THE OCCURRENCE OF WEIL'S DISEASE IN INDIA

By B. M. DAS GUPTA

and

R. N. CHOPRA, c.i.e., k.h.p., m.r.c.p. (Lond.), m.d., sc.D. (Cantab.) BREVET-COLONEL, I.M.S.

From the School of Tropical Medicine, Calcutta

From time to time epidemics of j aunui^ suggestive of Weil's disease have been describee by workers in India, but in no case so iar

recorded could the causative organism ^e

demonstrated with certainty. Tucker (1907) reported a very severe epidenj10

of jaundice in the crowded quarters about tne

Byculla District of Bombay. These cases showed the usual signs of yellow atrophy of t"e liver and nine cases out of ten terminated fatally- No bacteriological examination was carried ou

?

Franklin (1913) studied a mild outbreak 0

jaundice among the Kashmir Imperial Service

Troops stationed at Gilgit, and a similar outbreak among the civil population of the locality. pe suspected the leptospiral nature of the infects1 but did not come to any definite conclusion- Parmanand (1922) observed seven cases. The

symptoms were typical of Weil's disease.

any case the causal organism was not isolated by culture and therefore the nature of the infeC" tion was not precisely ascertained. Listo*1 (1922) examined the material sent to him fr0111

a fatal case at Santa Cruz. He found no spir?' chaete, but the histological appearance suggested acute yellow atrophy as the cause of death- Turkhud (1928) recorded two cases and believed

?ct., 1937J WEIL'S DISEASE IN INDIA : DAS GUPTA & CHOPRA G11

that, they wore cases CliD'Cal

?7"d>ao (1932).?v?d demic of jaundice in the Ahpu i ?racter. Under symptoms were of very mud

' .

^ have been the suspicion that the epidemic ._e(j all then one of leptospiral origin, spirochete but energies to the isolation of establish the with negative results, ^ .u)k ^ey were

leptospiral nature of the m disease W?IS

inclined to suppose that From the

probably due to a filterable ^ that labora- foregoing account it would ai I ^^ough cases tory confirmation is still *a. -

are not uncom- suggestive of leptospiral origi mon in this country. . +iie position ot Knowles (1928) in discuss:11 ?rVcd that it is

Weil's disease in India relB exists m tlus

almost certain that this disea- possible to

country although it has not methods. verify the infection by ^a 01.c their celebrated

Taylor and Goyle this opinion and work on leptospirosis confirm < future a

expressed their earnest desne blood complete investigation, parti ^ be carried culture and animal inoculation, - ^e^>s disease out, in all suspicious cases o^ occurring in any part of fndl?.

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connection that It may be mentioned w J ^ were the first Knowles and Das Gupta j -rndian rats. to detect leptospiral infection a telephone On the 6th September this y 0^onei Thakur,

message was received from Hospital, Superintendent, Sambhunatn iaundice had stating that two cases of

Qne caSe, how-

been admitted to the hospital- ^ report on ever, died on the following '/ 'i ]ater. The this fatal case will be P" >s'

of the present other case is the subject-ma paper-

? l j +n the hospital with The patient was admitted congestion and fever, jaundice, conjunctiva clinical bleeding from the gums. 1

tjve of Weils presented was strongly sl1?^

.yere centred on

disease and so all our efforts

isolating the causal organism- rather late Blood culture.?Although 1

was taken on (9th day of illness) blood cu ^ ^ept in the Fletcher's medium, which is .

gtock cultures ,

laboratory for the maintenance inoculated of rat leptospira. Six tubes

i (0.2 c.cm., 0.4 ( with varying amounts of Rnd 1.5 c-cm., 0.6 c.cm., 0.8 c.cm., 1 cJn t 37?C., HI aIK! Tubes I and II were incuba

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^ 31?C.) and IV at room temperature (*?*? V and VI at 22?C.

