Leptospiroz Epidemiyolojisi, Tanı ve Tedavisi
Özet
Leptospiroz, Leptospira cinsinin patojenik spiroketlerinin neden olduğu, dünyada en sık görülen zoonotik hastalıklardan biridir. Genelde kemirgenler, çiftlik hayvanları ve köpekler, hastalığın yayılmasında önemli vektörlerdir. İnfekte hayvan idrarıyla kontamine olan sularla bütünlüğü bozulmuş derinin veya muköz membranların temas etmesi, leptospira içeren partiküllerin inhalasyonu başlıca bulaşma yollarıdır. Ilıman ve tropik bölgelerde endemiktir. Klinik olarak genelde asemptomatik veya hafif seyreder ancak bazen yaygın organ tutulumuyla seyredebilir. Tanı sıklıkla serolojiyle konulur, referans tanı testi mikroskobik aglütinasyon testidir (MAT). Tedavide hafif hastalıkta oral doksisiklin, ağır hastalıkta intravenöz penisilin, ampisilin, seftriakson önerilen tedavilerdir. Korunmada en önemli yol, infekte hayvan veya bu hayvanların idrarıyla kontamine ortamlarla temastan kaçınmaktır.
Leptospirosis is one of the most common zoonotic diseases in the world, caused by pathogenic spirochetes of the genus Leptospira. In general, rodents, livestock, and dogs are important vectors for the spread of the disease. Contact of damaged skin or mucous membranes with water contaminated with infected animal urine and inhalation of particles containing leptospira are the main means of transmission. It is endemic to temperate and tropical regions. Clinically, it is generally asymptomatic or mild, but sometimes it may progress with widespread organ involvement. Diagnosis is often made by serology, with the reference diagnostic test being the microscopic agglutination test (MAT).
Referanslar
Adler B, de la Peña Moctezuma A. Leptospira and leptospirosis. Vet Microbiol. 2010; 140(3-4): 287-96.
Versalovic J. Manual of clinical microbiology: American Society for Microbiology Press; 2011.
Bulach DM, Kalambaheti T, de la Peña-Moctezuma A, Adler B. Lipopolysaccharide biosynthesis in Leptospira. J J Mol Microbiol Biotechnol. 2000; 2(4): 375-80.
Levett PN. Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. Clin Infect Dis. 2003; 36(4) :447-52.
Morey RE, Galloway RL, Bragg SL, Steigerwalt AG, Mayer LW, Levett PN. Species-specific identification of Leptospiraceae by 16S rRNA gene sequencing. J Clin Microbiol. 2006; 44(10): 3510-6.
Trevejo RT, Rigau-Pérez JG, Ashford DA, et al. Epidemic leptospirosis associated with pulmonary hemorrhage—Nicaragua, 1995. J Infect Dis. 1998; 178(5): 1457-63.
Torgerson PR, Hagan JE, Costa F, et al. Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years. PLoS Negl Trop Dis. 2015; 9(10): e0004122.
Sasaki DM, Pang L, Minette HP, et al. Active surveillance and risk factors for leptospirosis in Hawaii. Am J Trop Med Hyg. 1993; 48(1): 35-43.
Ko AI, Reis MG, Dourado CMR, Johnson WD, Riley LW. Urban epidemic of severe leptospirosis in Brazil. Lancet.1999; 354(9181): 820-5.
Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis. 2015;9(9):e0003898.
Grambusch D, Hoedebecke KL. Unforeseen risk: leptospirosis and the us. Special operations community. J Spec Oper Med. 2012; 12(3): 36-42.
Nardone A, Capek I, Baranton G, Campèse C, Postic D, Vaillant V, et al. Risk factors for leptospirosis in metropolitan France: results of a national case-control study, 1999–2000. Clin Infect Dis. 2004; 39(5): 751-3.
Sugunan A, Natarajaseenivasan K, Vijayachari P, Sehgal S. Percutaneous exposure resulting in laboratory-acquired leptospirosis–a case report. J Med Microbiol. 2004; 53(12): 1259-62.
