Leptospirosis

Leptospirosis may be a zoonosis of ubiquitous distribution, caused by infection with pathogenic Leptospira species. The spectrum of human disease caused by leptospires is extremely wide, starting from subclinical infection to a severe syndrome of multiorgan infection with high mortality. This syndrome, icteric leptospirosis with renal failure, was first reported over 100 years ago by Adolf Weil in Heidelberg. However, an apparently identical syndrome occurring in sewer workers was described several years earlier. Earlier descriptions of diseases that were probably leptospirosis were reviewed recently. Leptospirosis was certainly recognized as an hazard of rice harvesting in ancient China and therefore the Japanese name akiyami, or autumn fever, persists in modern medicine. With hindsight, clear descriptions of leptospiral jaundice are often recognized as having appeared earlier within the 19th century, some years before the outline by Weil. It has been suggested that Leptospira interrogans serovar icterohaemorrhagiae was introduced to Western Europe in the 18th century by westward extension of the range of Rattus norvegicus from Eurasia. The etiology of leptospirosis was demonstrated independently in 1915 in Japan and Germany. In Japan, Inada and Ido detected both spirochetes and specific antibodies within the blood of Japanese miners with infectious jaundice, and two groups of German physicians studied German soldiers afflicted by “French disease” in the trenches of northeast France. Uhlenhuth and Fromme and Hubener and Reiter detected spirochetes in the blood of guinea pigs inoculated with the blood of infected soldiers. Unfortunately, these two groups became so embroiled in arguments over priority that they overlooked the first publications in English and German of papers by Inada’s group, whose initial publications predated their own by 8 months. Confirmation of the occurrence of leptospirosis on both sides of the Western Front was obtained rapidly after the publication in Europe of Inada’s work.