Recent Work on Leptospirosis.
Recent Work on Leptospirosis.
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DOI：
10.1016/s0035-9203(34)90094-8
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发表时间：
1934-01-01
影响因子：
2.2
通讯作者：
Schuffner, W.
中科院分区：
文献类型：
--
作者：
Schuffner, W.
这篇有价值的文章总结了钩端螺旋体病的最新工作，特别是作者和他的同事在荷兰的调查，也包含了一个不同的菌株的感染剂，犬型钩端螺旋体，造成一个特定的犬疾病的描述。在过去10年中，经血清学或钩端螺旋体分离确诊的452例病例中，有46例死亡，病死率为10.2%，这一事实表明韦伊氏病在荷兰的流行，虽然病例可能发生在一年中的任何一个月，但在夏末秋初有一定的积累，游泳者感染的结果。详细介绍了感染的途径和各种外部因素对钩端螺旋体的影响。RUYS的实验表明，这些生物可以在任何盐度的水中存活至少几个小时，但在高盐度的沃茨中的存活时间比在低盐度的沃茨中短。这可以解释为什么荷兰南部（低盐度）的发病率高，而荷兰北方（高盐度）的发病率低得多。研究发现，所有地方流行病都无一例外地伴随着严重的鼠感染（高达56%，已感染），作者认为，人类感染是这些受感染老鼠的尿液污染水的结果。然而，感染很可能通过被尿液污染的食物或通过性交从一只大鼠传播到另一只大鼠。该疾病的细菌学诊断基于（a）通过直接显微镜检查在新鲜抽取的血液中检测钩端螺旋体，（B）培养，（c）血清学反应。这些方法中的第一种很少成功，因为即使在高离心速度下，生物体也经常不沉淀。在最初的3或4天收集患者的血液时，培养通常更成功，但寄生虫可能迟至第8或第10天。在疾病结束后进行血清学试验，可以检测可疑感染的性质，因为血清的凝集和溶解特性持续存在，并在至少8年内保持良好发展。凝集试验最好借助于保存在0.5%纯福尔马林中的灭活钩端螺旋体进行。保存两年的这些悬浮液以未受损的方式凝集，直到最高稀释度，并且不以与活生物体相同的方式裂解。此外，它们对于吸收测试的应用非常方便。以前只有一株S.在荷兰曾发现过黄疸型血吸虫，但在1931年11月，作者从一只狗的尿中培养出一个菌株，虽然在形态上与普通型相同，但有许多不同之处。对豚鼠只有轻微的毒力;不引起黄疸;钩端螺旋体从不出现在血液中，只在接种动物的腹腔中出现很短时间;通过豚鼠传代可以提高毒力，但即使在致命的病例中，经过两次或三次传代后，也不发生黄疸;豚鼠恢复后几乎总是成为带菌者;在白色小鼠中，寄生虫的行为与在豚鼠中的行为相似。此外，通过血清学试验，发现新菌株与典型的Weil菌株明显不同。它只在人类患者中发现过一次，迄今为止从未在大鼠中发现过。鉴于其不同的特征，作者与KLABENBEEK一起，认为它是一个独特的物种，因此建议将其命名为犬型钩端螺旋体。E.亨德尔
This valuable article summarizes recent work on leptospirosis with special reference to the investigations of the author and his colleagues in Holland, and also contains the description of a divergent strain of the infective agent, Leptospira canicola, causing a specific canine disease. The prevalence of Weil's disease in Holland is indicated by the fact that during the last 10 years 452 cases have been diagnosed either serologically or by isolation of leptospirae, and of these 46 died, a case fatality of 10.2 per cent. Although cases may occur in any month of the year, there is a definite accumulation of them in late summer and early autumn, the result of infection among bathers and swimmers. Details are given of the ways in which infection may be acquired and the influence of various external factors on the leptospira. Experiments by RUYS show that these organisms can survive for at least a few hours in water of any degree of salinity, but the survival period in waters of a high degree of salinity is less than in waters with a low degree. This may explain the high incidence of the disease in Southern Holland (low salinity) compared with the much lower incidence in Northern Holland (high salinity). All the local epidemics studied were found to be invariably accompanied by heavy murine infections (up to 56 per cent, infected) and the author considers that human infections are the result of the contamination of the water by the urine of these infected rats. It is probable, however, that infection may pass from one rat to another by way of food polluted with urine, or by sexual intercourse. The bacteriological diagnosis of the disease is based on (a) detecting leptospira in freshly drawn blood by direct microscopical examination, (b) cultivation, (c) serological reaction. The first of these methods is rarely successful since even at high centrifuge speeds frequently the organisms are not precipitated. Cultivation is generally more successful when the patient's blood is collected during the first 3 or 4 days but parasites may be present as late as the 8th or 10th day. Serological tests after the disease has run its course make it possible to test the nature of suspicious infections, for the agglutinating and lytic properties of the serum persist and remain well developed for at least 8 years. Agglutination tests are best carried out with the aid of leptospira killed ana preserved in 0.5 per cent, pure formalin. Suspensions of these kept for two years agglutinate in an unimpaired manner, up to the highest dilutions, and do not lyse in the same way as living organisms. Moreover, they are very convenient for the application of absorption tests. Previously only one strain of S. icterohaemonhagiae had been met with in Holland, but in November, 1931, the author cultivated a strain from the urine of a dog, which, although morphologically identical with the ordinary type, presents many points of difference. It has only a slight virulence for guineapigs; does not cause jaundice; leptospira never appear in the blood and only for a short time in the peritoneal cavity of inoculated animals; the virulence can be raised by passages through guineapigs, but even in fatal cases, produced after two or three passages, jaundice does not develop; after recovery the guineapigs almost invariably become carriers; in white mice the behaviour of the parasite is similar to that in guineapigs. Moreover, by serological tests the new strain is found to be sharply distinguished from the typical Weil strains. It has only once been identified in a human patient and hitherto has never been found in rats. In view of its divergent characters the author, in conjunction with KLABENBEEK, considers it to be a distinct species, for which the name Leptospira canicola is proposed. E. Hindle.