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Icterohaemorrhagic leptospirosis in patients with history of alcohol abuse - report of two cases.

Leptospirosis is a re-emerging zoonosis caused by spirochetes from the genus Leptospira and is typically associated with rural settings. Transmission occurs via contact with urine from infected animals; incubation period ranges from 4 days to 4 weeks. The clinical spectrum of leptospirosis may be mild and self-limited or severe with jaundice, renal failure, and bleeding manifestations (icterohaemorrhagic leptospirosis, so called Weil's disease). Mortality in severe forms remains high even when optimal treatment is provided. Early clinical suspicion and laboratory confirmation of leptospirosis is essential since delays in diagnosis may increase mortality. Alcohol-related toxicity and alcoholic hepatitis are common pathological processes, which can occasionally produce clinical syndromes similar to leptospirosis. There are few reports regarding the clinical course of leptospirosis in chronic alcoholics. Here, we describe two patients with Weil's disease, in whom alcohol abuse caused therapeutic difficulties. One of the cases was with lethal outcome.