Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Weil disease or pulmonary haemorrhage
Jaundice with acute kidney injury, shock, bleeding, meningism, myocarditis, hypoxaemia, haemoptysis or diffuse alveolar infiltrates after animal or contaminated-water exposure indicates severe multisystem leptospirosis.
Action: Use ABCDE, obtain cultures and UKHSA blood and urine samples, start intravenous antibacterial treatment without awaiting confirmation, involve infection and critical care, and provide cautious haemodynamic, renal, respiratory and bleeding support.
Synopsis
Recognise leptospirosis after animal-urine or freshwater exposure, detect Weil disease and pulmonary haemorrhage early, select time-dependent reference tests, and begin severity-appropriate antibiotics and organ support.
Pathogenic Leptospira are shed in urine from rats, mice, cattle, pigs, dogs and other animals, contaminating freshwater, mud, soil and occupational environments.
Organisms enter through cuts, softened skin or conjunctival and oral mucosa; kayaking, open-water swimming, flooding, sewage work, farming and animal-tissue contact are typical risks.
Acute leptospirosis causes fever, severe headache, prominent calf or lower-back myalgia, nausea and conjunctival suffusion without purulent discharge.
Key red flags
Jaundice with oliguria or rising creatinine is classic severe Weil disease and requires admission even when aminotransferase elevation is modest.
Weil triad
Jaundice, acute kidney injury and haemorrhagic tendency identify severe multisystem disease rather than uncomplicated viral-like illness.
Investigation priorities
01
First-line organ severity panelFirst stepFirst line
Identify kidney, liver, muscle, haematological and coagulation injury at presentation.
Record exposure date, skin breaks, immersion, occupation, country, animal species and protective equipment, then ask about calf pain, red eyes, urine, jaundice, bleeding and breathing.
Perform ABCDE and an organ-focused examination, obtaining bedside glucose, urine output, blood tests, urinalysis, ECG and chest assessment before classifying severity.
MILDTreat stable early disease
A suitable adult has a compatible mild syndrome, reliable oral intake and no renal, hepatic, pulmonary, neurological, cardiac or obstetric red flag.
Key medicines
DoxycyclineGive 100 mg orally twice daily for five to seven days for suitable non-severe adult leptospirosis, beginning promptly when clinical suspicion is strong.
Intravenous benzylpenicillinGive 1.2 g intravenously every six hours for five to seven days for severe adult leptospirosis, adjusting the plan to renal function and local specialist advice.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.