Leptospirose (Indwara ya Weil) Nyuma yo Kuzerera mu mazi y'Umwuzure cyangwa Amazi meza: Amaso atukura adafite Pus, ububabare bw'inyana, na Jaundice¶

Iyo inkubi y'umuyaga, imvura, imyuzure, cyangwa gusubira mu miyoboro ihindura imihanda yo mu baturanyi no munsi yo munsi y'amazi yijimye yijimye - cyangwa iyo umuntu woga, kayaker, triathlete, umuhinzi, cyangwa umunywanyi wo kwiruka yambukiranya imigezi ishyushye y'amazi meza, imiyoboro, cyangwa ibyondo bitose byandujwe n'inkari za ** imbeba, imbeba, inka, ingurube, imbwa, cyangwa inyamaswa z’inyamabere ** ukoresheje uruhu rworoshe amazi, uduce duto, cyangwa ururenda rwamaso, izuru, numunwa. Niba hari umuntu urwaye umuriro mwinshi utunguranye, kunyeganyega, gutitira imbere / retro-orbital umutwe, kubabara bikabije inyana ninyuma yo hepfo, n'amaso atukura adafite ibibyimba bifatanye (conjunctival suffusion) ** ahantu hose kuva **2 to 30 days (typically 5 to 14 days) ** nyuma y'amazi y'umwuzure cyangwa guhuza amazi meza - cyangwa gutera imbere kuri ** uruhu rwumuhondo-orange / amaso (amaso) (jaundice), icyayi cyijimye cyangwa inkari nkeya, kuva amaraso, cyangwa gukorora amaraso (Weil's Disease) ** - hamagara nomero yawe yihutirwa ikoresheje iyacu nimero yihutirwa ububiko cyangwa ujye mubitaro Ishami ryihutirwa. Baza kandi abatuyobora Vibrio vulnificus ("kurya inyama" kwandura amazi yo mu nyanja), Indwara ya Hantavirus Indwara ituruka kumitsi, gukomeretsa impyiko, rhabdomyolysis, hamwe ninkari zijimye, na sepsis na septike yo kumenyekana.

Nk’uko Umuryango w’ubuzima ku isi **WHO) **, Ibigo ** bishinzwe kurwanya no gukumira indwara (CDC) **, hamwe na ** Pan American Health Organisation (PAHO) **, leptospirose ni ** indwara ya bacteri zoonotic ikwirakwizwa cyane ku isi **, yanduza hejuru 1.03 million people no gutera 58,900 deaths buri mwaka - hamwe n’ibyorezo byinshi nyuma y’umuyaga na nyuma y’umwuzure byanditswe muri ** Porto Rico, Florida, Hawayi, Texas, Ubwongereza, Umugabane w’Uburayi, Burezili, Ubuhinde, Filipine, Ubuyapani, n’amajyaruguru ya Ositaraliya **. Kubera ko icyiciro cya mbere cya leptospirose gisa nkumuriro wa dengue, ibicurane, cyangwa indwara isanzwe ya virusi, abarwayi bakunze kubura hakiri kare ** Umunwa Doxycycline cyangwa idirishya rya Azithromycin (Days 1 to 5) **, bigaragara ko wakize muminsi 1 kugeza kuri 3, hanyuma ugwe muri ** Icyiciro cya 2 Icteric Leptospirose (Weil's Disease) ** cyangwa ** Indwara ya Leptospiral Indwara ya Hemorrhage ()LPHS) **, aho impfu ziva < 1% kugeza kuri 10% to 50%+ kubera guhuriza hamwe ** non-oliguric / oliguric acute impyiko kunanirwa **, ** conjugated hyperbilirubinemia (orange jaundice) **, ** trombocytopenia **, na ** amaraso manini ya alveolar ava **. Kumenya ** ibimenyetso bibiri byo kuryama kumubiri (Conjunctival Suffusion + Severe Calf Squeeze Tenderness) ** no kwerekana amazi yawe yumwuzure uhita ufungura imiti ivura antibiotique.

