Can Weil's Disease Kill You?

Introduction

Adolf Weil, a German physician, characterised the condition for the first time in 1886. Weil's disease, also recognised as Leptospirosis, is a bacterial infection that affects both people and animals. It is a type of bacterial infection, caused by Leptospira bacteria found in the urine of infected animals like mice, rats, cattle, pigs, and dogs. Humans can become infected by coming into contact with rat or cattle urine, most commonly transmitted through contaminated fresh water. 

Bacteria may enter the body via the skin or mucous membranes (eyes, nose, mouth), particularly if the skin is damaged due to a cut or scrape. Infections are mainly caused by contact with water, soil, or mud contaminated with the urine of diseased animals. Consuming polluted water might also lead to illness. Leptospira bacteria may be found in the kidneys of a variety of mammals from eating infected food. Leptospirosis outbreaks are often induced by exposure to polluted water like flooding. Person-to-person transmission is uncommon.

Signs and Symptoms

Leptospirosis may produce a variety of symptoms in people, including high fever, severe headaches, chills, muscular pains, vomiting, jaundice (yellow skin and eyes), red eyes, stomach discomfort, diarrhoea, rashes, bleeding, and breathing difficulties. Symptoms generally appear unexpectedly; many of which might be confused with those of other disorders such as influenza, making diagnosis difficult. Furthermore, some infected people may exhibit no symptoms at all. 

The interval between being exposed to a polluted source and being ill ranges from 2 days to 4 weeks. Without therapy, recovery might take months. Symptoms typically appear 5 to 14 days (but may vary from 2 to 30 days) after infection and can continue from a few days to 3 weeks or more.

The illness onset is frequently sudden, with fever and other symptoms. Following a leptospirosis infection, some persons may have long-term complications. Weil’s disease may manifest itself in two stages

  • After the initial stage (fever, chills, headache, muscular pains, vomiting, diarrhoea), the patient may recover for a while before becoming unwell again. 
  • If a second phase develops, it is more serious; the individual may suffer from renal or liver failure, as well as meningitis (inflammation of the brain and spinal cord lining). The majority of persons who acquire severe illness need hospitalisation, and severe leptospirosis may be deadly. 

Risk Factors

Leptospirosis is found throughout the globe, however, it is more frequent in temperate or tropical settings. Because there are so many distinct strains of Leptospira bacteria, it is possible to get infected with another strain and acquire leptospirosis once again. Furthermore, the prevalence of Leptospirosis infection among urban youngsters seems to be rising.

Cases of Weil's disease may spike after tropical storms or floods, when individuals may have to wade through polluted water or drink or bathe in it. The following are a few risk factors: 

  • Consuming water from possibly polluted sources, such as floodwater, streams, rivers, or bad tap water. 
  • Bathing, swimming, wading, kayaking, wading, and rafting in floodwater or polluted freshwater, particularly if your head is submerged or you have an open cut or scrape. 
  • Eating food that has been polluted by dirty water or that has been urinated on by rats
  • Camping, gardening, bushwalking, white water rafting, and other water activities fall within this category. 
  • People who have had direct contact with animals or have been exposed to polluted water, dirt, soil, or vegetation. It is a danger for many persons who work outside or around animals, for example, farmers (particularly the sugar cane and banana ones), miners, workers in the sewers, slaughterhouse employees, fishermen, farmers producing milk, personnel from the military, veterinary professionals, and animal caregivers.

Treatments

Prevention is heavily reliant on sanitary measures, which may be difficult to execute, particularly in developing countries.1 Avoiding contact with possibly infected animals, as well as avoiding swimming or wading in water that may be polluted with animal urine, will dramatically lower the chance of contracting leptospirosis. Those who are exposed to polluted water or soil as a result of their employment or leisure activities should wear protective apparel or footwear.

A blood test may be used to identify leptospirosis. The bacteria may also be found in cerebrospinal fluid (fluid lining the brain and spinal cord) and urine. Two blood tests conducted more than two weeks apart are often necessary to establish a diagnosis.

No vaccine is available.1 Paracetamol or ibuprofen are used to relieve any aches, pains, or a high temperature. Antibiotic therapy is regarded to be most beneficial if begun early in Weil’s disease progression. Antibiotics, e.g. doxycycline or penicillin, are routinely used for treatment. Persons with more severe symptoms may need intravenous antibiotics. Because testing may be time-consuming and the condition might be severe, a doctor may decide to start antibiotics before confirming the diagnosis with tests. Some patients, however, recover on their own without the need for antibiotics.

