Leptospirosis (Weil's Disease) Ma hope o ka Hee ʻana i loko o ka wai Kaʻi a i ʻole ka wai maʻemaʻe: nā maka ʻulaʻula me ka ʻole o ka naʻau, ka ʻeha bipi, a me ka jaundice.¶

Ke hoʻololi ka makani ʻino, ka hau, ka waikahe, a i ʻole ka wai hoʻihoʻi wai i nā alanui a me nā hale lalo i wai ʻeleʻele a hiki i ke kuli - a i ʻole i ka wā e hele ai ka mea ʻauʻau, kakaya, triathlete, mahiʻai, a i ʻole ka mea hoʻokūkū huakaʻi ma nā kahawai wai wela, nā awāwa, a i ʻole ka lepo pulu i haumia i ka mimi o ʻiole, ʻiole, pipi, puaʻa i kapa ʻia he ʻīlio ʻīlio, ʻīlio, ʻīlio. Hiki i nā interrogans* ke hoʻopololei ma ka ʻili i hoʻoluliluli ʻia i ka wai, nā ʻili liʻiliʻi, a i ʻole nā ʻili mucous o ka maka, ka ihu, a me ka waha. Inā loaʻa kekahi ** i ke kuni kiʻekiʻe hikiwawe, haʻalulu haʻalulu, ʻeha ʻeha ma mua/retro-orbital headache, ʻeha nui ma nā keiki bipi a me ke kua lalo, a me nā maka ʻulaʻula ʻulaʻula ME KA ʻole o ka nahu (conjunctival suffusion)** ma nā wahi a pau mai 2 to 30 days (typically 5 to 14 days) ma hope o ka hoʻopili ʻana i ka wai kahe a i ʻole ka wai maʻemaʻe - a i ʻole e holomua i ka ** ʻili melemele-alani/maka (jaundice), mimi kala ʻeleʻele a liʻiliʻi paha, ka ihu, a i ʻole ke ʻā ʻana o ke koko (Weil's Disease)** - kelepona i kāu helu ulia pōpilikia ma o kā mākou helu pilikia papa kuhikuhi a i ʻole e hele koke i ke Keʻena Emergency Hospital. E kūkākūkā pū i kā mākou alakaʻi ma Vibrio vulnificus ("ʻai ʻiʻo" maʻi wai kai mahana), ʻO ka Hantavirus Pulmonary Syndrome mai nā ʻōpala ʻiole, ʻeha ʻeha ʻeha, rhabdomyolysis, a me ka hoʻāʻo ʻana i ka mimi ʻeleʻele, a sepsis a me ka ʻike haʻalulu septic.

Wahi a ka World Health Organization (WHO), nā Ke kikowaena no ka hoʻopaʻa ʻana a me ka pale ʻana i ka maʻi (CDC), a me ka Pan American Health Organization (PAHO), ʻo ka leptospirosis ka maʻi maʻi maʻi maʻi maʻi zoonotic nui loa ma ka Honua, e maʻi ma luna o 1.03 million people a me ka hana ana 58,900 deaths i kēlā me kēia makahiki - me nā maʻi ʻino nui ma hope o ka makani ʻino a me ke kai ma hope o ke kai i kākau ʻia ma waena o Puerto Rico, Florida, Hawaii, Texas, United Kingdom, Continental Europe, Brazil, India, Philippines, Iapana, a me ka ʻākau o Australia. No ka mea, ua like ka māhele mua o ka leptospirosis i ka dengue fever, influenza, a i ʻole ka maʻi viral maʻamau, nalo pinepine nā poʻe maʻi i ka puka mua Oral Doxycycline a i ʻole Azithromycin (Days 1 to 5), ʻike ʻia e ola hou ana no 1 a 3 mau lā, a laila hāʻule i ka Phase 2 Icteric Leptospirosis (Weil's Disease) aiʻole Leptospiral Pulmonary Hemorrhage Syndrome (LPHS), kahi e piʻi ai ka make < 1% a hiki i 10% to 50%+ ma muli o ka hui ʻole ** non-oliguric/oliguric acute renal failure**, conjugated hyperbilirubinemia (orange jaundice), thrombocytopenia, a me ke koko alveolar nui. ʻO ka ʻike ʻana i ka ** ʻelua mau hōʻailona hoʻokolohua kino (Conjunctival Suffusion + Severe Calf Squeeze Tenderness)** a me ka hōʻike ʻana i kou ʻike wai wai e wehe koke i ka lāʻau antibiotic curative.