Kora ubu¶

1. ** Niba urwaye umuriro utunguranye (>= 38.5 C / 101.3 F), gukonja, kubabara umutwe cyane, no kubabara imitsi imbere 2 to 30 days yo kuzerera mu mazi y’umwuzure, gusukura munsi y’umwuzure wuzuye, koga mu kiyaga / uruzi, cyangwa gutunganya inkari / amatungo y’amatungo: reba umuganga cyangwa ujye mu bitaro by’ishami ryihutirwa uyu munsi kandi ugaragaze neza amazi yawe / imyuzure. ** Gutangira umunwa ** Doxycycline (100 mg twice daily for 7 days) ** cyangwa ** Azithromycin (500 mg daily for 3 days) ** muminsi 5 yambere ikuraho vuba spirochette mumaraso kandi ** irinda gutera imbere indwara ya Weil ibangamira ingingo **.
2. ** Reba mu ndorerwamo ku bazungu b'amaso yawe (sclera/conjunctiva) hanyuma witonze witonze imitsi yinyana yo hepfo (gastrocnemius): **
3. ** Ikimenyetso # 1 (Conjunctival Suffusion). Guhuza kwa conjunctival bibaho kugeza kuri 55% y'indwara ya leptospirose (appearing on Days 3 to 4) kandi hafi ya ** ntabwo ** igaragara muri grippe isanzwe, malariya, cyangwa tifoyide.
4. ** Ikimenyetso # 2 (Severe Calf & Lumbar Myalgia): ** Ese gukora gusa cyangwa gukanda inyuma yinyana zawe cyangwa gukanda kumugongo wo hasi ((erector spinae) bitera ** ubukana, gutsindira ubwuzu **? Uku guhuza (Fever + Flood/Freshwater Contact + Red Eyes Without Pus + Severe Calf Pain) ni classique yo kwisuzumisha tetrad ya acute leptospirose.
5. ** Hamagara 911/112/999/000 cyangwa ujye mu ishami ryihutirwa ry’ibitaro AKAZI niba ICYICIRO CYA 2 "Indwara ya Weil" cyangwa Ibendera ritukura rya Hemorhagasi ()often after a deceptive 1-to-3-day dip in fever around Day 5 to 7): **
6. ** Umuhondo cyangwa umuhondo wijimye uhinduka umweru w'amaso cyangwa uruhu (Jaundice) **,
7. ** Kugabanuka kw'inkari (not urinating for > 8 hours) cyangwa umwijima wijimye / inkari zifite ibara ry'icyayi **,
8. ** Gukorora amaraso (hemoptysis), ibara ryijimye ryijimye, cyangwa guhumeka gitunguranye (Leptospiral Pulmonary Hemorrhage Syndrome - 50%+ mortality) **,
9. ** Erekana ibara ry'umutuku / umutuku (petechiae), kuva amenyo, kuva amaraso, cyangwa intebe yumukara **, CYANGWA
10. ** Ijosi rikomeye, gufotora bikabije (light hurts eyes), urujijo, cyangwa umutima udasanzwe (aseptic meningitis or myocarditis) **.
11. ** Vuga aya magambo nyayo kubyihutirwa byihutirwa Umuforomo na Muganga mumasegonda 30 yambere: "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. ** Irinde Ibuprofen (Advil/Motrin), Naproxen (Aleve), Aspirin, hamwe nubundi buryo bwo kugabanya ububabare bwa NSAID niba ufite umuriro nyuma y’amazi y’umwuzure cyangwa ubushyuhe bwo mu turere dushyuha.thrombocytopenia) ** na ** gukomeretsa gukabije kwimpyiko **: gufata NSAIDs ibuza prostaglandine yimpyiko (precipitating complete kidney shutdown) no guhagarika platine isigaye (triggering fatal gastrointestinal or lung hemorrhage). Koresha gusa amakenga ya acetaminofeni / paracetamol GUSA niba imikorere yumwijima / jaundice yakuweho na muganga, cyangwa ukoreshe imyenda ikonjesha umubiri kugeza isuzumwe.
13. ** Niba muri iki gihe urimo gukora isuku nyuma yumwuzure cyangwa inkubi y'umuyaga: NTUKIGERE wigeze wambara ibirenge cyangwa inkweto / inkweto ukoresheje amazi cyangwa icyondo gihagaze.wellingtons.

