the first antibiotic dose, things briefly get worse: the temperature shoots up, shivering starts, blood pressure drops. This is a recognised reaction to the mass die-off of bacteria; it passes, but it is better to go through it under observation than alone at home.
How to avoid catching it
There is no human vaccine in general use, so protection is a matter of simple habits.
- Cover cuts, grazes and blisters with a waterproof dressing before going into water or out into the fields.
- For work with water, animals or waste, wear boots and gloves, and eye protection where there is splashing.
- Do not swallow water from rivers, canals, lakes or ponds, and do not dive where rats are obviously about or where floodwater stood not long ago. Do not drink unboiled water from natural sources.
- Shower after swimming or working in water, and clean any wounds.
- Do not pick up dead animals with bare hands or go near carcasses without gloves.
- Do not leave food waste or animal feed accessible: that is how rats settle in a yard.
- Vaccinate dogs. The veterinary vaccine exists and lowers the risk both for the animal and for the household, though it does not cover every variety of the bacterium.
- If a short, predictably high-risk trip is coming up — a tropical river descent, an adventure race, work in a flooded area — ask a doctor about taking a preventive antibiotic. Such a regimen exists, but it is prescribed case by case.
Online consultation
A remote appointment suits the moment when the first need is to work out quickly what to take seriously. The doctor can go through how a recent fishing trip, journey or spell of work in water relates to the present fever, suggest which tests are worth asking for and exactly what to say at the face-to-face visit so that leptospirosis is not put down to an ordinary viral infection. The same conversation covers results already in hand and how to convalesce after the illness.
Be seen in person immediately if yellowing of the skin or eyes appears, along with bleeding, breathlessness, coughing up blood, confusion, or a marked drop in the amount of urine passed. Those belong in hospital, not in a message thread.
This material is for information only and does not replace medical advice.
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Discuss your symptoms and possible next steps for Leptospirosis (Weil's disease) with a doctor online.