7 hnrat0rV ^limalsnZt Blood inoculation int? . ,i :n?r 192 and 202 Two young guinea-pigs VkC1^

injected intra- grammes respectively were .

peritoneally with 2.5 c.cm. ot Uowing proce- Examination of urine.-?-p ^ ipS (1928), waS

dure, as advocated by K" |anS penis were followed. The meatus and tnc b gwabbe(1 wlth cleaned with alcohol and t1 i-ne A small cotton-wool soaked in sterile sail

quantity of urine first passed by the patient was discarded, for obvious reasons, and then 20 c cm were centrifuged at high speed. The supernatant fluid was pipetted off and another 20 c.cm were added to the same tube and centrifuged again. This process was repeated till the

deposit from 100 c.cm. of urine was collected. This deposit was examined under the dark-

ground illumination. The leptospira was first detected on the 19th day of illness. The spiro- chEctes occurred in fair numbers. They possessed typical leptospiral characters but none were

motile. Now a catheter specimen was obtained with rigid aseptic precautions and centrifuged. The deposit was then examined by the method mentioned above. A larger number of lepto- spira) was found. In this case also they were immobile. A quantity of centrifuge deposits plus 2 c cm

of whole urine were injected into a young guinea- pig. Two tubes of Fletcher's medium were also inoculated with the catheter specimen.

Results

Blood culture.?Out of six tubes one (inocu- lated with 0.6 c.cm. of blood and placed in a

dark corner of the laboratory at room tempera- ture) gave a very scanty growth of leptospira? on the 13th day of inoculation. One of the two tubes incubated at 37?C. was found contamina- ted. The remaining tubes have remained sterile so far (till the 14th day after inoculation). Animal inoculation,?The blood of the guinea-

pigs was examined by dark-ground illumination from the third to the eighth day of inoculation On no occasion could leptospira) be detected The concentration method advocated bv Schiiffner and Sieburgh (1926) was also tried with negative results.

Urine.?Direct examination of the centrifuged deposits (catheter specimens) showed the pre- sence of leptospira; from the 19th day of illness They are still present (23rd day), although their number is decreasing. The blood of the guinea-pig inoculated with

the urinary deposits was examined 48 hours after inoculation, giving negative results. The time for the examination of the culture

has not yet matured. Comment.?The workers who have success-

fully cultivated leptospira from the blood of human cases are inclined to the view that suc- cessful results are obtained only when the blood cultures are taken within the first seven davs of illness. In a series of 64 cases studied by Tavlor and Goyle (1931) in the Andamans the biood culture done later than the 7th day of the illness was invariably negative. It is significant that the present case gave a positive blood cul- ture as late as the 9th day but the guinea- pigs inoculated at the same time proved refrac- tory to infection. Although found in fairly larce numbers in the urine the leptospira) were always immobile and most of them showed varying degrees of degeneration. This is probably due

612 THE INDIAN MEDICAL GAZETTE [Oct., 1937

to the presence of plenty of bile (which has a lytic action on leptospira) still present in the urine.

Conclusions A case of Weil's disease with demonstration of

the causal organism, L. icterohcemorrhagice, 'in the blood (culture) and urine is recorded for the first time in India. The writers' grateful thanks are due to

Colonel K. S. Thakur, i.m.s., for so kindly draw- ing their attention to these cases.

References

Franklin, G. D. (1913). A Mild Epidemic of Jaundice. Indian Med. Gaz., Vol. XLVIII, p. 218.

Knowles, R. (1928). An Introduction to Medical

Protozoology. Thacker, Spink and Co., Calcutta. Knowles, R., and Das Gupta, B. M. (1932). Ann.

Rep., Calcutta School of Tropical Medicine and the

Carmichael Hospital for Tropical Diseases, 1931- Bengal Govt. Press, Calcutta.

Liston, W. G. (1922). Opening Remarks on the

Discussion of 'Jaundice in the Tropics'. Indian Me?-

Gaz., Vol. LVII, p. 268. Pandit, C. G., and Rao, R. S. (1932). An Epidemic

of Jaundice in the Alipuram Jail, Bellary (S. India)- Ibid., Vol. LXVII, p. 77.

Parmanand, M. J. (1922). The Presence of Infectious Jaundice in Bombay. Ibid., Vol. LVII, p. 54.

Schtiffner, W. A. P., and Sieburgh, G. (1926). Early Diagnosis bv Microscope of Leptospiroses. (Abstract^ T.rop. Dis. Bull., 1927, Vol. XXIV, p. 709.) Taylor, J., and Goyle, A. N. (1931). Leptospirosis i11

the Andamans. Indian Med. Res. Mem., No. XX.

Tucker, E. F. G. (1907). An Epidemic of Malign^ Jaundice in Bombay. Indian Med. Gaz., Vol. XLlb p. 4.

Turkhud, D. A. (1928). A Note on Weil's Disease oi

Leptospirosis icterohcemorrhagica. Ibid., Vol. LXIU> p. 583.