Leptospirosis (Weil's)


  • Zoonosis - caused by Leptospira spirochetes
  • Assoc. with rodent urine and poor sanitation (or sports yahoos)
  • Usually occupational in Ireland - Water workers, farmers, sewer workers
  • May present with sepsis, acute renal failure and jaundice


Sudden onset:


  • Fever
  • "Meningism" ±photophobia etc
  • Conjunctivitis
  • Myalgia (esp. back or leg)
  • Dry Cough
  • GI upset (D&V)


  • Jaundice
  • Acute renal failure
  • Shock
  • Thrombocytopenia ±haemorrhage (check the palate)
  • Pulmonary haemorrhage - mistaken for "pneumonia"
  • DIC or HUS (TTP (less common)

Differential Dx


  • FBC (↓platelets ± ↓Hb), Coag (±normal)
  • LFT may show ↑bili but relatively normal INR (unless DIC)
  • Cultures
  • Serum (±CSF) for Leptospira IgM/IgG
  • Leptospira PCR (blood, CSF or urine)
  • CXR - pneumonia is more common than Weil's but beware pulm. haemorrhage mistaken for "pneumonia" or "aspiration"


  • ABC ... as in sepsis ... early inotropes in shock
  • PO Doxycycline or Clarithromycin if well
  • IV Cefotaxime or IV Amoxicillin (Erythromycin if Pen. allergy) if unwell
  • Early renal team involvement if ARF
  • Ophthalmology if eye signs prominent


Content by Dr Íomhar O' Sullivan 19/12/2019. Last review Dr ÍOS 10/06/21.