Lecour H, Miranda M, Magro C, Rocha A, Gonçalves V
Department of Infectious Diseases, School of Medicine, Hospital S. João, Porto.
Infection. 1989 Jan-Feb;17(1):8-12. doi: 10.1007/BF01643489.
Epidemiological and clinical aspects of 50 consecutive patients, 47 adults and three children, hospitalized between 1977 and 1987 for human leptospirosis, were reviewed. 45 (90%) of the patients were from rural regions. 32 (64%) cases occurred in individuals at occupational risk for the infection. 35 (70%) cases were registered in the warm season. The source of infection was known in 34 (68%) cases. Weil's disease was diagnosed in 31 (62%) patients, aseptic meningitis in 12 (24%) and acute unexplained fever in seven (14%). Haemodialysis was required for 11 (35%) patients with Weil's disease. Three (6%) patients died. Cause of death was massive gastrointestinal haemorrhage in two and renal failure in one. Leptospira icterohaemorrhagiae was responsible for 39 (78%) cases, Leptospira canicola for six (12%), Leptospira grippotyphosa for two (4%), and Leptospira australis, Leptospira ballum and Leptospira sejroe, for one case each. A muscle biopsy was performed in six patients and a renal biopsy in three. Focal necrotic muscular changes, with mild mononuclear infiltrate, were found. Pigmented casts in distal convoluted tubules, mild interstitial inflammatory infiltrate and mesangial enlargement of some glomeruli were observed in kidney biopsies. A good knowledge of the protean clinical manifestations of leptospirosis and an accurate laboratory study are required for a correct diagnosis.
回顾了1977年至1987年间因钩端螺旋体病住院的50例患者（47例成人和3例儿童）的流行病学和临床情况。45例（90%）患者来自农村地区。32例（64%）病例发生在有职业感染风险的个体中。35例（70%）病例在温暖季节登记。34例（68%）病例的感染源已知。31例（62%）患者被诊断为韦尔病，12例（24%）为无菌性脑膜炎，7例（14%）为急性不明原因发热。11例（35%）韦尔病患者需要进行血液透析。3例（6%）患者死亡。死亡原因是2例大量胃肠道出血和1例肾衰竭。出血性黄疸钩端螺旋体导致39例（78%）病例，犬钩端螺旋体导致6例（12%），波摩那钩端螺旋体导致2例（4%），澳洲钩端螺旋体、巴姆钩端螺旋体和赛罗钩端螺旋体各导致1例。对6例患者进行了肌肉活检，3例进行了肾活检。发现局灶性坏死性肌肉改变，伴有轻度单核细胞浸润。在肾活检中观察到远曲小管中的色素管型、轻度间质炎性浸润和一些肾小球系膜增大。正确诊断需要充分了解钩端螺旋体病的多种临床表现并进行准确的实验室检查。