E hana i kēia i kēia manawa¶

1. Inā loaʻa ʻoe i ke kuni kiʻekiʻe koke (>= 38.5 C / 101.3 F), ke anu, ke poʻo nui, a me ka ʻeha ʻiʻo o loko 2 to 30 days o ka au ana i ka wai kahe, ka hoʻomaʻemaʻe ʻana i lalo o ka wai, ka ʻauʻau ʻana i loko o ka loko/ka muliwai, a i ʻole ka lawelawe ʻana i ka mimi mahiʻai/pet: e ʻike i ke kauka a i ʻole e hele i ke Keʻena ʻOihana Hoʻomaʻamaʻa i kēia lā a hōʻike maopopo i kāu ʻike wai/ka wai. Hoʻomaka waha Doxycycline (100 mg twice daily for 7 days) aiʻole Azithromycin (500 mg daily for 3 days) i loko o nā lā 5 mua e hoʻomaʻemaʻe wikiwiki i nā spirochetes mai ke koko a pale i ka piʻi ʻana i ka maʻi Weil e hoʻoweliweli i ke kino.
2. E nana i ke aniani i ka keokeo o kou mau maka (sclera/conjunctiva) a e ʻomi mālie i nā ʻiʻo o kou wāwae wāwae lalo (gastrocnemius:
3. ** Kuhikuhi #1 (Conjunctival Suffusion):** ʻO nā keʻokeʻo o nā maka ʻelua ** ʻulaʻula ʻulaʻula-a-ʻulaʻula me nā kīʻaha koko i hoʻopaʻa ʻia, ME KA ʻole o ka peʻa melemele paʻa, ka ʻāʻī, a i ʻole ka ʻona**? Hiki mai ka conjunctival suffusion a hiki i 55% o na hihia leptospirosis (appearing on Days 3 to 4) a ʻaneʻane ʻaʻole loa ʻike ʻia i ka maʻi maʻi maʻamau, malaria, a i ʻole typhoid.
4. ** Kuhikuhi #2 (Severe Calf & Lumbar Myalgia):** Hoʻopā wale a ʻomi paha i ke kua o kāu mau keiki bipi a i ʻole ke kaomi ʻana i kou kua lalo (erector spinae) ke kumu ** ikaika, wincing tenderness**? ʻO kēia hui ʻana (Fever + Flood/Freshwater Contact + Red Eyes Without Pus + Severe Calf Pain) ʻo ia ka tetrad diagnostic maʻamau o ka maʻi leptospirosis.
5. E kelepona iā 911 / 112 / 999 / 000 a i ʻole e hele koke i ke Keʻena ʻOihana Hoʻomaʻamaʻa inā ʻike ʻia kekahi Phase 2 "Weil's Disease" a i ʻole Hemorrhagic Red Flags (often after a deceptive 1-to-3-day dip in fever around Day 5 to 7:
6. Ka melemele a ʻalani ʻalani paha i nā keʻokeʻo o nā maka a i ʻole ka ʻili (Jaundice),
7. Ua emi ka mimi (not urinating for > 8 hours) a i ʻole ka mimi ʻeleʻele/ʻeleʻele kī,
8. Ake koko (hemoptysis), ʻulaʻula ʻulaʻula ʻula, a i ʻole pōkole o ka hanu (Leptospiral Pulmonary Hemorrhage Syndrome - 50%+ mortality),
9. Kōʻike i nā kiko ʻulaʻula/ʻulaʻula (petechiae), kahe koko, ka ihu, a me ka ʻeleʻele maloʻo, OR
10. ** ʻāʻī ʻoʻoleʻa, photophobia koʻikoʻi (light hurts eyes), huikau, a i ʻole ka puʻuwai maʻamau (aseptic meningitis or myocarditis)**.
11. E haʻi i kēia mau huaʻōlelo pololei i ke Keʻena Hoʻomaʻamaʻa Triage Nurse a me Kauka i nā kekona 30 mua: "I waded in floodwater / freshwater ___ days ago and now have fever, calf pain, and red eyes/jaundice. Please evaluate immediately for Leptospirosis / Weil's Disease, start IV Ceftriaxone (or IV Penicillin G / Doxycycline), and check serum Creatinine, Potassium, Bilirubin, CPK, Platelets, and a Chest X-Ray."
12. ** E ALOHA iā Ibuprofen (Advil/Motrin), Naproxen (Aleve), Aspirin, a me nā mea hōʻeha ʻeha NSAID ʻē aʻe inā loaʻa ʻoe i ke kuni ma hope o ka wai kahe ʻana a i ʻole ka ʻike ʻana i ka wela.thrombocytopenia)** a me ʻeha puʻupaʻa interstitial koʻikoʻi: ʻo ka lawe ʻana i nā NSAID e poloka i nā prostaglandins renal (precipitating complete kidney shutdown) a hoʻopale i ke koena platelets (triggering fatal gastrointestinal or lung hemorrhage). E ho'ohana wale i ka acetaminophen/paracetamol me ka akahele wale no ke ho'oma'ema'e 'ia ka hana o ke akepa'a/jaundice e ke kauka, a i 'ole e ho'ohana i nā lole ho'olu'olu kino a hiki i ka loiloi 'ia.
13. Inā ʻoe e hoʻomaʻemaʻe i kēia manawa ma hope o ka waikahe a i ʻole ka makani pāhili: MAI hele wāwae ʻole a i ʻole nā kāmaʻa kāmaʻa ma ka wai kū a i ʻole ka lepo.wellingtons) a i ʻole nā mea holo umauma a me ** mau mīkina lima paʻa wai ʻole/nitrile**, e uhi i kēlā me kēia ʻoki liʻiliʻi a i ʻole nahu namu me kahi kāʻei hydrocolloid/Tegaderm wai wai, a holoi i ka ʻili me ke kopa a me ka wai maʻemaʻe ma hope koke o ka hoʻopili ʻana.

Ka lāʻau hoʻoholo: Ka hoʻāʻo ʻana i ka maʻi maʻi ma hope o ka wai kahe a me ka wai maʻemaʻe no Leptospirosis¶

E hahai i kēia lāʻau hoʻoholo lapaʻau i ka wā e loiloi ai i kekahi maʻi febrile i loko o 30 mau lā ma hope o ka ʻike ʻia ʻana o ka wai kahe, lepo, ʻōpala, a i ʻole ka wai maʻemaʻe.

flowchart TD
    Exposure["Hōʻike i loko o 2 a 30 mau lā i hala (Median 5 a hiki i 14 mau lā): - Kaʻauʻau ʻana i ka wai ma hope o ka makani pāhili/ka ʻino, ka hoʻihoʻi ʻana i ka lepo, a i ʻole ka lepo pulu - ʻauʻau, kayak, triathlon, a i ʻole rafting i loko o nā loko wai maʻemaʻe, nā muliwai, a i ʻole nā canal - Hoʻopili i ka hana me ka ʻiole, pipi, puaʻa, ʻīlio, a i ʻole ʻīlio."] --> SxCheck{"Aia anei ke kuni, ke anu, ka eha, a me ka eha o ka io?"}

    SxCheck -->|"ʻAʻohe hōʻailona i kēia manawa (Hiki a i ʻole ke hoʻomau ʻia nei ka ʻike ʻana o ka wai Kaʻi."| ProphyBox["DECONTAMINATION & CHEMOPROPHYLAXIS TRIAGE: 1. Holoi ka ʻili me ke kopa a me ka wai maʻemaʻe; e hoʻohāinu i nā ʻoki me ka povidone-iodine 2. E hoʻohana i nā kāmaʻa a me nā mīkina lima wai no ka hoʻomaʻemaʻe ʻana i ka wai."]

