Leptospirosis--3 cases and a review

Leptospirosis is an infectious disease of variable severity characterized by sudden onset of headache, myalgia and prostration. Although most common in the tropics, an increasing number of cases is reported in Europe and Northern America. Severe forms referred to as Weil's disease commonly involve kidneys, liver, lungs, CNS and heart and require early recognition and immediate initiation of adequate therapy. We describe 3 patients with Weil's syndrome from an urbanized region in Southern Germany, who developed renal and respiratory failure. PCR facilitated early diagnosis, and therefore, specific treatment before serological tests were positive. Illustrating the case histories, initial presentations and clinical courses, we point out difficulties with early diagnosis and treatment. Furthermore, we offer a comprehensive overview on leptospirosis with emphasis on renal involvement, current diagnostic tools and evidence-based therapy.