Wasinski B, Dutkiewicz J. Leptospirosis-current risk factors connected with human activity and the environment. Ann Agric Environ Med. 2013; 20(2): 239-44.
Sugunan A, Vijayachari P, Sharma S, Roy S, Manickam P, Natarajaseenivasan K, et al. Risk factors associated with leptospirosis during an outbreak in Middle Andaman, India. Indian J Med Res; 130(1) :67-73.
Lupi O, Netto MAC, Avelar K, Romero C, Bruniera R, Brasil P. Cluster of leptospirosis cases among military personnel in Rio de Janeiro, Brazil. Int J Infect Dis. 2013; 17(2): e129-e31.
Jesus MSd, Silva LA, Lima KMdS, Fernandes OCC. Cases distribution of leptospirosis in City of Manaus, State of Amazonas, Brazil, 2000-2010. Rev Soc Bras Med Trop. 2012; 45: 713-6.
Khalil H, Santana R, de Oliveira D, Palma F, Lustosa R, Eyre MT, et al. Poverty, sanitation, and Leptospira transmission pathways in residents from four Brazilian slums. PLoS Negl Trop Dis. 2021; 15(3): e0009256.
Morgan J, Bornstein SL, Karpati AM, et al. Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998. Clin Infect Dis. 2002; 34(12): 1593-1599.
Agampodi SB, Matthias MA, Moreno AC, Vinetz JM. Utility of quantitative polymerase chain reaction in leptospirosis diagnosis: association of level of leptospiremia and clinical manifestations in Sri Lanka. Clin Infect Dis. 2012; 54(9): 1249-55.
Arean VM. The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). Am J Pathol. 1962; 40(4): 393.
Souza Ld, Koury M. Isolation and biological activities of endotoxin from Leptospira interrogans. Can J Microbiol. 1992; 38(4): 284-9.
Werts C, Tapping RI, Mathison JC, et al. Leptospiral lipopolysaccharide activates cells through a TLR2-dependent mechanism. Nat Immunol. 2001; 2(4): 346-52.
Nahori M-A, Fournié-Amazouz E, Que-Gewirth NS, et al. Differential TLR recognition of leptospiral lipid A and lipopolysaccharide in murine and human cells. J Immunol. 2005; 175(9): 6022-31.
Que-Gewirth NL, Ribeiro AA, Kalb SR, et al. A methylated phosphate group and four amide-linked acyl chains in Leptospira interrogans lipid A: the membrane anchor of an unusual lipopolysaccharide that activates TLR2. J Biol Chem. 2004; 279(24): 25420-9.
Chassin C, Picardeau M, Goujon J-M, et al. TLR4-and TLR2-mediated B cell responses control the clearance of the bacterial pathogen, Leptospira interrogans. J Immunol. 2009; 183(4): 2669-77.
Chu KM, Rathinam R, Namperumalsamy P, Dean D. Identification of Leptospira species in the pathogenesis of uveitis and determination of clinical ocular characteristics in south India. J Infect Dis. 1998; 177(5): 1314-21.
Haake DA. Spirochaetal lipoproteins and pathogenesis. Microbiology (Reading). 2000; 146(7): 1491-504.
Pavli A, Maltezou HC. Travel‐acquired leptospirosis. J Travel Med. 2008; 15(6): 447-53.
Edwards GA, Domm BM. Human leptospirosis. Medicine (Baltimore). 1960; 39: 117-156.
Feigin RD, Anderson DC, Heath CW. Human leptospirosis CRC Crit Rev Clin Lab Sci. 1975; 5(4): 413-67.
Turner LH. Leptospirosis. I. Trans R Soc Trop Med Hyg. 1967; 61(6): 842-55.
Silva HR, Tanajura GM, Tavares-Neto J, Maria de Lourdes CG, et al. Aseptic meningitis syndrome due to enterovirus and Leptospira sp in children of Salvador, Bahia. Rev Soc Bras Med Trop. 2002; 35(2) :159-165.