    SxCheck -->|"KA LEPTOSPIROSIS ANICTERIC (Nā lā 1 a hiki i ka 7): ʻO ke kuni kiʻekiʻe (> 38.5 C), ʻoʻoleʻa, ka ʻeha nui o ke keiki bipi a me ke kua lalo, ʻeha ke poʻo mua, nausea / luaʻi ʻana, a me ka conjunctival suffusion (nā maka ʻulaʻula ʻulaʻula me ka ʻole o ka nahu)"| OutpatientVsER{"Loaʻa nā Hae ʻulaʻula o Weil's maʻi a i ʻole Organ-Failure?"}

    OutpatientVsER -->|"ʻAʻohe Hae ʻulaʻula (Maʻi haʻahaʻa a haʻahaʻa, Puka Mimi maʻamau, ʻaʻohe Jaundice, hanu maʻamau)"| EarlyAbx["WINDOW CURATIVE ANTIBIOTIC EARLY (Hoʻopaʻa i ka maʻi o Weil): 1. ʻO ka loiloi lāʻau lapaʻau i ka lā hoʻokahi -> Kakau i ke koko/Urine PCR (inā ʻo nā lā 1-7) & IgM ELISA + CBC, Creatinine, LFTs, CPK 2. Hoʻomaka i ka Doxycycline waha (100 mg PO x Oral lā) PO x Oral. i kēlā me kēia lā x 3 lā) a i ʻole Amoxicillin (i ka wā hāpai/keiki liʻiliʻi) 3. Hōʻalo i nā NSAID āpau (Ibuprofen/Naproxen/Aspirin) + E mālama i ka hoʻomaʻemaʻe waha."]

    OutpatientVsER -->|"ʻAe - KA maʻi o WEIL A i ʻole LPHS ʻulaʻula: - Nā Maka Melemele/Alani a i ʻole ʻili (Jaundice) - Puka Mimi Haʻahaʻa (<400 mL/lā) a i ʻole Mimi kī ʻeleʻele - ʻO ke koko (Hemoptysis), pōkole o ka hanu, a i ʻole SpO2 <94% - Petechiae, Nosebleeds, Confusion"| EmergencyICU["KA MA'I O WEIL OLA / PULMONARY HEMORRHAGE EMERGENCY: 1. E kelepona i ka 911 / 112 / 999 -> Komo koke i ka Halemai / ICU 2. STAT Intravenous Ceftriaxone (1 a 2 g IV q24h) A i 'ole IV Penicillin G IV (Doxy 1000) IVs IV (Doxy 1 mg) IV. q12h) 3. E nānā no ka hopena o Jarisch-Herxheimer i loko o 2 a 6 mau hola o ka hoʻopaʻa ʻana o ka lāʻau antibiotic IV mua."]

Māhele 1: Pehea e komo ai ʻo Leptospira i ke kino (And Why You Do Not Need an Open Cut to Get Infected)¶

1. ʻO ka Corkscrew Spirochete a me ka Waihona ʻIole Urban/Rural¶

Leptospira interrogans (with over 250 pathogenic serovars, notably *Icterohaemorrhagiae* carried by brown rats, *Canicola* in dogs, *Pomona* in pigs and cattle, and *Hardjo* in cattle) he ma'i bacteria spirochete aerobic i wili pa'a me na welau hookui e milo ana a puni kona mau filament e like me ka pahu kaa. - Pehea ka wai kahe o nā ʻiole a me nā mea momona: ʻiole i maʻi mau ʻia ** nā ʻiole brown (Rattus norvegicus), nā ʻiole o ka hale, nā ʻiole, nā holoholona, a me nā ʻīlio i hoʻopaʻa ʻole ʻia e hoʻopaʻa mau iā Leptospira i loko o kā lākou renal proximal convoluted tubules me ka ʻike ʻole ʻia o ka maʻi, hoʻoheheʻe ʻia miliona miliona o ka mimi. - **Ke Ola Kaiapu i loko o ka wai a me ka lepo:* ʻOiai e ake koke ana ʻo eptospira* ma ke kahua paʻa maloʻo a i ʻole i ka wai kai paʻakai kiʻekiʻe, **i loko o ka wai mehana, kū ʻole-a-ʻaʻaleʻa liʻiliʻi (pH 6.8 to 7.6, nā mahana wela 20 to 32 degrees Celsius / 68 to 90 degrees Fahrenheit), ka wi waikahe ū, ka lepo pulua me ka lepo ma hope o ka makani pāhili, ola ʻo Leptospira weeks to several months.

