Description, Causes and Risk Factors:
Weil's disease is a bacterial infection, caused by the Leptospira interrogans, and is spread by the urine of rats. Cave water draining from farmland or areas of human habitation is usually infected with leptospirosis to varying degrees. Whether you will catch Weil's disease depends on the levels of infection, what you do with the water, and how susceptible you are.
The bacteria usually enter our body via cuts to the skin, or via the nose, mouth or alimentary tract (for those with a limited medical vocabulary, the alimentary tract sees the food on the way out, the mouth sees it on the way in). Thus, anyone coming into contact with infected water or swallowing any of it is at risk of infection.
Note that infected water does not have to look and smell like raw sewage to be dangerous. The cave does not have to be infested with rats if the run-off comes from an infested surface area. However, water which does appear polluted, or the sight of some of our furry friends, is Warning Number One that the water is to be avoided.
To minimize the risks of infection, the only truly effective way is to avoid contact with the water. Thus, avoid immersion, especially the head, and cover any cuts with waterproof dressings. Wear oversuits and gloves, and divers, who are particularly at risk, should opt for drysuits and try as much as possible to avoid swallowing any water when purging or changing regs.
Weil's disease runs itself much like the flu. The period of incubation within the body is about 3 weeks, with symptoms presenting themselves between 3 and 14 days. The disease will typically ebb after a few days, giving the appearance of recovery, before returning.
The disease hits people suddenly, starting with flu-like symptoms including muscle pain, nausea and a fever higher than 102 F. Severe headaches also accompany the first phase, hitting suddenly with the pressure and pain of a migraine. In about one-third of all Weil's disease, the individual infected will develop a rash. This rash is similar in appearance to that which is caused by meningitis. It will appear red with a series of pinpricked-shaped valleys.
The bacteria is alive in the bloodstream during this time period. In mild cases, the disease will be fought by white blood cells and kept at bay. In severe cases, the blood-borne bacteria could cause the body to go into septic shock.The first phase will often last 3 to 5 days.
The second window of the disease does not open in mild cases. Typically restricted to moderate-to-severe cases of Weil's disease, a second phase will usually manifest itself after 2 to 3 days of apparent recovery. This second stage is usually more aggressive, with the return of the fever, headache and muscle pain, as well as pain in the upper torso and additional symptoms that mimic meningitis--neck stiffness, vomiting and kidney issues.Mild cases will clear up completely in 3 to 5 weeks.
In more serious cases, people with Weil's disease can expect severe, and oftentimes, fatal, organ trauma. Jaundice will onset, indicative of liver and kidney failure. The bacteria will also cause infections in the heart and cause massive internal bleeding.
Individuals in poor health will see the disease onset and progress much quicker, with death an almost certainty.
Diagnosis may include:
Prolonged prothrombin time (coagulation times may be elevated in patients with hepatic dysfunction and/or disseminated intravascular coagulation).
FBC: thrombocytopenia, leukocytosis and anemia.
Renal function and electrolytes (renal failure); serum amylase levels are raised in acute renal failure.
Raised creatine kinase (muscle involvement, rhabdomyolysis).
MSU usually shows sediment and proteinuria.
CXR: may be normal or show patchy shadowing in alveolar haemorrhage.
Liver function tests: increased serum bilirubin, transaminases.
Diagnosis can be confirmed by serology (paired), either using microscopic slide agglutination test or new rapid serodiagnostic kits.
Enzyme-linked immunosorbent assay (ELISA); has greater sensitivity and comparable specificity to microscopic slide agglutination test.
Treatment options may include:
Oral amoxicillin, ampicillin and doxycycline are effective in mild-to-moderate infections.
Intravenous penicillin G is the drug of choice for severely ill patients.
A recent clinical trial showed that third-generation cephalosporins are as effective as doxycycline and penicillin in the treatment of acute disease.
Chloramphenicol is also active against Leptospira but should be reserved for critically ill patients.
Supportive care and treatment of the hypotension, haemorrhage, renal failure and liver failure.
Vitamin K should be administered for hypoprothrombinemia.
Immunity to leptospirosis is incomplete and so patients should be advised to adopt lifestyle changes to avoid re-exposure if possible.
First-choice drug is oral doxycycline, starting within 48 hours of illness (starting antibiotics can lead to a Jarisch-Herxheimer reaction).
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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