5-87
disease,
Auscultation: Respiratory distress (in severe disease may have ARDS), tachypnea, rales
Palpation: Generalized adenopathy, tender calf muscles, tender abdominal rectus/paraspinal muscles,
hepatosplenomegaly (severe disease)
Using Advanced Tools: Lab: WBC is normal to slightly elevated; urine may show proteinuria, pyuria,
hematuria. CXR can show pulmonary edema like findings with diffuse whiteout, pleural effusions
Assessment:
Differential Diagnosis:
Dengue - more prominent petechial rash; jaundice unusual
Yellow Fever - endemic areas; jaundice is fulminant; bleeding manifestations; vaccine should be protective
Influenza - more nasopharyngeal symptoms, cough, sore throat; no conjunctival discharge
Hepatitis - more anorexia, malaise, jaundice; hepatitis A, E often febrile, while B, C not so likely; protective
vaccine for A, B
Cytomegalovirus - more chronic fatigue; unlikely to have conjunctival redness, severe myalgias; sexual
exposure is likely source
Malaria - fevers/chills; blood smears are diagnostic; cyclical fevers, but not biphasic pattern; conjunctival
discharge is unusual; malarious blackwater fever or cerebral malaria could be confused with Weil’s disease
(severe leptospirosis).
Hantavirus pulmonary syndrome - for Weil’s Disease, history of exposure to rodents versus standing
freshwater may differentiate
Plan:
Treatment
Primary: Doxycycline 100 mg po bid x 7 days
Alternative: Amoxicillin 500 mg q 6 h x 7 days
Severe disease: IV penicillin 6-10 million units/day in q 4-6 hour doses x 7 days
NOTE: Consider pretreatment with Tylenol before starting antibiotics due to Jarisch-Herxheimer like reactions
(fever, tachycardia, mild hypotension, chills, vasodilatation within 2 hours of treatment; peaking at 7-8 hours
and resolving in one day)
Patient Education
Activity: Avoid sun exposure with doxycycline.
Diet: As tolerated
Medications: Photosensitivity with doxycycline treatment. Avoid doxycycline in young children and
pregnant/nursing mothers.
Prevention and Hygiene: Use doxycycline 200 mg po q week prophylactically during period of exposure.
Dispose of urine appropriately to avoid further transmission. Wear boots and avoid skin exposure to streams,
standing water and mud after rainy season.
No Improvement/Deterioration: Return promptly for reevaluation.
Follow-up Actions:
Evacuation/Consultation Criteria: The cultures and serologies for definitive diagnosis are not available in
the field. Acute renal failure may develop, promoting the need for peritoneal dialysis.
Zoonotic Disease Considerations:
Principal Animal Hosts: Dogs, cattle, swine, mice, rats.
Clinical Disease in Animals: Usually asymptomatic renal infection.