Zoonotic spirochaetal infection acquired from water contaminated with animal urine; severe form is Weil's disease.
Clinical features
- • Abrupt fever, severe myalgia (calves)
- • Conjunctival suffusion
- • Jaundice with AKI (Weil's)
- • Pulmonary haemorrhage
Investigations
- • Dark-field/PCR early, MAT or IgM after day 5
- • Bilirubin markedly raised with modest transaminases
- • CK raised, thrombocytopenia, CXR for haemorrhage
Management
- • Mild: doxycycline 100 mg BD × 7 days
- • Severe: penicillin G 1.5 MU IV q6h or ceftriaxone 1 g IV OD
- • Dialysis for AKI, ventilatory support for pulmonary haemorrhage
- • Watch for Jarisch-Herxheimer reaction
Clinical pearls
- • Conjunctival suffusion without discharge is a valuable clue
- • Renal failure is typically non-oliguric with hypokalaemia
Related in WardRound
Educational — verify locally.
