Vinetz J M
World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas 77555-0609, USA.
Curr Opin Infect Dis. 2001 Oct;14(5):527-38. doi: 10.1097/00001432-200110000-00005.
Leptospirosis is a globally important zoonotic disease that affects humans on all continents, in both urban and rural contexts, and in temperate and tropical climes. Leptospirosis is a disease of the environment; transmission depends on interactions between humans and mammalian reservoir hosts. A variety of infectious diseases that present as undifferentiated febrile syndromes, such as malaria, dengue and influenza, as well as viral hemorrhagic fevers can mimic leptospirosis. The importance of pulmonary hemorrhage as a lethal complication of leptospirosis has become more widely recognized. In contrast to textbook dogma, population-based studies indicate that there is a poor correlation between infecting leptospiral strain and clinical expression of disease. Genetic transformation of a Leptospira sp. has now been reported, which should allow for detailed analysis of a variety of leptospiral genes. Publication of the whole Leptospira genome is eagerly awaited. Following recent reports of a new, highly effective conjugate typhoid vaccine, new efforts to find leptospirosis vaccines should include the manufacture and testing of conjugate leptospiral lipopolysaccharide vaccines. Recent advances, particularly in epidemiology, molecular genetics and pathogenesis, are placing leptospirosis at the cutting edge of biomedical science.
钩端螺旋体病是一种全球重要的人畜共患病，在各大洲均有影响人类的病例，无论城市还是农村，温带还是热带地区都有发生。钩端螺旋体病是一种环境性疾病；其传播取决于人类与哺乳动物储存宿主之间的相互作用。多种表现为未分化发热综合征的传染病，如疟疾、登革热和流感，以及病毒性出血热都可能与钩端螺旋体病相似。肺出血作为钩端螺旋体病的一种致命并发症，其重要性已得到更广泛的认识。与教科书上的教条相反，基于人群的研究表明，感染的钩端螺旋体菌株与疾病的临床表型之间相关性较差。现已报道了钩端螺旋体属的基因转化，这将有助于对多种钩端螺旋体基因进行详细分析。人们急切期待钩端螺旋体全基因组的公布。继最近报道一种新型高效结合伤寒疫苗之后，寻找钩端螺旋体病疫苗的新努力应包括结合型钩端螺旋体外膜脂多糖疫苗的研发和测试。最近的进展，尤其是在流行病学、分子遗传学和发病机制方面的进展，使钩端螺旋体病处于生物医学科学的前沿。
