PP015 Weil's Disease: A Case of the Deadly Rodent

Abstract

Leptospirosis is   an emerging zoonotic illness in recent years due to increased incidents of flooding and outdoor recreational activities. It is endemic in tropical and subtropical countries in South-East Asia .Leptospirosis   has been reported in Malaysia from 1925. It is a water borne disease mainly spread by rodents.Weil’s disease is a severe form of leptospirosis with a high mortality rate. .We present a case of Weil’s Disease referred to our centre.

A 39 year old gentleman was referred to our centre with a history of fever for five days followed by shortness of breath  and jaundice.He had a history of trekking in the jungle  two weeks prior to the illness and had bathed in the river with an open wound on his arm. He was a chronic smoker. He tested positive for Leptospira IgM and was started on appropriate intravenous antibiotics at the private centre where he presented.His respiratory distress however worsened and upon arrival to our emergency department ,he was intubated and noted to have pulmonary haemorrhage. His blood investigations  revealed deranged liver enzymes and renal function.

 The majority of patients with leptospirosis manifest a mild, anicteric febrile illness, but a small number  develop a severe form with multiorgan involvement, called Weil’s disease which has a mortality rate of 5-10 %.  Weil’s disease is characterized by multisystem dysfunction and can present with  significant jaundice, renal failure, hepatic necrosis, pulmonary involvement, cardiovascular collapse, neurologic changes and haemorrhagic diathesis. Three variables were independently associated with mortality in these patients: hemodynamic instability, serum creatinine level > 265.2 µmol/L, and serum potassium level > 4.0 mmol/L. There has been an association of smoking with pulmonary manifestation.

The clinician treating leptospirosis  should be aware of the signs and symptoms of severe leptospirosis in order to initiate aggressive treatment early.