Outlook

Leptospirosis was first documented in India in the early twentieth century, and is now prevalent in numerous sections of the nation, with intermittent seasonal outbreaks. It is more common in the Andaman Islands. Furthermore, in tropical and developing nations, focus may have been given to the chain of infection including animals and humans in agricultural regions with substantial annual rainfall, associated with unclean conditions and waterlogging. Several epidemics and occasional cases were documented in Andaman during an inter-epidemic interval, however, pulmonary involvement has been the most common consequence in outbreaks in north Andaman. The molecular epidemiology of leptospirosis reveals numerous novel and widespread serogroups and serovars that are active in various regions of the globe.2

According to the Health Protection Agency, there are typically fewer than 40 cases of leptospirosis documented in people in England and Wales each year. It is more frequent in nations with a tropical or subtropical environment; there were 141 documented cases in Australia in 2005, and 212 in France. Leptospirosis incidence fell in Europe over the second part of the twentieth century, resulting in a reduction in disease awareness and preventative measures. However, the resurgence of leptospirosis in developed nations, especially in cities, has lately been recorded. This phenomenon, for example, has been documented in Marseille, the principal city in southern France. Overall, there is a scarcity of detailed data for understanding the dynamics of leptospirosis incidence in Europe.4

In England and Wales in 2006, there were 44 laboratory-confirmed cases of leptospirosis. In the previous five years, 301 instances of leptospirosis have been verified in the UK. A sizable number (78 out of 301, or 25.9%) were obtained overseas, with the bulk coming from tropical nations. In the UK, the yearly number of recorded cases in England surpasses the combined total for Scotland, Wales, and Northern Ireland, but seems to have decreased over the previous four years.3

Life Expectancies

To produce nation-specific, regional, and global estimates for incidence and mortality that were corrected for imperfect diagnostic testing, a Monte Carlo model was used that included age and gender-specific incidence and death at the country level. Annual morbidity and mortality from leptospirosis were estimated to be 14.77 cases per 100,000 people (95% CI 4.38–25.03) and 0.84 fatalities per 100,000 people (95% CI 0.34–1.37), respectively. Oceania (150.68 instances per 100,000, 95% CI 40.32–272.29), South-East Asia (55.54, 95% CI 20.32–99.53), the Caribbean (50.68, 95% CI 14.93–87.58), and East Sub-Saharan Africa (25.65, 95% CI 9.29–43.31) had the highest illness occurrences. Small tropical islands exhibited a high predicted incidence of leptospirosis; nevertheless, there was substantial uncertainty associated with such projections in some situations, including information on morbidity and mortality by WHO sub-region, nation, and age and gender stratification.5

Males aged 20–29 had the greatest morbidity (35.27 cases per 100,000, 95% CI 13.79–63.89), whereas older males aged 50–59 had the highest estimated mortality (2.89 fatalities per 100,000, 95% CI 1.22–4.95). A considerable share of the worldwide burden of leptospirosis infections and fatalities occurred in men aged 20–49 years (48% [95% CI 40–61%] and 42% [95% CI 34–53%], respectively).5

Can Weil’s Disease Kill You?

The recent high-profile death of a British Olympic rower from leptospirosis contracted in the UK has boosted public and medical awareness of this rare but potentially dangerous illness.3 Weil syndrome may affect persons of various ages; at least 75% of those are men.

Leptospirosis is predicted to cause 1.03 million cases and 58,900 deaths yearly.5 Every year, around 500,000 severe cases occur across the globe, with a mortality rate of 5–20%.4 When the lungs are implicated, however, the chance of mortality rises to 50–70%. According to these figures, leptospirosis is the greatest zoonotic cause of illness and death. Furthermore, morbidity and death were highest in the world's poorest regions and in locations where monitoring is not frequently undertaken.

When should you contact your doctor?

It is critical to notify your doctor if feeling ill in the weeks after suspected exposure to animal urine or a polluted environment. Cases of leptospirosis must be reported to the local public health unit by laboratories. Where cases seem to be related, public health personnel will conduct an investigation to establish common exposures and methods of contacting the source of illness.

Summary

Leptospirosis, especially in severe instances presenting as Weil's disease, is a rare but potentially lethal illness in the United Kingdom.3 It is a major emerging epidemic across the world, mostly in underdeveloped nations with inadequate sanitation and little healthcare. This bacterial disease remains a problem with various hosts, multiple transmission mechanisms, and numerous serovar combined with diverse presentations.3 Nevertheless, early detection and treatment may typically prevent late complications and mortality.

References

  1. Bharti A, Nally J, Ricaldi J, Matthias M, Diaz M, Lovett M, et al. Leptospirosis: a zoonotic disease of global importance. The Lancet Infectious Diseases. 2003;3(12):757-771.
  2. Hasnain S, Ahrned N. Leptospirosis. The Lancet Infectious Diseases. 2004;4(9):543.
  3. Forbes A, Zochowski W, Dubrey S, Sivaprakasam V. Leptospirosis and Weil's disease in the UK. QJM. 2012;105(12):1151-1162.
  4. Dupouey J, Faucher B, Edouard S, Richet H, Kodjo A, Drancourt M et al. Human leptospirosis: An emerging risk in Europe?. Comparative Immunology, Microbiology and Infectious Diseases. 2014;37(2):77-83.
  5. Costa F, Hagan J, Calcagno J, Kane M, Torgerson P, Martinez-Silveira M, et al. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLOS Neglected Tropical Diseases. 2015;9(9):e0003898.

Sara Maria Majernikova

Bachelor of Science - BSc, Biomedical Sciences: Drug Mechanisms, UCL (University College London)
Experienced as a Research Intern at Department of Health Psychology and Methodology Research, Faculty of Medicine, Laboratory Intern at Department of Medical Biology, Faculty Medicine Biomedical Sciences Research Intern and Pharmacology Research Intern.

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