Stimson AM. Note on an organism found in yellow-fever tissue. Public Health Rep. 1907; 22: 541.
Vale TC, de Toledo Santos GC, Saturnino SF, Neto ASA, Amâncio FF, Oliveira MAA, et al. Weil syndrome: a rare cause of cerebral venous thrombosis. JAMA Neurol. 2014; 71(2): 238-9.
Koshy J, Koshy J, John M, Loomba V, Deodhar D. Leptospiral Uveitis. J Assoc Physicians India. 2014; 62(11): 65-7.
Adler B, de la Peña Moctezuma A. Leptospira and leptospirosis. Vet Microbiol. 2010; 140(3-4): 287-96.
Edwards CN, Nicholson GD, Hassell TA, Everard C, Callender J. Leptospirosis in Barbados. A clinical study. West Indian Med J. 1990; 39(1): 27-34.
Esen S, Sunbul M, Leblebicioglu H, Eroglu C, Turan D. Impact of clinical and laboratory findings on prognosis in leptospirosis. Swiss Med Wkly. 2004; 134(23-24): 347-52.
Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev. 1998; 11(3): 480-496.
Abdulkader RC, Seguro AC, Malheiro PS, Burdmann EA, Marcondes M. Peculiar electrolytic and hormonal abnormalities in acute renal failure due to leptospirosis. Am J Trop Med Hyg. 1996; 54(1): 1-6.
Edwards CN, Nicholson GD, Hassell TA, Everard CO, Callender J. Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation. Am J Trop Med Hyg. 1986; 35(2): 352-4.
Lai KN, Aarons I, Woodroffe AJ, Clarkson AR. Renal lesions in leptospirosis. Aust N Z J Med. 1982; 12(4): 276-9.
Zaki SR, Shieh WJ. Leptospirosis associated with outbreak of acute febrile illness and pulmonary haemorrhage, Nicaragua, 1995. The Epidemic Working Group at Ministry of Health in Nicaragua. Lancet. 1996; 347(9000): 535-6.
Yersin C, Bovet P, Mérien F, et al. Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles. Trans R Soc Trop Med Hyg. 2000; 94(1): 71-6.
Im JG, Yeon KM, Han MC, et al. Leptospirosis of the lung: radiographic findings in 58 patients. AJR Am J Roentgenol. 1989; 152(5): 955-9.
Carvalho CRR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med. 2002; 23(2): 469-78.
Parsons M. Electrocardiographic changes in leptospirosis. Br Med J. 1965; 2(5455): 201.
Sacramento E, Lopes AA, Costa E, Passos OL, Costa YA, Matos ED. Electrocardiographic alterations in patients hospitalized with leptospirosis in the Brazilian city of Salvador. Arq Bras Cardiol. 2002; 78(3): -70.
Vijayachari P, Sugunan AP, Umapathi T, Sehgal SC. Evaluation of darkground microscopy as a rapid diagnostic procedure in leptospirosis. Indian J Med Res. 2001;114:54-8.
Brown PD, Gravekamp C, Carrington DG, van de Kemp H, Hartskeerl RA, Edwards CN, et al. Evaluation of the polymerase chain reaction for early diagnosis of leptospirosis. J Med Microbiol. 1995; 43(2): 110-4.
Merien F, Baranton G, Perolat P. Comparison of polymerase chain reaction with microagglutination test and culture for diagnosis of leptospirosis. J Infect Dis. 1995; 172(1): 281-5.
Slack A, Symonds M, Dohnt M, Harris C, Brookes D, Smythe L. Evaluation of a modified Taqman assay detecting pathogenic Leptospira spp. against culture and Leptospira-specific IgM enzyme-linked immunosorbent assay in a clinical environment. Diagn Microbiol Infect Dis. 2007; 57(4): 361-6.