2. Nā ʻīpuka ʻehā o ke komo ʻana o ke kanaka (Including Waterlogged "Pruney" Skin)¶

'A'ole e like me ka nui o nā ma'i bacteria e koi ana i ka 'eha hohonu e 'alo ai i ka 'ili, 'o Leptospira's corkscrew motility a me outer-membrane collagenase/hyaluronidase enzymes e hiki ai ke komo i ke koko o ke kanaka ma o 'ehā puka kaawale: 1. ** ʻOki ʻokiʻoki ʻia, ʻokiʻoki, nahu namu, a i ʻole nā ​​lau i hoʻopaʻa ʻia:** ʻOiai he 1-millimeter ʻO ka ʻōpala mai ka mauʻu, ka ʻōpala, a i ʻole nā kāmaʻa e hiki ai i nā kaukani spirochetes pololei i loko o nā capillaries dermal. 2. Water-Macerated ("Waterlogged / Pruney") Intact Skin: I ka wa e hele ai ka mea noho a mea hoopakele paha i ka wai kahe a komo i ka pulu pulu a me na sneakers no ** ma mua o 30 a 60 minuke**, e pehu a palupalu ka papa o waho o ka ili (maceration), e ʻae ana iā Leptospira e hue pololei ma ka ʻili paʻa ʻole i haki ʻia i ka wai. 3. Conjunctiva (Eyes) a me Nasal/Oral Mucous Membranes: Kawili ʻana i ka wai kahe lepo lepo i kou mau maka (while clearing storm drains or pressure-washing a flooded garage - NEVER pressure-wash flood mud without unvented goggles and an N95 mask) a i ʻole ka holoi ʻana i kou maka me nā lima lima pulu e hoʻomaʻamaʻa pololei i ka conjunctiva. 4. Ke ale ʻana i ka wai i hoʻohaumia ʻia: ʻO ke kahe ʻana i ka muliwai a i ʻole ka wai loko i ka wā e ʻauʻau ana, e hoʻohuli ana i kahi kayak, a i ʻole e inu ana i ka wai punawai i hoʻopōʻino ʻia.

Mahele 2: ʻElua mau hōʻailona moe maʻamau a me ka Biphasic Clinical Timeline¶

No ka serology hale hana (Microscopic Agglutination Test / MAT a me IgM ELISA) ʻaʻole huli maikaʻi a hiki i ka La 5 a hiki i ka 10 o ka maʻi, ʻike nā kauka pilikia i ka leptospirosis acute ma ka ʻaoʻao moe ma ka ʻike ʻana i kāna ʻelua mau hōʻailona kino pathognomonic a me kāna biphasic clinical course:

1. ʻElua mau hōʻailona hōʻailona kino (Conjunctival Suffusion + Gastrocnemius Myalgia)¶

+-------------------------------------------------------------------------+
|  HOW TO SPOT LEPTOSPIROSIS AT THE BEDSIDE IN 60 SECONDS                 |
|                                                                         |
|  1. CONJUNCTIVAL SUFFUSION (RED EYES WITHOUT PUS - DAYS 3 TO 4):        |
|     - Pull down the lower eyelid and look at the bulbar and palpebral   |
|       conjunctiva (the covering over the white of the eye).             |
|     - In Leptospirosis, spirochetal vasculitis dilates the pericorneal  |
|       and conjunctival blood vessels, turning the eyes BRIGHT RED OR    |
|       PINK-ORANGE (often with subconjunctival hemorrhages) - character-   |
|       istically WITHOUT purulent yellow discharge, sticky eyelids, or   |
|       itching (unlike viral or bacterial pinkeye).                      |
|                                                                         |
|  2. EXCRUCIATING CALF & LUMBAR TENDERNESS (RHABDOMYOLYTIC MYOSITIS):    |
|     - Leptospira directly invades skeletal muscle fibers, causing       |
|       focal myofibrillar necrosis and elevated Creatine Kinase (CPK).   |
|     - Gently squeezing the patient's CALF MUSCLES (gastrocnemius),      |
|       thighs, or lower back muscles elicits disproportionate pain       |
|       (patients often say walking feels like their calves were beaten   |
|       with a baseball bat), and abdominal wall myalgia can mimic an     |
|       acute surgical abdomen.                                           |
+-------------------------------------------------------------------------+

