Christova Iva, Tasseva Evgenia, Manev Hristo
National Reference Laboratory for Leptospirosis, Department of Microbiology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria.
Scand J Infect Dis. 2003;35(11-12):869-72. doi: 10.1080/00365540310016709.
A total of 455 confirmed and reported to the Bulgarian Ministry of Health leptospirosis cases between 1989 and 2001 were analysed. Overall incidence of the disease was 0.42/100.000 population (range 0.20-0.64/100.000). The overall fatality rate was 6.6%. Infection was acquired through occupational (30.3%), recreational (45.1%), and accidental (4.6%) exposure or was home contracted (5.1%). A tendency towards the main mode of transmission moving from occupational to recreational exposure was noted. Fishing and livestock farming together accounted for more than half of all leptospirosis cases. Leptospirosis was contracted more frequently through indirect contact with animal excreta and less commonly through direct contact with animal urine or tissue. Serovars belonging to 10 different serogroups caused infection during the 13-year study period. Two serogroups, Icterohaemorrhagiae and Pomona, accounted for more than 87% of all leptospirosis cases. The third main cause was serogroup Australis. The significant change in the infecting serovars has to be related to widely performed vaccinations of cattle and pigs but still inefficient measures for rodent control. The most frequently reported symptoms were fever, myalgia, jaundice, and hepatomegaly. Anicteric cases (40.3%) had milder flu-like course. Acute renal failure was reported in 52 (33.8%) of the patients, all of them with icteric leptospirosis. Knowledge of epidemiological, clinical, and serological features of leptospirosis in Bulgaria during the 13-year study period is an appropriate base to outline measures for successful prevention and early diagnosis of the disease.
对1989年至2001年间保加利亚卫生部确诊并报告的455例钩端螺旋体病病例进行了分析。该病的总体发病率为0.42/10万人口（范围为0.20 - 0.64/10万）。总体病死率为6.6%。感染是通过职业暴露（30.3%）、娱乐活动暴露（45.1%）、意外暴露（4.6%）或家庭感染（5.1%）获得的。注意到主要传播方式有从职业暴露转向娱乐活动暴露的趋势。捕鱼和畜牧养殖加起来占所有钩端螺旋体病病例的一半以上。钩端螺旋体病更常通过间接接触动物排泄物感染，较少通过直接接触动物尿液或组织感染。在13年的研究期间，属于10个不同血清群的血清型引起了感染。两个血清群，出血性黄疸型和波摩那型，占所有钩端螺旋体病病例的87%以上。第三个主要病因是澳洲型血清群。感染血清型的显著变化与广泛开展的牛和猪疫苗接种有关，但鼠类控制措施仍然低效。最常报告的症状是发热、肌痛、黄疸和肝肿大。无黄疸型病例（40.3%）病程类似流感，症状较轻。52例（33.8%）患者报告有急性肾衰竭，所有这些患者均为黄疸型钩端螺旋体病。了解13年研究期间保加利亚钩端螺旋体病的流行病学、临床和血清学特征，是制定成功预防和早期诊断该病措施的合适基础。
