Leptospirosis in humans.
Leptospirosis in humans.
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DOI：
10.1007/978-3-662-45059-8_5
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发表时间：
2015
影响因子：
--
通讯作者：
Levett, Paul N.
中科院分区：
文献类型：
--
作者：
Haake, David A.;Levett, Paul N.
钩端螺旋体病是一种广泛存在且可能致命的人畜共患疾病，在许多热带地区流行，并在暴雨和洪水后引起大规模流行。感染是由直接或间接接触受感染的储存宿主动物引起的，这些宿主动物的肾小管中携带病原体，并在尿液中排出致病性钩端螺旋体。尽管许多野生和家养动物可以作为储存宿主，但褐鼠（Rattusnorvegicus）是人类最重要的感染源。生活在卫生条件差和住房条件差的城市贫民窟环境中的个人面临老鼠暴露和钩端螺旋体病的高风险。随着人口结构的变化，预计全球钩端螺旋体病的负担将会增加，这有利于热带地区因气候变化而遭受日益严重的风暴和城市洪水的城市贫民人数的增加。前瞻性监测研究的数据表明，流行地区大多数人类钩端螺旋体感染都是轻微或无症状的。更严重结果的发生可能取决于三个因素：流行病学条件、宿主易感性和病原体毒力（图 1）。死亡率随着年龄的增长而增加，尤其是 60 岁以上的患者。高水平的菌血症与不良的临床结果相关，并且根据动物模型和体外研究，部分与人类 TLR4 对钩端螺旋体 LPS 的识别能力差有关。严重钩端螺旋体病患者会经历以高水平 IL-6、TNF-α 和 IL-10 为特征的细胞因子风暴。携带 HLA DQ6 等位基因的患者患病风险较高，这表明钩端螺旋体超抗原对淋巴细胞刺激有一定作用。钩端螺旋体病通常表现为一种非特异性急性发热性疾病，以发烧、肌痛和头痛为特征，可能与流感和登革热等其他疾病相混淆。新的诊断方法有利于早期诊断和抗生素治疗。进展为多系统器官衰竭的患者存在病原体广泛的血行播散。非少尿（高输出量）肾功能障碍应补充液体和电解质。当发生少尿性肾功能衰竭时，及时开始透析可以挽救生命。胆红素水平升高是由于肝细胞损伤和肝细胞之间的细胞间连接破坏，导致胆红素从胆小管漏出。出血并发症很常见，并且与凝血异常有关。由于广泛的肺泡出血而导致的严重肺出血综合征的死亡率>50%。读者可以参考之前与该主题相关的精彩摘要。
Leptospirosis is a widespread and potentially fatal zoonosis that is endemic in many tropical regions and causes large epidemics after heavy rainfall and flooding. Infection results from direct or indirect exposure to infected reservoir host animals that carry the pathogen in their renal tubules and shed pathogenic leptospires in their urine. Although many wild and domestic animals can serve as reservoir hosts, the brown rat (Rattus norvegicus) is the most important source of human infections. Individuals living in urban slum environments characterized by inadequate sanitation and poor housing are at high risk of rat exposure and leptospirosis. The global burden of leptospirosis is expected to rise with demographic shifts that favor increases in the number of urban poor in tropical regions subject to worsening storms and urban flooding due to climate change. Data emerging from prospective surveillance studies suggest that most human leptospiral infections in endemic areas are mild or asymptomatic. Development of more severe outcomes likely depends on three factors: epidemiological conditions, host susceptibility, and pathogen virulence (Fig. 1). Mortality increases with age, particularly in patients older than 60 years of age. High levels of bacteremia are associated with poor clinical outcomes and, based on animal model and in vitro studies, are related in part to poor recognition of leptospiral LPS by human TLR4. Patients with severe leptospirosis experience a cytokine storm characterized by high levels of IL-6, TNF-alpha, and IL-10. Patients with the HLA DQ6 allele are at higher risk of disease, suggesting a role for lymphocyte stimulation by a leptospiral superantigen. Leptospirosis typically presents as a nonspecific, acute febrile illness characterized by fever, myalgia, and headache and may be confused with other entities such as influenza and dengue fever. Newer diagnostic methods facilitate early diagnosis and antibiotic treatment. Patients progressing to multisystem organ failure have widespread hematogenous dissemination of pathogens. Nonoliguric (high output) renal dysfunction should be supported with fluids and electrolytes. When oliguric renal failure occurs, prompt initiation of dialysis can be life saving. Elevated bilirubin levels are due to hepatocellular damage and disruption of intercellular junctions between hepatocytes, resulting in leaking of bilirubin out of bile caniliculi. Hemorrhagic complications are common and are associated with coagulation abnormalities. Severe pulmonary hemorrhage syndrome due to extensive alveolar hemorrhage has a fatality rate of >50 %. Readers are referred to earlier, excellent summaries related to this subject.
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实时PCR的开发和验证，用于检测临床材料中致病性钩端螺旋体。
影响因子：
3.7
作者：
Ahmed A;Engelberts MF;Boer KR;Ahmed N;Hartskeerl RA
通讯作者：
Hartskeerl RA
影响因子：
9.4
作者：
Bajani, MD;Ashford, DA;Weyant, RS
通讯作者：
Weyant, RS
DOI：
10.2215/cjn.00680207
发表时间：
2007-07-01
影响因子：
9.8
作者：
Andrade, Lucia;Cleto, Sergio;Seguro, Antonio C.
通讯作者：
Seguro, Antonio C.
影响因子：
158.5
作者：
Amato, MBP;Barbas, CSV;Carvalho, CRR
通讯作者：
Carvalho, CRR
影响因子：
9.4
作者：
BAL, AE;GRAVEKAMP, C;TERPSTRA, WJ
通讯作者：
TERPSTRA, WJ