General Information:
简述：
-Leptospirosis is a tropical infectious disease that is also endemic in the US. (Estimated 16% seroprevalence in inner city Baltimore!)
钩端螺旋体病是一个热带感染性疾病，在美国也有流行（在巴尔的摩约有16％的血清阳性）
-The spirochete is spread through animal urine and can survive in water or soil for weeks.
钩端螺旋体通过动物尿传播，在水或土壤中可生存几周。
-Risk factors: rural exposure to animal urine (farming, adventure sports) or urban exposure to rat urine.
致病因素：与动物尿有直接接触（农场，冒险性运动）或城市内接触老鼠尿。
-Infection is acquired through breaks in the skin or mucus membranes
通过有裂伤的皮肤或粘膜感染。
-Outbreaks are often seen following rain or floods.
雨后或洪水后会出现暴发流行。

Clinical Presentation:
临床表现：
-Non-specific febrile illness (usually not diagnosed in these cases)
非特异性发热性疾病（在这一阶段常漏诊）
-If untreated, 5-10% progress to jaundice, renal failure, thrombocytopenia, hemorrhage, and respiratory failure.
如不治疗，5－10％的病人会出现黄疸，肾功能衰竭，血小板减少，出血，和呼吸衰竭。

Diagnosis:
诊断：
Primarily based on clinical presentation and history
主要根据病史和临床表现
Paired serum sent to CDC (the acute serum sample should be drawn in the ED)
将血清送到CDC（急性期的血清应在急诊科采取）

Treatment:
治疗：
Doxycycline, Ceftriaxone and Penicillin are all effective
四环素，头孢曲松，和青霉素都有效

Bottom Line:
要点：
Consider and treat for Leptospirosis in patients with possible exposure animal urine (especially after a flood) who present in extremis with renal failure, jaundice, and thrombocytopenia.
对有动物尿接触（尤其在洪水后）出现肾功衰竭，黄疸，和血小板减少的病人要考虑钩端螺旋体病。

University of Maryland Section of Global Emergency Health
Author作者: Andi Tenner, MD, MPH

References参考文献:

Childs JE, Schwartz BS, Ksiazek TG, et al. Risk Factors Associated with Antibodies to Leptospires in Inner-city Residents of Baltimore: A Protective Role for Cats. Am J Public Health. 1992;82:597-599.

Leung J, Schiffer J. Feverish, Jaundiced. Am J Med. 2009;122:129-131.

Center for Disease Control. (2012) Leptospirosis. Retrieved January 1, 2013 from http://www.cdc.gov/leptospirosis/infection/index.html