Treatment of Weil's Disease (Leptospirosis)
Doxycycline is the recommended drug of choice for leptospirosis, with a dosage of 100 mg orally twice daily for 7 days for mild to moderate cases. 1
Clinical Presentation and Diagnosis
Weil's disease is a severe form of leptospirosis characterized by:
- Fever, headache, chills, myalgia, and a biphasic illness pattern
- Jaundice and hepatomegaly/splenomegaly
- Conjunctival suffusion (redness without exudate)
- Renal involvement
- Coombs-negative intravascular hemolysis in severe cases
- Multi-organ failure in advanced cases
Early diagnosis is crucial for improved prognosis and depends on:
- Clinical features (sudden onset febrile illness, severe malaise, muscle pain)
- Laboratory findings (proteinuria, leukocytosis with neutrophilia)
- Epidemiological factors (exposure to contaminated water/soil, animal urine)
Treatment Algorithm
Mild to Moderate Leptospirosis
- First-line therapy: Doxycycline 100 mg orally twice daily for 7 days 1
Severe Leptospirosis (Weil's Disease)
- First-line options:
Special Populations
- Pregnant patients: Avoid doxycycline; use penicillin G or erythromycin 1
Monitoring and Supportive Care
- Monitor for Jarisch-Herxheimer reaction (JHR) after antibiotic initiation, which may require vasopressor support in severe cases 2
- Provide appropriate fluid management and electrolyte correction
- Consider renal dialysis for severe renal involvement
- Monitor hepatic function, as jaundice is an independent predictor of severe disease 3
- Observe cardiac function, as cardiac damage is also predictive of severe disease 3
Important Clinical Considerations
- Early antibiotic treatment is crucial for improved outcomes
- Streptomycin has shown excellent bactericidal activity against leptospires in some studies, with aminoglycosides like gentamicin, tobramycin, and isepamicin as effective alternatives 4
- When using antibiotics with inadequate bactericidal activity, long-term therapy with sufficient doses may be required from early disease stage until antibody appearance 4
- Patients started on antibiotics should be monitored for potential decompensation due to JHR before discharge or transfer to regular medical floors 2
Prognosis
With appropriate antibiotic treatment, most patients recover without residual organ impairment, even those with severe disease 5. However, untreated Weil's disease can be fatal, with mortality rates of 5-15% in severe cases 1.