Ahmed A, Grobusch M, Klatser P, Hartskeerl R. Molecular approaches in the detection and characterization of Leptospira. J Bacteriol Parasitol. 2012; 3(2): 1-12.
Esteves LM, Bulhões SM, Branco CC, et al. Diagnosis of human leptospirosis in a clinical setting: real-time PCR high resolution melting analysis for detection of Leptospira at the onset of disease. Sci Rep. 2018; 8(1): 9213.
Yang B, de Vries SG, Ahmed A, et al. Nucleic acid and antigen detection tests for leptospirosis. Cochrane Database Syst Rev. 2019; 8(8): Cd011871.
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Versalovic J. Manual of clinical microbiology: American Society for Microbiology Press; 2011.
Bulach DM, Kalambaheti T, de la Peña-Moctezuma A, Adler B. Lipopolysaccharide biosynthesis in Leptospira. J J Mol Microbiol Biotechnol. 2000; 2(4): 375-80.
Levett PN. Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. Clin Infect Dis. 2003; 36(4) :447-52.
Morey RE, Galloway RL, Bragg SL, Steigerwalt AG, Mayer LW, Levett PN. Species-specific identification of Leptospiraceae by 16S rRNA gene sequencing. J Clin Microbiol. 2006; 44(10): 3510-6.
Trevejo RT, Rigau-Pérez JG, Ashford DA, et al. Epidemic leptospirosis associated with pulmonary hemorrhage—Nicaragua, 1995. J Infect Dis. 1998; 178(5): 1457-63.
Torgerson PR, Hagan JE, Costa F, et al. Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years. PLoS Negl Trop Dis. 2015; 9(10): e0004122.
Sasaki DM, Pang L, Minette HP, et al. Active surveillance and risk factors for leptospirosis in Hawaii. Am J Trop Med Hyg. 1993; 48(1): 35-43.
Ko AI, Reis MG, Dourado CMR, Johnson WD, Riley LW. Urban epidemic of severe leptospirosis in Brazil. Lancet.1999; 354(9181): 820-5.
Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis. 2015;9(9):e0003898.
Grambusch D, Hoedebecke KL. Unforeseen risk: leptospirosis and the us. Special operations community. J Spec Oper Med. 2012; 12(3): 36-42.
Nardone A, Capek I, Baranton G, Campèse C, Postic D, Vaillant V, et al. Risk factors for leptospirosis in metropolitan France: results of a national case-control study, 1999–2000. Clin Infect Dis. 2004; 39(5): 751-3.
Sugunan A, Natarajaseenivasan K, Vijayachari P, Sehgal S. Percutaneous exposure resulting in laboratory-acquired leptospirosis–a case report. J Med Microbiol. 2004; 53(12): 1259-62.
Wasinski B, Dutkiewicz J. Leptospirosis-current risk factors connected with human activity and the environment. Ann Agric Environ Med. 2013; 20(2): 239-44.
Sugunan A, Vijayachari P, Sharma S, Roy S, Manickam P, Natarajaseenivasan K, et al. Risk factors associated with leptospirosis during an outbreak in Middle Andaman, India. Indian J Med Res; 130(1) :67-73.
Lupi O, Netto MAC, Avelar K, Romero C, Bruniera R, Brasil P. Cluster of leptospirosis cases among military personnel in Rio de Janeiro, Brazil. Int J Infect Dis. 2013; 17(2): e129-e31.
Jesus MSd, Silva LA, Lima KMdS, Fernandes OCC. Cases distribution of leptospirosis in City of Manaus, State of Amazonas, Brazil, 2000-2010. Rev Soc Bras Med Trop. 2012; 45: 713-6.
Khalil H, Santana R, de Oliveira D, Palma F, Lustosa R, Eyre MT, et al. Poverty, sanitation, and Leptospira transmission pathways in residents from four Brazilian slums. PLoS Negl Trop Dis. 2021; 15(3): e0009256.