2. Ka Manawa Biphasic Classic (Phase 1 Septicemic vs. Phase 2 Immune / Weil's Disease)¶

• Wā Hoʻomoe: 5 to 14 days ma hope o ka pili ʻana i ka wai/lepo (full range: 2 to 30 days).
• ** Māhele 1: ʻO ka maʻi Leptospiremic (Septicemic) Māhele (Lasts 4 to 7 Days:**
• Kaʻapuni nā spirochetes Leptospira ma loko o ka ** koko a me ka wai cerebrospinal (CSF)**.
• ʻO ka hoʻomaka koke ʻana o ke kuni kiʻekiʻe (39 to 40 C / 102 to 104 F), ʻoʻoleʻa, ʻehaʻeha retro-orbital/frontal headache, photophobia, ke keiki bipi koʻikoʻi a me ka myalgia hope lalo, conjunctival suffusion, nausea, luaʻi ʻana, diarrhea, a i kekahi manawa he maʻi macular/petechial rash ma ka ʻāʻī ("pretibial fever").
• Noho Nānā: I loko o La 1 a i 7, ** ʻO ke koko a me ka CSF Real-Time PCR** he POSITIVE, ʻoiai nā hoʻāʻo antibody (IgM) hiki ʻole paha ke ʻino.
• ** ʻO ka hoʻopunipuni 1-a-3-lā Interphase Lull (Around Day 5 to 8:**
• Ua hāʻule ke kuni i ka maʻamau a ʻoi aku ka maikaʻi o ka mea maʻi i ka wā e hoʻomaʻemaʻe ana nā antibodies i nā spirochetes mai ke koko (though spirochetes now hide in the kidney tubules and begin shedding in the urine). 85% to 90% 'o nā ma'i "anicteric" ma'alahi e ola mau ma hope o ka ho'i hou 'ana o ka ma'i po'o.
• Phase 2: The Immune Phase & Icteric Weil's Disease (Starts Day 6 to 10 and Lasts Weeks:
• In 10% to 15% o nā maʻi (ʻoi aku ka poʻe i loaʻa i ka maʻi serovar Icterohaemorrhagiae a i ʻole ka poʻe i loaʻa ʻole i nā lāʻau antibiotic mua), Puka ka Phase 2 e like me Weil's Disease (the classic triad of **Orange Jaundice + Acute Kidney Injury + Hemorrhage**) a/a i ʻole ** Leptospiral Pulmonary Hemorrhage Syndrome (LPHS)**:
  1. Ka "Jaundice ʻAlani" o ka maʻi o Weil (Cholestatic Hepatic Dysfunction Without Massive Liver Necrosis:
  2. Huli ka maka a me ka ʻili o ka mea maʻi i kahi ** melemele-ʻalani hohonu (rubinic icterus)** e like me ka serum conjugated bilirubin piʻi i 15 to 40+ mg/dL (because bright red conjunctival suffusion + yellow scleral icterus = orange eyes), akā naʻe nā transaminases (AST and ALT) ua hoʻokiʻekiʻe haʻahaʻa wale ʻia (typically 100 to 250 U/L, kakaikahi > 500 U/L), ka mea e hoʻokaʻawale koke ai i ka maʻi o Weil mai ka maʻi hepatitis A/B/E (where AST/ALT exceed 1,000 to 3,000 U/L).
  3. Unique Hypokalemic Non-Oliguric -> Oliguric Acute Kidney Injury (AKI:
  4. ʻO Leptospira nā polokina o waho-membrane e pāpā pololei i ka Na+-K+-2Cl- (NKCC2) cotransporter i loko o ka lālā mānoanoa piʻi o Henle a hōʻino i ka tubule kokoke.
  5. ʻO ka hopena, ʻaʻole ʻokoʻa ka maʻi leptospiral kidney ma mua ** non-oliguric a me ka pauka pālolo (causing normal or LOW blood potassium / hypokalemia ʻoiai ke piʻi aʻe nei ka creatinine)** - ma mua o ka piʻi wikiwiki ʻana i oliguric/anuric acute tubular necrosis (ATN) me ka hyperkalemia weliweli i ke ola, ka uremia, a me ka edema pulmonary e koi ana i ka ** hemodialysis wikiwiki**.
  6. ** Leptospiral Pulmonary Hemorrhage Syndrome (LPHS - Ke kumu #1 o ka make wikiwiki):**
  7. Wehe ʻia ka ʻeha o ke kino i hoʻopaʻa ʻia e ka pale ʻana i nā ʻiʻo alveolar capillary basement membrane ma waena o nā māmā ʻelua, e hōʻeha ana i ** diffuse alveolar hemorrhage (DAH)**. Hoʻokumu ka poʻe maʻi i ka dyspnea hikiwawe, tachypnea, hypoxia, bilateral patchy alveolar infiltrates ma ka umauma X-ray, a me hemoptysis (coughing up bright red blood), hiki ke kumu i ka asphyxiation a me ka make i loko o 24 a 48 hola ʻoiai i nā poʻe maʻi ʻaʻole i huli i ka jaundice.

Māhele 3: Papa Papa Hoʻomaʻamaʻa ʻokoʻa Master: Post-Flood & Tropical Fever Mimics¶

Ma hope o ka ʻino ʻino, ka ua, a i ʻole ka waikahe, ʻike nā keʻena pilikia i ka piʻi ʻana o Leptospirosis, Dengue Fever, Malaria, Typhoid, Hantavirus, a me Vibrio Sepsis i ka manawa like. E hoʻohālikelike i kā lākou mau manamana lima lapaʻau a me ka lab:

Mahele 4: Hoʻomaʻamaʻa Halemaʻi, ka ʻōlelo aʻo ʻo Jarisch-Herxheimer, a me ka pale ʻana i ka hoʻomaʻemaʻe ʻana i ka wai.¶

1. Nā Papa Hana Antibiotic Laina Mua (CDC / WHO Guidelines) a me ka wā e kauoha ai i kēlā me kēia hoʻāʻo¶

1. Ka manawa o nā hoʻokolohua diagnostic (Why Blood PCR Works in Week 1 and Urine PCR/IgM Works in Week 2:
2. Nā lā 1 a 7 o ke kuni (Phase 1): Kauoha Whole-Blood (a me CSF) Leptospira Real-Time PCR (positive from Day 1 before antibodies exist) me kahi kumu IgM ELISA / MAT serum sample.
3. La 7 Ma mua (Phase 2 / Weil's Disease): Nalo nā Spirochetes mai ke koko a neʻe i loko o nā puʻupaʻa; kauoha Urine Leptospira PCR me Serum Anti-Leptospira IgM ELISA a me Convalescent Microscopic Agglutination Test (MAT).
4. Koho Antibiotic Curative:
5. Ma'i Leptospirosis Anicteric Ma'i-a-Ma'i:
   • Nā makua (Nā Hāpai ʻole): ** Doxycycline waha 100 mg ʻelua manawa i kēlā me kēia lā no 7 days** (Bonus: Hoʻōla like ʻo Doxycycline i nā maʻi rickettsial co-endemic e like me Scrub Typhus, Murine Typhus, a me nā kuni kikoʻī), OR Azithromycin waha 500 mg hoʻokahi manawa i kēlā me kēia lā no 3 days, OR Amoxicillin waha 500 mg ʻekolu manawa i kēlā me kēia lā no 7 days.
   • Na Wahine Hapai a me na keiki < 8 Years: Azithromycin waha (10 mg/kg Day 1, then 5 mg/kg/day Days 2-3) aiʻole Amoxicillin (50 mg/kg/day divided TID).
6. ** Leptospirosis i hoʻopaʻa ʻia i ka haukapila / Weil's Disease / Pulmonary Hemorrhage:**
   • Ceftriaxone i loko o ke koko (1 to 2 grams IV every 24 hours for 7 days), A i ʻole ka penicillin G (1.5 million units IV every 6 hours for 7 days), A I ʻole Cefotaxime Intravenous (1 gram IV every 6 hours), A I ʻole Doxycycline Intravenous (100 mg IV every 12 hours).