Igiti cyemezo: Amazi yumwuzure nyuma yumuriro wamazi meza ya Leptospirose¶

Kurikiza iki giti cyemezo cyamavuriro mugihe usuzumye uburwayi ubwo aribwo bwose mugihe cyiminsi 30 amazi yumwuzure, ibyondo, umwanda, cyangwa amazi meza yimyidagaduro.

flowchart TD
    Exposure["Kumenyekanisha Muminsi 2 kugeza 30 (Median 5 to 14)"] --> SxCheck{"Ese umuriro, gukonja, kubabara umutwe, cyangwa kurwara imitsi birahari?"}

    SxCheck -->|"NTA BIMENYETSO Nyamara (Ibyago byinshi-Amazi Yumwuzure Kumenyekana Byabayeho cyangwa Birakomeje)"| ProphyBox["DECONTAMINATION & CHEMOPROPHYLAXIS TRIAGE: 1. Karaba uruhu ukoresheje isabune & amazi meza; kuhira ibice byose hamwe na povidone-iyode 2. Wambare inkweto za rubber zitagira amazi & gants kugirango ibintu byose bikomeje gusukurwa n’umwuzure 3. Niba udashobora kwirindwa igihe kirekire cy’umwuzure ushobora kwibasirwa n’akarere k’icyorezo -"]

    SxCheck -->|"ICYICIRO CYA 1 LEPTOSPIROSIS ANICTERIC (Umunsi wa 1 kugeza 7): Umuriro mwinshi (> 38.5 C), Rigors, Inyana ikabije & Ububabare bwo hepfo-Kubabara, Kubabara umutwe imbere, Isesemi / Kuruka, hamwe no Kwishira hamwe (Amaso atukura adafite Pus)"| OutpatientVsER{"HARI URUGENDO-Kunanirwa cyangwa Indwara ya Weil Ibendera ritukura rirahari?"}

    OutpatientVsER -->|"NTA Bendera ritukura (Indwara yoroheje-igereranije, Indwara isanzwe yinkari, Nta jundice, guhumeka bisanzwe)"| EarlyAbx["EREGA CURATIVE ANTIBIOTIC WINDOW (Irinda Indwara ya Weil): 1.Gusuzuma umunsi umwe wubuvuzi -> Shushanya Amaraso / Inkari PCR (niba iminsi 1-7) & IgM ELISA + CBC, Creatinine, LFTs, CPK 2. Tangira umunwa Doxycycline (100 mg PO BID x 7 iminsi) Amoxicillin (mugutwita / abana bato) 3. Irinde NSAIDs zose (Ibuprofen / Naproxen / Aspirin) + Komeza Amazi yo mu kanwa"]

    OutpatientVsER -->|"YEGO - INDWARA Z'UBUNTU CYANGWA LPHS ZITUKANA: - Umuhondo / Orange Amaso cyangwa Uruhu (Jaundice) - Inkari zisohoka (<400 mL / kumunsi) cyangwa Inkari z'icyayi cyijimye - Gukorora Amaraso (Hemoptysis), Kubura Umwuka, cyangwa SpO2 <94% - Petechiae, Hypose,"| EmergencyICU["INDWARA Z'UBUZIMA / INDWARA ZIDASANZWE: 1. Hamagara 911/112/999 -> Kwinjira mu bitaro ako kanya / ICU 2. Jarisch-Herxheimer Igisubizo mugihe cyamasaha 2 kugeza kuri 6 yumuti wa mbere wa antibiotique ya IV."]

Igice cya 1: Uburyo * Leptospira * Yinjira mu mubiri (And Why You Do Not Need an Open Cut to Get Infected)¶

1. Corkscrew Spirochete n'ikigega cy'imbeba zo mu mijyi / Icyaro¶

• Leptospira abaza ibibazo * ((with over 250 pathogenic serovars, notably *Icterohaemorrhagiae* carried by brown rats, *Canicola* in dogs, *Pomona* in pigs and cattle, and *Hardjo* in cattle.
• ** Uburyo imbeba n’inyamabere byera amazi y’umwuzure: ** Indwara zanduye zanduye ** imbeba zijimye (* Rattus norvegicus *) **, imbeba zo hejuru, imbeba, amatungo, n’imbwa zidakingiwe icyambu * Leptospira * burundu imbere mu tubari twabo twa ** impyiko zegeranye ** zitagaragara nkizirwaye, zisuka miliyoni miliyoni za spirocheti nzima kuri mililitiro.
• ** Kurokoka Ibidukikije mumazi nicyondo: ** Mugihe * Leptospira * ipfa vuba kumuhanda wumye, utetse izuba cyangwa mumazi yinyanja yumunyu mwinshi, ** mumazi ashyushye, atabogamye-kuri-alkaline-amazi meza (pH 6.8 to 7.6, ubushyuhe 20 to 32 degrees Celsius / 68 to 90 degrees Fahrenheit), amazi yumwuzure uhagaze, ubutaka butose, nicyondo nyuma yumuyaga, * Leptospira * ikomeza kuba muzima kandi yanduye kuri weeks to several months**.