Morgan J, Bornstein SL, Karpati AM, et al. Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998. Clin Infect Dis. 2002; 34(12): 1593-1599.
Agampodi SB, Matthias MA, Moreno AC, Vinetz JM. Utility of quantitative polymerase chain reaction in leptospirosis diagnosis: association of level of leptospiremia and clinical manifestations in Sri Lanka. Clin Infect Dis. 2012; 54(9): 1249-55.
Arean VM. The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). Am J Pathol. 1962; 40(4): 393.
Souza Ld, Koury M. Isolation and biological activities of endotoxin from Leptospira interrogans. Can J Microbiol. 1992; 38(4): 284-9.
Werts C, Tapping RI, Mathison JC, et al. Leptospiral lipopolysaccharide activates cells through a TLR2-dependent mechanism. Nat Immunol. 2001; 2(4): 346-52.
Nahori M-A, Fournié-Amazouz E, Que-Gewirth NS, et al. Differential TLR recognition of leptospiral lipid A and lipopolysaccharide in murine and human cells. J Immunol. 2005; 175(9): 6022-31.
Que-Gewirth NL, Ribeiro AA, Kalb SR, et al. A methylated phosphate group and four amide-linked acyl chains in Leptospira interrogans lipid A: the membrane anchor of an unusual lipopolysaccharide that activates TLR2. J Biol Chem. 2004; 279(24): 25420-9.
Chassin C, Picardeau M, Goujon J-M, et al. TLR4-and TLR2-mediated B cell responses control the clearance of the bacterial pathogen, Leptospira interrogans. J Immunol. 2009; 183(4): 2669-77.
Chu KM, Rathinam R, Namperumalsamy P, Dean D. Identification of Leptospira species in the pathogenesis of uveitis and determination of clinical ocular characteristics in south India. J Infect Dis. 1998; 177(5): 1314-21.
Haake DA. Spirochaetal lipoproteins and pathogenesis. Microbiology (Reading). 2000; 146(7): 1491-504.
Pavli A, Maltezou HC. Travel‐acquired leptospirosis. J Travel Med. 2008; 15(6): 447-53.
Edwards GA, Domm BM. Human leptospirosis. Medicine (Baltimore). 1960; 39: 117-156.
Feigin RD, Anderson DC, Heath CW. Human leptospirosis CRC Crit Rev Clin Lab Sci. 1975; 5(4): 413-67.
Turner LH. Leptospirosis. I. Trans R Soc Trop Med Hyg. 1967; 61(6): 842-55.
Silva HR, Tanajura GM, Tavares-Neto J, Maria de Lourdes CG, et al. Aseptic meningitis syndrome due to enterovirus and Leptospira sp in children of Salvador, Bahia. Rev Soc Bras Med Trop. 2002; 35(2) :159-165.
Stimson AM. Note on an organism found in yellow-fever tissue. Public Health Rep. 1907; 22: 541.
Vale TC, de Toledo Santos GC, Saturnino SF, Neto ASA, Amâncio FF, Oliveira MAA, et al. Weil syndrome: a rare cause of cerebral venous thrombosis. JAMA Neurol. 2014; 71(2): 238-9.
Koshy J, Koshy J, John M, Loomba V, Deodhar D. Leptospiral Uveitis. J Assoc Physicians India. 2014; 62(11): 65-7.
Adler B, de la Peña Moctezuma A. Leptospira and leptospirosis. Vet Microbiol. 2010; 140(3-4): 287-96.
Edwards CN, Nicholson GD, Hassell TA, Everard C, Callender J. Leptospirosis in Barbados. A clinical study. West Indian Med J. 1990; 39(1): 27-34.
Esen S, Sunbul M, Leblebicioglu H, Eroglu C, Turan D. Impact of clinical and laboratory findings on prognosis in leptospirosis. Swiss Med Wkly. 2004; 134(23-24): 347-52.
Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev. 1998; 11(3): 480-496.
