Leptospirosis: an emerging global public health problem
Leptospirosis: an emerging global public health problem
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DOI：
10.1007/s12038-008-0074-z
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发表时间：
2008-11-01
影响因子：
2.9
通讯作者：
Shriram, A. N.
中科院分区：
文献类型：
--
作者：
Vijayachari, P.;Sugunan, A. P.;Shriram, A. N.
由于钩端螺旋体病在发展中国家和发达国家的发病率都在不断上升，因此已被公认为一个新出现的全球公共卫生问题。过去数年，尼加拉瓜、巴西及印度等地曾爆发多宗端螺旋体病。其中一些是由于自然灾害，如飓风和洪水造成的。它是由属于钩端螺旋体属不同致病种的螺旋体引起的直接人畜共患疾病。大量的动物是带菌者或病媒。人类感染是由于意外接触带菌者动物或受钩端螺旋体污染的环境。钩端螺旋体的主要来源是排泄动物，钩端螺旋体从其肾小管随动物尿液排泄到环境中。大多数钩端螺旋体感染是亚临床或导致非常轻微的疾病，并恢复没有任何并发症。然而，由于涉及多个器官系统，一小部分患者会出现各种并发症。在这些患者中，临床表现取决于所涉及的主要器官，病死率可能约为40%或更高。发热性疾病伴有黄疸、脾肿大和肾炎（称为韦氏病），急性发热性疾病伴有严重肌肉疼痛，发热性疾病伴有咯血形式的肺出血，黄疸伴肺出血，黄疸伴血尿，脑膜炎伴出血（包括结膜下出血）或发热性疾病伴心律失常（伴或不伴出血）是其中一些综合征。由于钩端螺旋体病的临床表现多变，常被误诊和漏报。虽然减少污染源、环境卫生、更卫生的工作和个人习惯等基本预防原则，由于所有地方的流行病都是一样的，因此没有适用于所有流行病环境的通用控制方法。全面了解面临钩端螺旋体病问题的社区的生态-流行病学和文化特征是制定有效和可接受的控制措施的基本先决条件。
Leptospirosis has been recognized as an emerging global public health problem because of its increasing incidence in both developing and developed countries. A number of leptospirosis outbreaks have occurred in the past few years in various places such as Nicaragua, Brazil and India. Some of these resulted due to natural calamities such as cyclone and floods. It is a direct zoonotic disease caused by spirochetes belonging to different pathogenic species of the genus Leptospira. Large number of animals acts as carriers or vectors. Human infection results from accidental contact with carrier animals or environment contaminated with leptospires. The primary source of leptospires is the excretor animal, from whose renal tubules leptospires are excreted into the environment with the animal urine. Majority of leptospiral infections are either sub clinical or result in very mild illness and recover without any complications. However, a small proportion develops various complications due to involvement of multiple organ systems. In such patients, the clinical presentation depends upon the predominant organs involved and the case fatality ratio could be about 40% or more. Febrile illness with icterus, splenomegaly and nephritis (known as Weil's disease), acute febrile illness with severe muscle pain, febrile illness with pulmonary haemorrhages in the form of haemoptysis, jaundice with pulmonary haemorrhages, jaundice with heamaturea, meningitis with haemorrhages including sub conjunctival haemorrhage or febrile illness with cardiac arrhythmias with or without haemorrhages are some of the syndromes. Because of the protean manifestations of leptospirosis it is often misdiagnosed and under-reported. Although the basic principles of prevention such as source reduction, environmental sanitation, more hygienic work-related and personal practices etc., are same everywhere, there is no universal control method applicable to all epidemiological settings. Comprehensive understanding of the eco- epidemiological and cultural characteristics of a community that faces the problem of leptospirosis is an essential prerequisite for evolving an effective and acceptable control measure.