小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 弛张性高热
- 头痛
- 肌痛
- 结膜充血
- 肌肉压痛
其他诊断因素
- 寒战或寒颤
- 腹痛
- 恶心或呕吐
- 腹泻
- 乏力
- 厌食
- 畏光
- 眼痛
- 颈项强直
- 咳嗽
- 呼吸困难
- 胸痛
- 咯血
- 少尿或多尿
- 心律失常
- 淋巴结肿大
- 脾肿大
- 肝肿大
- 黄疸
- 淋巴结肿大
- 精神状态改变
- 麻疹样皮疹
危险因素
- 接触（直接或间接）受感染动物的尿液
- 在疫区居住或到疫区旅行
- 在近期发生水灾的地区居住或到近期发生水灾的地区旅行
- 参加水上运动
- 生活条件差/卫生设施缺乏
诊断性检查
首要检查
- 全血细胞计数 (FBC) 和分类计数
- 尿液分析
- 显微镜凝集试验 (MAT)
- 酶联免疫吸附试验 (ELISA)
- 聚合酶链反应 (PCR)
- 暗视野检查
- 血培养
- 脑脊液 (CSF) 培养
- 心电图 (ECG)
- 胸部 X 线检查
- 肝功能检查 (LFT)
- 结合胆红素
- 代谢指标
- 血清胰酶
- 脑脊液 (CSF) 分析
需考虑的检查
- 尿液培养
- 肾脏活检
- 肺活组织检查
- 染色方法
- 乳胶凝集试验
- 蛋白质印迹法
- 定量 PCR
新兴检查
- 侧流测定
- 细胞因子
治疗流程
轻度疾病
中重度病情者
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.
鉴别诊断
- 汉坦病毒心肺综合征
- 登革热
- 疟疾感染
更多 鉴别诊断指南
- CDC 黄皮书：国际旅行健康信息——钩端螺旋体病
- 英国国家钩端螺旋体病服务
更多 指南
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