2. E nānā no ka ʻO Jarisch-Herxheimer Reaction (2 to 6 Hours After the First Antibiotic Dose)¶

No ka mea, he spirochete ka Leptospira (related to the bacteria that cause syphilis and Lyme disease), ka lawelawe ʻana i ka maʻa mua o ka bactericidal Penicillin G a i ʻole Ceftriaxone ke kumu e lyse ai nā miliona o nā spirochetes i ka manawa like, e hoʻolei ana i nā lipoproteins like endotoxin i loko o ke kahe koko: - i loko o 1 to 6 hours o ka ma'i antibiotic mua, hiki i ka mea ma'i ke loaa i ka Jarisch-Herxheimer Reaction: ka haalulu ikaika, a 1 to 2 C ka piʻi ʻana o ke kuni, ka ʻili ʻana, ka tachycardia, a me ka ** hāʻule koke o ke koko (hypotension). - Tula koʻikoʻi: ʻO ka pane ʻana o Jarisch-Herxheimer ** ʻAʻole he hopena maʻi i ka penicillin/ceftriaxone. Pono nā kauka ʻaʻole loa e hoʻōki i ka lāʻau lāʻau hoʻōla ola; akā, nānā lākou i ka mea maʻi i loko o ka ER/ICU a kākoʻo i ke kahe koko me ka makaʻala intravenous crystalloids a me nā vasopressors i ka wā e hoʻoholo ai ka hopena ma luna o 12 a 24 mau hola.

3. Hiki iā ʻoe ke lawe i nā lāʻau antibiotic Preventive (Chemoprophylaxis) Inā Koʻi ʻia e ʻau i loko o ka wai Kaʻi?¶

• E hele mua mai nā mea pale pono'ī: ʻO ke komo ʻana i nā kāmaʻa ʻeleʻele kiʻekiʻe o ke kuli, nā mīkina lima wai ʻole, a me nā maka maka. > 90% o na hoolaha waikahe.
• Pikikala Doxycycline Pre-/Post-Exposure Prophylaxis (CDC / WHO Guidance for High-Risk Responders): No nā pūʻali koa, nā hui hoʻopakele wai wikiwiki, a i ʻole ka poʻe kamaʻāina e ʻauheʻe ʻole ʻia i loko o nā wai kahe i hoʻopiha ʻia i ka ʻiole i ka wā o ka maʻi ʻino ma hope o ka ʻino, ua hōʻike ʻia nā hoʻokolohua hoʻokolohua maʻamau ʻo Oral Doxycycline 200 mg lawe ʻia i hoʻokahi pule i kēlā me kēia pule (two 100-mg capsules taken together once a week with food and a full glass of water) i ka wā o ka hoʻolaha ʻia ʻana o ka wai kahe e hoʻemi nui ʻia ka maʻi leptospirosis.

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

ʻO ka Leptospirosis kahi maʻi maʻi maʻi hiki ke hoʻomaopopo ʻia i ka ʻāina ma waena o nā mana olakino olakino nui:

• ** ʻAmelika Hui Pū ʻIa (Me Puerto Rico, U.S. Virgin Islands, Hawaii, Florida, & Gulf/Atlantic Coasts):**
• Ka Hoʻouna ulia pōpilikia: Kāhea iā 911 no kekahi maʻi maʻi ma hope o ke kaiakahinai i hui pū ʻia me ka jaundice, pōkole o ka hanu, ʻaʻa koko, a i ʻole ka emi ʻana o ka mimi.
• Alakaʻi Ola a me Lab: Mālama ʻia ma lalo o CDC Bacterial Special Pathogens Branch (bspb@cdc.gov / Ke kikowaena hana hoʻomāinoino CDC 770-488-7100), e hana ana i ke kuhikuhi MAT serology a me lipL32 PCR manawa maoli.
• Kanada:
• Kāhea iā 911. Hoʻonohonoho ʻia ka hoʻokolohua diagnostic ma o Provincial Public Health Laboratories a me ka National Microbiology Laboratory (NML Winnipeg).
• United Kingdom:
• E kelepona iā 999 no nā hōʻailona koʻikoʻi a i ʻole NHS 111 no ka loiloi wikiwiki ʻana i nā hōʻailona like me ka maʻi maʻi i loko o 30 mau lā o ʻauʻau wai hāmama (Thames/river triathlons, rowing, kayaking), ka hana paʻa i ke kahawai, ka hoʻomaʻemaʻe wai, a i ʻole ka ʻiole. ** Keʻena Palekana Ola Ola UK (UKHSA) Ke Keʻena Hana Hana Lakaʻikaʻi a lawe ʻia mai (RIPL Porton Down)** hāʻawi i ka PCR aupuni a me ka hoʻāʻo serology.
• Uni ʻEulopa:
• Kāhea i ka 112. Mālama ʻia e ka European Center for Disease Prevention and Control (ECDC) (with seasonal peaks after summer flash floods, agricultural harvesting, and freshwater triathlons in France, Germany, the Netherlands, Italy, and Spain).
• Australia a me Aotearoa:
• Australia: Kāhea iā 000. Loaʻa ka hopena ma ** ʻo ʻAkau ʻĀkau Queensland (banana and dairy farming, sugar cane, and post-cyclone flooding)** a me ka Teritore Akau; ka hoʻāʻo ʻana ma o ka WHO/FAO/OIE Collaborating Center for Reference and Research on Leptospirosis (Queensland Health Forensic and Scientific Services, Brisbane).
• New Zealand: Kāhea iā 111. ʻIke ʻia nā pipi waiu, hipa, a me nā mea ʻiʻo ʻiʻo/abattoir i kekahi o nā hanana ʻoihana kiʻekiʻe loa ma ka honua hoʻomohala (Te Whatu Ora / WorkSafe NZ Leptospirosis Guidelines).
• India, Philippines, Palakila, Iapana, a me Asia-Pacific:
• I ka wā o ke kai a me ka ʻino ma India (Kerala, Mumbai/Maharashtra, Tamil Nadu, Gujarat - ulia pōpilikia: 112 / 108), ka Pilipine (Metro Manila - ulia pōpilikia: 911), a me Brazil (Rio Grande do Sul, Sao Paulo, Rio de Janeiro - ulia pōpilikia: 192 SAMU), hoʻolaha nā ʻoihana o ke olakino i ke kaiāulu lehulehu Doxycycline prophylaxis station a me ka wikiwiki Weil's Disease dialysis & ICU protocols. E nana helu pilikia.

