Because disease

Classification according to ICD-10
A27.0	Leptospirosis icterohaemorrhagica (Weil disease)
ICD-10 online (WHO version 2019)

Leptospira in dark field microscopy

The Weil's disease , including Crohn Weil and Weilsche disease (named after the German physician Adolf Weil ) and Leptospirosis icterohaemorrhagiae and jaundice infectiosus (Because) called, is an infectious disease caused by bacterial pathogens from the group of spirochetes caused and by fever, Jaundice (or inflammation of the liver ) and inflammation of the kidneys . The ubiquitous pathogens are Leptospira species , in Western Europe especially Leptospira interrogans . This makes Weil's disease one of the leptospiroses .

Epidemiology

In Germany, 15 to 20 cases are reported each year. Leptospirosis occurs in Europe primarily in people who come into contact with media that are contaminated by the urine of rats , although pigs and dogs are also considered to be pathogen reservoirs. The route of infection is the ingestion of contaminated media, such as contaminated sewage or soil, via the softened or non-intact skin or via the mucous membrane . Airborne uptake is also possible, i. H. a respiratory intake . The incubation period is 7 to 12 days. Occupational groups at risk are u. a. Employees in the field of sewage technology (sewer workers) and in the forest, as well as people who are involved in the control of rodents. Weil's disease is recognized as an occupational disease for these professions . Proof of leptospirosis is notifiable in Germany according to the Infection Protection Act.

course

The course of the disease is typically divided into two phases, whereby the course can be very different depending on the immune system and the serotype of the pathogen. The first phase begins with a sudden high fever and unspecific symptoms such as headache and body aches, which can easily be mistaken for flu-like infections . In the absence of therapy and favored by the serotype Leptospira icterohaemorrhagica , serious organ complications can occur after a brief defever in the second phase, the so-called immune stage. Jaundice , meningitis , kidney or heart inflammation occur partly due to the pathogen itself, partly due to immune reactions (the clinical picture originally called Weil's disease). The lethality is up to 10%.

diagnosis

The disease was first described in 1886 by the clinician Weil, who worked at the University of Dorpat . Evidence of 1915 discovered for the first time by the Japanese bacteriologist Inada Ryukichi and almost simultaneously by German researchers Paul Uhlenhuth and Fromme (as icterogenes Spirochaeta later Leptospira icterohaemorrhagiae called) pathogen described succeeds in the first phase in the blood or cerebrospinal fluid , in the second phase difficult, with kidney involvement e.g. B. from urine. The detection of antibodies is usually only possible in the second phase. In contrast to other leptospiroses , the disease can be fatal if left untreated, especially in its severe hemorrhagic form . Since it occurs very rarely, the attending physician should be informed of any possible suspicion. The suspicion should be justified with reference to work in the sewage or soil remediation.

therapy

In the initial phase, the disease can and must be treated with high-dose antibiotics (e.g. penicillin G or 3rd generation cephalosporins ) with a very good chance of success. Therapy should be started even if it is suspected. Since immune reactions play a decisive role in the pathogenesis in the second phase , antibiotic therapy is no longer effective and therapy must be symptomatic .

Prevention

Weil's disease is classified in risk group two according to the WHO classification. This means that the pathogen can cause disease in humans; however, it is unlikely that the pathogen will spread to the population; effective prevention or treatment is usually possible.

• The population can be protected by rigorous rat control , usually with feeding baits that contain coumarin derivatives as an active ingredient .
• Kitchen waste and other organic waste that can be considered as "rat food" should not be stored in the open, not disposed of via the toilet or in the countryside.
• Avoidance of skin, eye and mucous membrane contact with sewage, contaminated floors or puddles, the use of personal protective equipment (protective gloves and waders in the sewage)
• Hygienic measures after work in the sewage area, when combating rodents (especially when emptying traps or when handling bait stations) or when cleaning up the soil.

literature

• Gerd Herold: Internal Medicine. Cologne 2003.
• Mediscript internal medicine. Elsevier, Munich 2007.
• Hahn, Falke, Kaufmann: Medical Microbiology. 5th edition. Springer, Berlin 2004.
• Weil's disease . In: Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 9-223, here: pp. 149-152.

Individual evidence

1. ↑ Werner Köhler : Weil's disease. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1470.
2. ↑ Karl Wurm, AM Walter: Infectious Diseases. 1961, p. 149.

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