2. Inzira enye zinjira mu bantu (Including Waterlogged "Pruney" Skin)¶

Bitandukanye na bagiteri nyinshi zisaba igikomere cyimbitse kugirango zambuke imbogamizi zuruhu, * Leptospira * ya corkscrew moteri na enzymes zo hanze-membrane collagenase / hyaluronidase zemerera kwinjira mumaraso yabantu binyuze muri ** portal enye zitandukanye **: 1. ** Gukata Microscopique, Ibisigazwa, Inzitiramubu, cyangwa Ibishishwa Byataye: ** Ndetse a 1-millimeter gushushanya ibyatsi, imyanda, cyangwa inkweto bireka ibihumbi bya spirochette muri capillaries dermal. 2. ** Amazi-Amazi ("Waterlogged / Pruney") Uruhu rwuzuye: ** Iyo umuturage cyangwa umukozi wubutabazi yiroha mumazi yumwuzure cyangwa akambara amasogisi atose, yuzuye amasogisi hamwe na siporo kuminota irenga ** kugeza kuminota 60 **, urwego rwinyuma rwa corneum rwuruhu rwabyimba kandi rworoshe (maceration), kwemerera * Leptospira * kugeza ** yabyaye igororotse binyuze mu ruhu rudakomeye, rutavunitse uruhu **. 3. ** Conjunctiva (Eyes) na Amazuru / Umunwa Mucous Membrane: ** Kumena amazi y'umwuzure wuzuye ibyondo mumaso yawe (while clearing storm drains or pressure-washing a flooded garage - NEVER pressure-wash flood mud without unvented goggles and an N95 mask) cyangwa guhanagura mu maso hawe n'amaboko atose yanduye atera conjunctiva mu buryo butaziguye. 4. ** Kumira Amazi Yanduye: ** Gufata uruzi cyangwa amazi yikiyaga mugihe cyo koga, gufata kayak, cyangwa kunywa amazi meza yanduye umwuzure.

Igice cya 2: Ibimenyetso bibiri bya kera byo kuryama hamwe na Biphasic Clinical Timeline¶

Kuberako laboratoire ya laboratoire (** Ikizamini cya Microscopique Agglutination / MAT** na ** IgM ELISA **) ntabwo ihinduka neza kugeza ** Umunsi wa 5 kugeza ku wa 10 wuburwayi **, abaganga byihutirwa basuzuma leptospirose ikaze kumuriri bamenye ibimenyetso byayo ** byindwara ya patognomonic ** hamwe namasomo yayo ya ** biphasic **:

1. Ibimenyetso bibiri byerekana ibimenyetso bifatika (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. Ibihe Byibihe Byibihe ((Phase 1 Septicemic vs. Phase 2 Immune / Weil's Disease)¶