Nīnau pinepine¶

He aha ke ʻano o ka "conjunctival suffusion", a pehea ka ʻokoʻa mai ka pinkeye maʻamau (conjunctivitis)?¶

**Conjunctival suffusion** ʻo ia kekahi o nā hōʻailona pili moe hilinaʻi no ka leptospirosis, e ʻike ʻia ana ma kahi o ka lā 3 a i ʻole 4 o ke kuni. Ke nānā ʻoe i nā keʻokeʻo o nā maka o ka mea maʻi, ua pehu nā kīʻaha koko liʻiliʻi ma ka conjunctiva a ʻulaʻula ʻulaʻula a ʻulaʻula-alani paha (`often most intense around the edges of the cornea`), **akā, ʻaʻole like me ka pinkeye viral a bacterial (`conjunctivitis`), aia ka ZERO pume melemele/'ōmaʻomaʻo, ZERO ʻāʻī maka i ke kakahiaka, a ʻaʻohe ʻehaʻeha**. Ke ulu ka jaundice i ka Phase 2 (`Weil's disease`), ʻo ka hui pū ʻana o nā kīʻaha koko conjunctival ʻulaʻula ma luna o kahi sclera melemele e hāʻawi i nā maka i kahi ** ʻālani ʻālani ʻulaʻula**.

No ke aha he mea pōʻino loa ke lawe ʻana iā Ibuprofen (Advil), Naproxen (Aleve), a i ʻole Aspirin no ke kuni a me ka ʻeha bipi ma hope o ke au ʻana i ka wai kahe?¶

ʻElua mau hōʻailona weliweli i ke ola o ka leptospirosis (`as well as dengue fever, which often circulates at the same time after tropical storms`) he **ʻeha puʻupaʻa koʻikoʻi (`interstitial nephritis and tubular damage`)** a me **ka hāʻule ʻana o nā platelets koko (`thrombocytopenia`)**. ʻO ka lawe ʻana i nā lāʻau anti-inflammatory non-steroidal (`NSAIDs like ibuprofen, naproxen, diclofenac, or aspirin`) hoʻopaʻa i nā kīʻaha koko afferent e hānai ana i nā puʻupaʻa - hiki iā ia ke hoʻokuʻu i kahi puʻupaʻa maʻi i loko o ka **ka hoʻopau ʻana i ka renal acute renal failure** - ʻoiai e pale ana i ka hana platelet clotting i ka manawa like, hiki ke hoʻoulu ** ka maʻi hemorrhage momona (`hemoptysis`) a i ʻole ka ʻōpū koko**. E ʻimi mau i ka loiloi olakino no nā lāʻau antibiotic i hoʻopaʻa ʻia (`Doxycycline or Azithromycin`) ma mua o ka lawe ʻana i nā mea hōʻeha ʻeha.

Hiki iaʻu ke hopu i ka Leptospirosis mai kaʻu ʻīlio pipi ponoʻī inā ʻaʻohe kahe?¶

** ʻAe.** Hiki i nā ʻīlio home ke loaʻa i ka *Leptospira* (`serovars Canicola, Grippotyphosa, Pomona, or Icterohaemorrhagiae`) ma ka inu ʻana i nā puddles o hope, nā loko, a i ʻole ka mauʻu pulu kahi i mimi ai nā ʻiole hihiu, raccoons, opossums, a me nā skunks. ʻOiai ke nānā aku nei ka ʻīlio i ka maʻi haʻahaʻa wale nō (`or after it recovers`), hiki iā ia ke hoʻokahe i ka hua bacteria *Leptospira* i loko o kona mimi no nā pule. Inā hoʻomaʻemaʻe ʻoe i ka mimi ʻīlio i loko o ka hale me ka lima ʻole a ʻoki ʻia paha kou mau lima, hiki iā ʻoe ke loaʻa i ka maʻi. E hoʻohana mau i nā mīkina lima rubber/nitrile i ka wā e hoʻomaʻemaʻe ai i ka mimi holoholona, ​​e holoi pono i nā lima me ke kopa a me ka wai, a e noi i kāu kauka holoholona no ka makahiki **4-serovar Canine Leptospirosis Vaccine**.

