Mišić-Majerus Ljiljana, Habuš Josipa, Štritof Zrinka, Bujić Nevenka, Mađarić Vesna, Kolaric-Sviben Gordana, Vince Silvijo, Peršić Zdenka, Turk Nenad
Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia.
National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia.
Trop Med Int Health. 2017 Nov;22(11):1405-1413. doi: 10.1111/tmi.12967. Epub 2017 Sep 22.
To present the features of human leptospirosis over three time periods (1970-1975; 2000-2005; 2010-2015), to compare the collected data and to determine whether the incidence, seasonal and spatial distribution, prevalence of presumptive infective serogroups and clinical features have changed over the last 50 years.
Epidemiological and clinical data obtained from patients hospitalised and treated in a well-known endemic focus of leptospirosis, Koprivnica-Križevci County in Croatia, were analysed.
We observed a steady decline in the overall incidence of leptospirosis and a change in the patient age distribution, with the age ratio changing in favour of middle-aged and older patients. Although leptospirosis was most frequently diagnosed in August in all time periods, the number of cases increased in autumn. The most prevalent serogroup during the first and the second time period was Icterohaemorrhagiae, while in the third time period, the serogroup Australis prevailed. We also noted an increase in the number of severe clinical manifestations.
This retrospective research demonstrates a continuous decline in the incidence of human leptospirosis in Croatia. The pattern of disease has changed from predominantly mild clinical forms observed in children to more severe clinical forms observed in middle-aged to older patients, especially those working in agriculture. Additional epidemiological changes included an increase in the number of cases during the autumn months and changes in prevailing serogroups. Statistical analysis revealed a significant relationship between the severity of the clinical picture, patient age and presumed sources of infection.
呈现三个时间段（1970 - 1975年；2000 - 2005年；2010 - 2015年）人类钩端螺旋体病的特征，比较收集到的数据，并确定在过去50年中发病率、季节性和空间分布、假定感染血清群的流行情况以及临床特征是否发生了变化。
分析了从克罗地亚科普里夫尼察 - 克里热夫齐县一家著名钩端螺旋体病流行区住院治疗的患者那里获得的流行病学和临床数据。
我们观察到钩端螺旋体病的总体发病率稳步下降，患者年龄分布发生变化，年龄比向中年和老年患者倾斜。尽管在所有时间段中钩端螺旋体病最常于8月确诊，但秋季病例数增加。在第一个和第二个时间段中最流行的血清群是出血性黄疸型，而在第三个时间段中，澳洲型血清群占主导地位。我们还注意到严重临床表现的数量有所增加。
这项回顾性研究表明克罗地亚人类钩端螺旋体病的发病率持续下降。疾病模式已从儿童中观察到的主要为轻度临床形式转变为中年至老年患者中观察到的更严重临床形式，尤其是从事农业工作的患者。其他流行病学变化包括秋季月份病例数增加以及流行血清群的变化。统计分析显示临床症状的严重程度、患者年龄和假定感染源之间存在显著关系。