Abdulkader RC, Seguro AC, Malheiro PS, Burdmann EA, Marcondes M. Peculiar electrolytic and hormonal abnormalities in acute renal failure due to leptospirosis. Am J Trop Med Hyg. 1996; 54(1): 1-6.
Edwards CN, Nicholson GD, Hassell TA, Everard CO, Callender J. Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation. Am J Trop Med Hyg. 1986; 35(2): 352-4.
Lai KN, Aarons I, Woodroffe AJ, Clarkson AR. Renal lesions in leptospirosis. Aust N Z J Med. 1982; 12(4): 276-9.
Zaki SR, Shieh WJ. Leptospirosis associated with outbreak of acute febrile illness and pulmonary haemorrhage, Nicaragua, 1995. The Epidemic Working Group at Ministry of Health in Nicaragua. Lancet. 1996; 347(9000): 535-6.
Yersin C, Bovet P, Mérien F, et al. Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles. Trans R Soc Trop Med Hyg. 2000; 94(1): 71-6.
Im JG, Yeon KM, Han MC, et al. Leptospirosis of the lung: radiographic findings in 58 patients. AJR Am J Roentgenol. 1989; 152(5): 955-9.
Carvalho CRR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med. 2002; 23(2): 469-78.
Parsons M. Electrocardiographic changes in leptospirosis. Br Med J. 1965; 2(5455): 201.
Sacramento E, Lopes AA, Costa E, Passos OL, Costa YA, Matos ED. Electrocardiographic alterations in patients hospitalized with leptospirosis in the Brazilian city of Salvador. Arq Bras Cardiol. 2002; 78(3): -70.
Vijayachari P, Sugunan AP, Umapathi T, Sehgal SC. Evaluation of darkground microscopy as a rapid diagnostic procedure in leptospirosis. Indian J Med Res. 2001;114:54-8.
Brown PD, Gravekamp C, Carrington DG, van de Kemp H, Hartskeerl RA, Edwards CN, et al. Evaluation of the polymerase chain reaction for early diagnosis of leptospirosis. J Med Microbiol. 1995; 43(2): 110-4.
Merien F, Baranton G, Perolat P. Comparison of polymerase chain reaction with microagglutination test and culture for diagnosis of leptospirosis. J Infect Dis. 1995; 172(1): 281-5.
Slack A, Symonds M, Dohnt M, Harris C, Brookes D, Smythe L. Evaluation of a modified Taqman assay detecting pathogenic Leptospira spp. against culture and Leptospira-specific IgM enzyme-linked immunosorbent assay in a clinical environment. Diagn Microbiol Infect Dis. 2007; 57(4): 361-6.
Ahmed A, Grobusch M, Klatser P, Hartskeerl R. Molecular approaches in the detection and characterization of Leptospira. J Bacteriol Parasitol. 2012; 3(2): 1-12.
Esteves LM, Bulhões SM, Branco CC, et al. Diagnosis of human leptospirosis in a clinical setting: real-time PCR high resolution melting analysis for detection of Leptospira at the onset of disease. Sci Rep. 2018; 8(1): 9213.
Yang B, de Vries SG, Ahmed A, et al. Nucleic acid and antigen detection tests for leptospirosis. Cochrane Database Syst Rev. 2019; 8(8): Cd011871.
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Sayfalar
39-54
Gelecek
29 Nisan 2024
Telif Hakkı (c) 2024 Akademisyen Yayınevi Kitap Portalı
Lisans
LisansNasıl Atıf Yapılır
1.
Keskin Sarıtaş Ç. Leptospiroz Epidemiyolojisi, Tanı ve Tedavisi. Içinde: Dal T, editör. Mikrobiyolojide Güncel Konular V (Bahar) [Internet]. Türkiye: Akademisyen Yayınevi Kitap DOI Portalı; 2024 [a.yer 13 Temmuz 2026]. ss. 39-54. Erişim adresi: https://www.omp35.books.akademisyen.net/index.php/akya/catalog/book/3058/chapter/13579