No ke aha i pau ai ke kuni o ka mea maʻi no nā lā ʻelua a laila hoʻi mai me ka uwē me nā maka melemele a me ka mimi ʻeleʻele?¶

ʻO ia ka pahele **biphasic ("ʻelua-phase") o ka leptospirosis**. I loko o **Phase 1 (`Days 1 to 7`)**, kaʻapuni ka bacteria i loko o ke koko, e hoʻoulu ai i ke kuni kiʻekiʻe, ke anu, ka ʻulaʻula o nā maka, a me ka ʻeha bipi. Ma kahi o ka lā 5 a hiki i ka 7, hoʻopuka ka ʻōnaehana pale i nā antibodies e hoʻomaʻemaʻe i ka maʻi bacteria mai ke kahe koko, no laila ** hāʻule pōkole ke kuni i ka maʻamau no 1 a 3 mau lā**. A laila **Phase 2 (`the Immune Phase`)** hoʻomaka: ma nā hihia koʻikoʻi (`Weil's Disease`), ʻo ka ʻaʻa nui o ka immune-complex e paʻa ana i ke ake, nā puʻupaʻa, a me nā māmā, e hoʻoulu ai i ka ** jaundice (`yellow/orange eyes`), hāʻule ʻole o ka puʻuwai (`scant or dark tea urine`), maningitis, a i ʻole ʻaʻa koko**. Mai manaʻo i ka pau ʻana o ke kuni ma hope o ke kaiakahina a hiki i ka wā i mālama ʻia ai e ke kauka me nā lāʻau antibiotic piha.

Lawe ʻia ka wai paʻakai moana i ka Leptospira?¶

ʻO *Leptospira* spirochetes he **mea ola wai a me ka lepo pulu**: ʻaʻole hiki iā lākou ke ola no ka lōʻihi me ka ikaika piha, ka wai kai paʻakai kiʻekiʻe (`35 parts per thousand`). **Akā naʻe**, ma hope o ka ua nui o ke kahakai a i ʻole nā makani ʻino, kahe ka wai maʻemaʻe o ka muliwai a me nā ʻauwaha ʻino e hoʻoheheʻe ʻia i ka wai ʻiole i hoʻohaumia ʻia i loko o **nā kahakai kahakai, nā nuku o ka muliwai, nā kahawai, nā kahakai, a me nā wai kahe o ke alanui ʻo ka ʻāʻī **, kahi i loaʻa ai ka wai maʻemaʻe *Leptospira*** a me ** kai. [*Vibrio vulnificus*](hemorrhagic-bullae-vibrio-vulnificus-warm-seawater-wound-infection-and-raw-oyster-septicemia-in-liver-disease.md)** hiki ke hoʻopili i ka poʻe ʻauʻau kai a me ka poʻe i pakele i ka wai i ka manawa like.

• Hāʻawi kēia alakaʻi i ka ʻike hoʻonaʻauao olakino a ʻaʻole ia e pani i ka mālama ulia pōpilikia ʻoihana, loiloi maʻi maʻi maʻi, a i ʻole ka hoʻokele nephrology/ICU. Ma muli o ka ma'i a Weil a me ka leptospiral pulmonary hemorrhage hiki ke ho'oulu i ka hana 'ole o ka renal a me ka hopu 'ana i ka hanu, makemake nui mākou e lawe i ke kōkua mua a me ka papa CPR i hō'oia 'ia mai ke Cross Cross, St John Ambulance, a i 'ole kekahi mea ho'olako ho'ona'auao kūloko.*

Nā alakaʻi pili¶

• ʻO Vibrio vulnificus ("ʻai ʻiʻo" wai mehana a me ka maʻi ʻoʻo maka)
• Hantavirus Pulmonary Syndrome (HPS): hoʻomaʻemaʻe wai-bleach vs.
• ʻO ka ʻeha puʻupaʻa koʻikoʻi, rhabdomyolysis, a me ka hoʻāʻo ʻana o ka mimi ʻeleʻele
• Hemoptysis: ʻāke koko a me ke kahe nui o ke ea
• Helu pilikia

Nā kumu a me ke alakaʻi kūhelu¶

• Ka Hui Ola Ola (WHO) a me International Leptospirosis Society (ILS): Human Leptospirosis: Alakaʻi no ka ʻike, nānā ʻana, a me ka hoʻomalu ʻana (Biphasic Clinical Triage, Weil's Disease, Pulmonary Hemorrhage Syndrome LPHS, a me nā Antibiotic Protocols).
• Nā kikowaena no ka hoʻopaʻa ʻana a me ka pale ʻana i nā maʻi (CDC Laa Bacterial Special Pathogens, United States): Leptospirosis Clinical Fact Fact for Healthcare Providers: Post-Hurricane Floodwater Exposure, Diagnostic PCR vs. MAT Time, and Doxycycline/Ceftriaxone Treatment (cdc.gov/leptospirosis).
• Pan American Health Organization (PAHO): Leptospirosis Field Guide in Disaster and Post-Flood Emergencies: Nā Lako Hoomalu Pilikino a me Chemoprophylaxis Evidence.
• ** Keʻena Palekana Ola Ola UK (UKHSA) & ʻOihana Ola Lahui (NHS, Aupuni Mōʻī Hui Pū ʻia):** Leptospirosis (Weil's Disease): Hoʻoponopono Hoʻomaʻamaʻa Hoʻomaʻamaʻa o ka wai maʻemaʻe leʻaleʻa a me nā hōʻike ʻana i nā ʻiole ʻoihana.
• Queensland Health / WHO Collaborating Center for Reference and Research on Leptospirosis (Australia): Nā kuhikuhi no ka mālama ʻana i ka Leptospirosis Kanaka a me ka Severe Pulmonary Hemorrhagic Syndrome.