Magne M C, Ondounda M, Mbethe L G, Mounguengui D, Nzenze J R
Hôpital des armées, médecine, 20404 Libreville, Gabon.
Med Sante Trop. 2013 Jul-Sep;23(3):347-50. doi: 10.1684/mst.2013.0228.
Leptospirosis is an endemic disease in tropical countries, where it is characterized by clinical polymorphism. We report four cases of leptospirosis diagnosed at the military hospital of Libreville (Gabon).
Four men aged 16 to 31-years-old, were admitted for febrile jaundice, with impaired general condition and pain. All lived in disadvantaged neighborhoods in the capital. In each case, the laboratory workups found hepatic cytolysis, renal failure, hyperleukocytosis, anemia, and an inflammatory state. Serology was negative for hepatitis B and C and for HIV, as was testing for malaria. The failure to respond to presumptive antimalarial treatment suggested leptospirosis, and the diagnosis was confirmed in every case by positive serologies with significant antibody titers. The course was quickly favorable under treatment by an appropriate antibiotic; liver and kidney function returned to normal within a few days.
In tropical zones, the diagnosis of leptospirosis must be considered in all cases of febrile jaundice, especially when liver and kidney function are impaired.
钩端螺旋体病是热带国家的一种地方病，其特点是临床症状多样。我们报告在利伯维尔（加蓬）军事医院诊断出的4例钩端螺旋体病病例。
4名年龄在16至31岁的男性因发热性黄疸入院，全身状况不佳且伴有疼痛。他们均居住在首都的贫困社区。在每例病例中，实验室检查均发现肝细胞溶解、肾衰竭、白细胞增多、贫血和炎症状态。乙肝、丙肝及HIV血清学检测均为阴性，疟疾检测结果也为阴性。对推定的抗疟治疗无反应提示钩端螺旋体病，每例病例均通过抗体滴度显著的阳性血清学检测得以确诊。在使用适当抗生素治疗后病情迅速好转；肝肾功能在数天内恢复正常。
在热带地区，所有发热性黄疸病例，尤其是伴有肝肾功能损害的病例，均须考虑钩端螺旋体病的诊断。
