944例钩端螺旋体病的流行病学及临床表现

报道１９７６年－１９９２年经实验室确诊的９４４例钩端螺旋体病的流行病学及临床表现综合分析资料。案例来自１１个地州市。农民占７０．７％，１０～３４岁占７２．６％；７－１０月占９１．３％；稻田、江河及沟塘型占８１．６％。早期典型病例数仅占１６．４％；流感伤寒及胃肠型为轻症型占８８．３％，黄疸、肺出血、肾及脑膜脑炎型为重症型占１１．７％；重症型由强毒菌群引发者占１２．４％（２２／１７７），由弱毒菌群引发者占３．８％（１０／２８５），两者间差异非常显著（Ｘ￣２＝１０．５９，Ｐ＜０，００５），并因地而异；其临床表现多样性，与流行菌型复杂及毒力差别因素有关。钩端螺旋体病多被误诊为其它热性传染病。     

Rapid serodiagnosis of leptospirosis by latex agglutination test and flow-through assay

PURPOSE: Diagnosis of leptospirosis facilitates patient management and initiation of therapy. The microscopic agglutination test (MAT) is the serological test used in reference laboratories because of its high degree of sensitivity and specificity. But the results are not available quickly for patient management. In the present study, in order to develop a simple, rapid immunodiagnostic assay, one of the outer membrane proteins (OMPs), recombinant LipL41 (rLipL41) has been utilised in latex agglutination test (LAT) and flow-through assay. METHODS: Part of LipL41 gene was expressed in Escherichia coli system and purified. The rLipL41 antigen of pathogenic Leptospira interrogans serovar Icterohaemorrhagiae, which is conserved in all pathogenic Leptospira spp. was used as capture antigen in the LAT and flow-through test. Both tests are very rapid and could be completed within 5 minutes. The sensitivity and specificity of rLipL41 was assessed and evaluated in LAT and flow-through assay in comparison with standard MAT. RESULTS: The sensitivity and specificity of the LAT were 89.70 and 90.45% and flow-through assay were 89.09 and 77.70%, respectively. CONCLUSIONS: The developed LAT and flow-through assays were simple, rapid and economical for the detection of leptospira infection and suitable for large-scale screening of samples in endemic areas without any sophisticated equipment.     

Leptospirosis-associated acute kidney injury: penicillin at the late stage is still controversial

What is known and Objective: Some antimicrobial agents are active in vitro against Leptospiras. The use of penicillins at the late stage of leptospirosis is still controversial. We aimed to evaluate the use of penicillin in patients with leptospirosis‐associated acute kidney injury (AKI). Methods: A retrospective study was conducted of patients with leptospirosis admitted to two hospitals in Fortaleza city, Brazil, between 1985 and 2008. AKI was defined according to the RIFLE and AKIN classifications. Patients were divided in two groups according to whether they were treated with a penicillin or not. Results: Two hundred and eighty‐seven patients were included, with an average age of 36·8 ± 15·6 years and mostly male (80·8%). One hundred and twelve patients (39%) received a penicillin. Patients treated with a penicillin were younger (32 ± 14 years vs. 39 ± 16 years, P = 0·0002) and had a shorter hospital stay (8·4 ± 5·0 vs. 11 ± 7·7 days, P < 0·0001). There was no difference in the onset of symptoms before hospital admission between the two groups (6·5 ± 3·0 vs. 7·7 ± 4·7, P = 0·33). Systolic blood pressure was lower in the penicillin group (111 ± 21 vs. 119 ± 22 mmHg, P = 0·04). AKI, need of dialysis and renal recovery at the time of hospital discharge were more frequent in patients who did not use a penicillin (P < 0·05). Mortality was similar in both groups (11·6% vs. 13·7%, P = 0·60). Conclusion: Treatment of leptospirosis with antibiotics, including the penicillin, remains controversial. The main benefit of using penicillin in the present study was a reduction in the length of hospital stay and fewer complications, such as AKI, but its use was not associated with a decrease in mortality. On balance of risks and benefits, we recommend the use of penicillin in late‐stage leptospirosis.     

2009年全国钩端螺旋体病监测分析

目的 了解全国钩端螺旋体病(钩体病)的流行趋势(未包括香港、澳门和台湾地区,下同),为有效调整防控措施提供科学依据。 方法 对2009年全国钩体病监测及实验室数据做描述性分析。 结果 全国钩体病的报告病例数和死亡数处于低水平波动,发病构成未见明显改变。各监测点疫情与全国总体疫情变化一致。监测点鼠密度合计为3.63%,略高于2008年(3.43%)。各监测点捕获的鼠类总体仍以黑线姬鼠最多,占捕获鼠的44.36%。血清学抗体滴度阳性界值的判定标准仍不统一,致使各监测点的血清学监测结果相互间缺乏可比性。 结论 全国发病总体趋势呈现较低水平,部分地区偶见散发。各省应继续对钩体病疫情加强关注,提高实验室检测能力。     

Leptospirosis in Hawaii, USA, 1999-2008

Although infrequently diagnosed in the United States, leptospirosis is a notable reemerging infectious disease throughout developing countries. Until 1995, when the disease was eliminated from the US list of nationally notifiable diseases, Hawaii led the nation in reported annual incidence rates. Leptospirosis remains a notifiable disease in Hawaii. To ascertain the status of leptospirosis in Hawaii since the most recent US report in 2002, we reviewed 1999-2008 data obtained from case investigation reports by the Hawaii State Department of Health. Of the 345 case reports related to in-state exposures, 198 (57%) were laboratory confirmed. Our findings indicate a change in seasonal disease occurrence from summer to winter and in the infective serogroup from Icterohemorrhagiae to Australis. Also, during the past 20 years, recreational exposures have plateaued, while occupational exposures have increased. Ongoing surveillance is needed to clarify and track the dynamic epidemiology of this widespread zoonosis.