Information on the following diseases can be found in the Related Disorders section of this report:

• Meningitis
• Leptospirosis

Symptoms of Weil syndrome usually start abruptly, with headache, disturbances in consciousness, pain in muscles and abdomen, a stiff neck, lack of appetite (anorexia), chills, nausea, vomiting, and fever. Prostration, coughing, expectoration of blood-stained sputum (hemoptysis), and nosebleed (epistaxis) may also occur. Yellowing of the skin (jaundice), bleeding in muscles, gastrointestinal tract, and visceral organs may be widespread. Small purplish-red spots (petechiae) may appear, caused by hemorrhages in the skin. Enlarged lymph nodes, and continued fever may occur for several days. Respiratory distress syndrome which includes great difficulty breathing and dangerously low levels of oxygen in the blood (hypoxemia) may sometimes develop in Weil syndrome.

Signs of liver and kidney dysfunction usually appear from the 3rd to the 6th day. Kidney abnormalities may include the appearance of protein (proteinuria), pus (pyuria), or blood in the urine (hematuria), and an excess of urea in the blood (azotemia). The kidney is often enlarged, and its capsule is tense. Bleeding in many places throughout the body may occur due to injury of tiny blood vessels (capillaries). A low number of blood platelets (thrombocytopenia) may also occur. Damage to the liver is usually minimal and complete healing almost always occurs. Fever usually abates on the 7th day, but it may be recurrent for weeks. After age 50 the prognosis for Weil syndrome is less optimistic than for younger people.

Weil syndrome is caused by an infection from the bacteria Leptospira icterohemorrhagiae or other related types of this bacteria (such as L canicola, or L pomona). The infection is usually transferred to humans through urine or tissue of an infected domestic or wild animal. The infection enters through a skin abrasion or the mucous membranes.

Weil syndrome may occur in people of all ages. At least 75% of persons infected with this disorder are male. It can be an occupational disorder striking farmers, veterinarians, or sewer and abattoir workers, but most patients are exposed incidentally during recreational activities.

Many types of bacterial infections may affect the liver, kidneys and respiratory organs, causing symptoms similar to those of Weil syndrome.

Leptospirosis is an inclusive term for all bacterial infections caused by any Leptospira bacteria, regardless of the type. (For more information, choose "Leptospirosis" as your search term in the Rare Disease Database.)

Meningitis is an infection of the membrane lining the skull or the spinal cavity (meninges) by either bacteria or viruses.

Diagnosis
The results of various laboratory tests, including blood and urine tests, assist in the diagnosis.

Treatment
If begun in the first three or four days after the onset of symptoms, the intravenous administration of antibiotics may be effective. Peritoneal dialysis in combination with antibiotics has been used successfully in some patients.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

TEXTBOOKS
Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:1188.

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1104.

Gorbach SL, Bartlett JG, Blacklow NR. Eds. Infectious Diseases. W.B. Saunders Company, Philadelphia, PA; 1992:1297-99.

Mandell GL, Bennett JE, Dolan R. Eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone Inc. New York, NY; 1995:2138.

JOURNAL ARTICLES
Yiu MW, Ooi GC, Yuen KY, et al. High resolution CT of Weil’s disease. Lancet. 2003;362:117.

Pea L, Roda L, Boussaud V, et al. Desmopressin therapy for massive hemoptysis associated with severe leptospirosis. Am J Respir Crit Care Med. 2003;167:726-28.

Kishor KK, Rao PV, Bhat KR, et al. Pancreatitis in Weil’s disease. Trop Doct. 2002;32:230-31.

Murali KV, Sujay R, Pavithran S, et al. Intracranial bleeding in Weil’s disease. J Postgrad Med. 2002;48:158.

Aoki T, Koizumi N, Watanabe H. A case of leptospirosis probably caused by drinking contaminated well-water after an earthquake. Jpn J Infect Dis. 2001;54:243-44.