Summary
Definition
病史和体格检查
关键诊断因素
- high remittent fever
- headache
- myalgia
- conjunctival suffusion
- muscle tenderness
其他诊断因素
- chills or rigors
- abdominal pain
- nausea or vomiting
- diarrhea
- asthenia
- anorexia
- photophobia
- eye pain
- neck stiffness
- cough
- dyspnea
- chest pain
- hemoptysis
- oliguria or polyuria
- cardiac arrhythmias
- lymphadenopathy
- splenomegaly
- hepatomegaly
- jaundice
- adenopathy
- mental status changes
- morbilliform rash
危险因素
- contact (direct or indirect) with urine of infected animals
- residence in or travel to an endemic area
- residence in or travel to an area with recent flooding
- involvement in water sports
- poor living conditions/lack of sanitation
诊断性检查
首要检查
- CBC and differential
- urinalysis
- microscopic agglutination test (MAT)
- enzyme-linked immunosorbent assay (ELISA)
- polymerase chain reaction (PCR)
- darkfield examination
- blood culture
- cerebrospinal fluid (CSF) culture
- ECG
- chest x-ray
- LFTs
- conjugated bilirubin
- metabolic profile
- serum pancreatic enzymes
- CSF analysis
需考虑的检查
- urine culture
- renal biopsy
- lung biopsy
- staining methods
- latex agglutination
- western blot
- quantitative PCR
新兴检查
- lateral flow assays
- cytokines
治疗流程
mild disease
moderate to severe disease
撰稿人
作者
John Fournier, MD
Clinical Fellow
Infectious Disease Section
Yale School of Medicine
New Haven
CT
利益声明
JF declares that he has no competing interests.
Albert I. Ko, MD
Professor of Epidemiology and Medicine
Department Chair
Epidemiology of Microbial Diseases
Yale School of Public Health
New Haven
CT
利益声明
AIK serves as an expert panel member for the Reckitt Global Hygiene Institute and a Board of Directors member for the American Society of Tropical Medicine. He has received grants from Zoetis and has patents which have been awarded and submitted for use in developing diagnostics and vaccines for leptospirosis.
鸣谢
Dr John Fournier and Dr Albert I. Ko would like to gratefully acknowledge Dr Nilmarie Guzman, a previous contributor to this topic.
利益声明
NG declares that she has no competing interests.
同行评议者
Carmen Isache, MD
Assistant Professor of Medicine
Infectious Disease Division
University of Florida College of Medicine
Jacksonville
FL
利益声明
CI declares that she has no competing interests.
Andreas Jansen, MD, DTM
Scientific Officer
Robert Koch Institute
Department for Infectious Disease Epidemiology
Gastrointestinal Infections
Zoonoses and Tropical Infections Unit
Berlin
Germany
利益声明
AJ declares that he has no competing interests.
Sean V. Shadomy, DVM, MPH
Epidemiologist
Bacterial Zoonoses Branch
DFBMD/NCZVED/CCID
Centers for Disease Control and Prevention
Atlanta
GA
利益声明
SVS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Levett P. Leptospirosis. In: Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2006:2495-500.
Vijayachari P, Sugunan AP, Shriram AN. Leptospirosis: an emerging global, public health problem. J Biosci. 2008 Nov;33(4):557-69. 摘要
World Health Organization. Human leptospirosis: guidance for diagnosis, surveillance and control. Geneva: World Health Organization; 2003.全文
Centers for Disease Control and Prevention: National Notifiable Diseases Surveillance System (NNDSS). Leptospirosis (Leptospira interrogans) 2013 case definition. Apr 2021 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Hantavirus cardiopulmonary syndrome
- Dengue fever
- Malaria infection
更多 鉴别诊断指南
- CDC Yellow Book: health information for international travel - leptospirosis
- Fever in returned travellers presenting in the United Kingdom: recommendations for investigation and initial management
更多 指南
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