Cruz Luzia S, Vargas Roberto, Lopes Antonio Alberto
CLINIRIM, Clínica do Rim e Hipertensão Arterial Ltda, Salvador, Bahia, Brazil.
Ethn Dis. 2009 Spring;19(1 Suppl 1):S1-37-41.
Leptospirosis, a spirochetal zoonosis, is a globally re-emerging infectious disease that has disseminated from its habitual rural base to become the cause of urban epidemics in poor communities of industrialized and developing nations. This review addresses the issues in the epidemiology, clinical features, and management of the disease, as well as progress made toward understanding the pathogenesis of leptospiral nephropathy. In developing nations, leptospirosis plays an important role as a potentially preventable cause of acute renal failure. The data indicate that in certain developing regions, such as the city of Salvador, Brazil, leptospirosis is misdiagnosed with other infectious disease such as dengue and the overall disease burden is likely underestimated partly because of the protean and nonspecific presentation. Severe forms of the disease are associated with high case-fatality rate. In urban Brazil, outbreaks of leptospirosis can be predicted by heavy rain and flooding and this may serve to indicate which resources should be allocated to prevent the disease. Advancements in the basic research and epidemiology of leptospirosis should contribute to the development of more accurate diagnostic tests and of an effective vaccine. Policy makers should be urged to address the underlying conditions of poverty as well as environmental issues, which have led to the emergence of leptospirosis.
钩端螺旋体病是一种螺旋体人畜共患病，是一种在全球范围内再度出现的传染病，它已从其传统的农村疫源地传播开来，成为工业化国家和发展中国家贫困社区城市疫情的病因。本综述阐述了该疾病在流行病学、临床特征和管理方面的问题，以及在理解钩端螺旋体肾病发病机制方面取得的进展。在发展中国家，钩端螺旋体病作为急性肾衰竭的一个潜在可预防病因发挥着重要作用。数据表明，在某些发展中地区，如巴西萨尔瓦多市，钩端螺旋体病被误诊为登革热等其他传染病，而且由于其症状多变且不具特异性，总体疾病负担可能被低估。该疾病的严重形式与高病死率相关。在巴西城市，钩端螺旋体病的暴发可通过暴雨和洪水预测，这或许有助于指明应分配哪些资源来预防该病。钩端螺旋体病基础研究和流行病学方面的进展应有助于开发更准确的诊断检测方法和有效的疫苗。应敦促政策制定者解决导致钩端螺旋体病出现的贫困等根本状况以及环境问题。