• ** Igihe cyubushakashatsi: ** 5 to 14 days nyuma yo guhuza amazi / icyondo (full range: 2 to 30 days).
• ** Icyiciro cya 1: Icyiciro cya Leptospiremic (Septicemic) Icyiciro (Lasts 4 to 7 Days): **
• Kubaho * Leptospira * spirochette ikwirakwira mu maraso ya ** n'amazi ya cerebrospinal fluid (CSF) **.
• Gutangira gutangira umuriro mwinshi (39 to 40 C / 102 to 104 F)."pretibial fever").
• ** Icyitonderwa cyo gusuzuma: ** Mugihe cya ** Iminsi 1 kugeza 7 **, ** Amaraso na CSF Igihe nyacyo PCR ** ni ** POSITIVE **, mugihe ibizamini bya antibody (IgM) birashobora kuba bibi.
• ** Ibihendo 1-kugeza-3-Interphase Ituje (Around Day 5 to 8): **
• Umuriro ugabanuka mubisanzwe kandi umurwayi muri make yumva amerewe neza nkuko antibodies ziva spirochette ziva mumaraso (though spirochetes now hide in the kidney tubules and begin shedding in the urine). 85% to 90% by'imanza zoroheje "anicteric" zikira burundu nyuma yigihe gito cyongeye kugaruka kubabara umutwe.
• ** Icyiciro cya 2: Icyiciro cya Immune & Icteric Weil Indwara (Starts Day 6 to 10 and Lasts Weeks): **
• Muri 10% to 15% y'abarwayi (cyane cyane abanduye serovar * Icterohaemorrhagiae * cyangwa abatarahawe antibiyotike hakiri kare), Icyiciro cya 2 kiraturika nka ** Indwara ya Weil ** (the classic triad of **Orange Jaundice + Acute Kidney Injury + Hemorrhage**) na / cyangwa ** Indwara ya Leptospiral Indwara ya Hemorhage ()LPHS) **:
  1. ** "Orange Jaundice" y'indwara ya Weil (Cholestatic Hepatic Dysfunction Without Massive Liver Necrosis): **
  2. Amaso yumurwayi nuruhu bihinduka bitangaje ** byimbitse yumuhondo-orange (rubinic icterus) ** nka serumu ** conjugated bilirubin izamuka kuri 15 to 40+ mg/dL** (because bright red conjunctival suffusion + yellow scleral icterus = orange eyes), ** nyamara transaminase y'umwijima (AST and ALT) byashyizwe hejuru gusa byoroheje (typically 100 to 250 U/L, gake > 500 U/L) **, ihita itandukanya indwara ya Weil na hepatite ikaze ya virusi A / B / E (where AST/ALT exceed 1,000 to 3,000 U/L).
  3. ** Hypokalemic idasanzwe Non-Oliguric -> Gukomeretsa impyiko zikomeye za Oliguric (AKI): **
  4. • Leptospira * poroteyine zo hanze-membrane zibuza mu buryo butaziguye ** Na + -K + -2Cl- (NKCC2) cotransporter mumaguru azamuka ya Henle ** kandi yangiza tubule yegeranye.
  5. Nkigisubizo, kunanirwa kwimpyiko za leptospiral kare ni umwihariko ** non-oliguric na potasiyumu-isesagura (causing normal or LOW blood potassium / hypokalemia nubwo izamuka rya creinine) ** - mbere yo gutera imbere byihuse kuri ** oliguric / anuric acute tubular necrosis (ATN) ** hamwe na hyperkalemia ishobora guhitana ubuzima, uremia, hamwe n'indwara yo mu bihaha isaba ** byihutirwa hemodialysis **.
  6. ** Indwara ya Leptospiral Indwara ya Hemorrhage (LPHS - # 1 Impamvu Yurupfu Ryihuse): **
  7. Imvune yatewe no gukingira indwara yangiza imitsi ya alveolar capillary yo munsi yibihaha byombi, itera ** diffuse alveolar hemorhage (DAH) **. Abarwayi barwara dyspnea itunguranye, tachypnea, hypoxia, alveolar patchy byombi byinjira mu gatuza X-ray, na ** hemoptysis (coughing up bright red blood) **, ishobora gutera guhumeka no gupfa bitarenze ** 24 kugeza 48 amasaha ** no mubarwayi batarahindukira.

Igice cya 3: Igishushanyo mbonera cyo gusuzuma Imbonerahamwe: Nyuma yumwuzure & Tropical Fever Mimics¶

Nyuma yumuyaga ushushe, imvura, cyangwa umwuzure, ibyumba byihutirwa bireba ubwinshi bwa ** Leptospirose, Dengue Fever, Malariya, Tifoyide, Hantavirus, na * Vibrio * Sepsis ** icyarimwe. Gereranya urutoki rwabo na laboratoire:

Igice cya 4: Kuvura ibitaro, kuburira Jarisch-Herxheimer, no gukumira umwuzure¶

1. Umurongo wa mbere Antibiyotike Gahunda (CDC / WHO Guidelines) n'igihe cyo gutumiza buri kizamini¶

1. ** Igihe cyo Kwipimisha (Why Blood PCR Works in Week 1 and Urine PCR/IgM Works in Week 2): **
2. ** Iminsi 1 kugeza 7 yumuriro (Phase 1): ** Tegeka ** Amaraso Yuzuye (na CSF) * Leptospira * Igihe nyacyo PCR ** (positive from Day 1 before antibodies exist) wongeyeho ibyingenzi ** IgM ELISA / MAT serumu icyitegererezo **.
3. ** Umunsi wa 7 Komeza (Phase 2 / Weil's Disease): ** Spirochetes ibura mumaraso ikinjira mumpyiko; gutumiza ** Inkari * Leptospira * PCR ** wongeyeho ** Serumu Anti- * Leptospira * IgM ELISA na Convalescent Microscopic Agglutination Ikizamini (MAT) **.
4. ** Guhitamo Antibiotique ivura: **
5. ** Indwara yoroheje-igereranije yo hanze Anicteric Leptospirose: **
   • ** Abakuze (Abatwite): ** ** Doxycycline yo mu kanwa 100 mg kabiri buri munsi kuri 7 days** *. 500 mg rimwe buri munsi kuri 3 days, ** CYANGWA Amoxicillin yo mu kanwa 500 mg gatatu kumunsi 7 days.
   • ** Abagore Batwite & Abana < 8 Years: ** ** Umunwa Azithromycin ** (10 mg/kg Day 1, then 5 mg/kg/day Days 2-3) cyangwa ** Amoxicillin ** (50 mg/kg/day divided TID).
6. ** Indwara ya Leptospirose ikabije mu bitaro / Indwara ya Weil / Amaraso ava mu bihaha: **
   • ** Ceftriaxone yinjira (1 to 2 grams IV every 24 hours for 7 days) **, ** CYANGWA Penicilline Yinjiza G (1.5 million units IV every 6 hours for 7 days) **, ** CYANGWA Cefotaxime Yinjiza (1 gram IV every 6 hours) **, ** CYANGWA Doxycycline Yinjira (100 mg IV every 12 hours) **.

2. Reba kuri Jarisch-Herxheimer Reaction (2 to 6 Hours After the First Antibiotic Dose)¶

Kuberako * Leptospira * ni spirochete (related to the bacteria that cause syphilis and Lyme disease), gutanga igipimo cya mbere cya bactericidal ** Penicillin G cyangwa Ceftriaxone ** itera amamiriyoni ya spirochette gutera icyarimwe, ikajugunya lipoproteine imeze nka endotoxine mumaraso: - Muri **1 to 6 hours ya antibiyotike yambere ya dose **, umurwayi ashobora guhura gitunguranye ** Jarisch-Herxheimer Reaction **: ibyuma byo kunyeganyega bikabije, a 1 to 2 C spike mu muriro, gutemba, tachycardia, no kugabanuka gutunguranye k'umuvuduko w'amaraso (hypotension) **. - ** Amategeko akomeye: ** Igisubizo cya Jarisch-Herxheimer ni ** SI reaction ya allergique kuri penisiline / ceftriaxone **. Abaganga bagomba ** kutigera bahagarika antibiyotike ikiza ubuzima **; Ahubwo, bakurikirana umurwayi muri ER / ICU kandi bagashyigikira umuvuduko wamaraso hamwe na christalloide yimitsi itagaragara hamwe na vasopressor mugihe reaction ikemura mumasaha 12 kugeza 24.

3. Urashobora gufata Antibiyotike Yirinda (Chemoprophylaxis) Niba Guhatirwa Kuzerera mumazi yumwuzure?¶

• ** Ibikoresho byo kurinda umuntu ku giti cye biza mbere: ** Kwambara inkweto za rubber zidafite ivi, uturindantoki twirinda amazi, hamwe na gogles birinda > 90% y'amazi y'umwuzure.
• ** Igihe gito Doxycycline Mbere- / Nyuma yo Kumenyekanisha Prophylaxis (CDC / WHO Guidance for High-Risk Responders). 200 mg gufatwa rimwe mu cyumweru (two 100-mg capsules taken together once a week with food and a full glass of water) ** mugihe cyo guhura n’amazi menshi y’umwuzure bigabanya cyane uburwayi bwa leptospirose.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

Leptospirose ni indwara yandura mu gihugu hose mu turere twinshi tw’ubuzima rusange:

• ** Amerika (Harimo na Porto Rico, Ibirwa bya Virginie ya Amerika, Hawayi, Floride, & Ikigobe / Atlantike): **
• ** Kohereza byihutirwa: ** Hamagara ** 911 ** kuri feri iyo ari yo yose nyuma yumwuzure iherekejwe na jaundice, guhumeka neza, gukorora amaraso, cyangwa kugabanuka kwinkari.
• ** Ubuyobozi rusange bwubuzima & Laboratwari: ** Bicungwa munsi ya ** CDC Indwara ya bagiteri idasanzwe ya Pathogens (bspb@cdc.gov / CDC Ibikorwa byihutirwa 770-488-7100) **, ikora reference MAT serologiya na lipL32 Igihe nyacyo PCR.
• ** Kanada: **
• Hamagara ** 911 **. Kwipimisha kwisuzumisha bihuzwa binyuze muri Laboratwari yubuzima rusange bwintara na ** Laboratwari yigihugu ya Microbiology (NML Winnipeg) **.
• ** Ubwongereza: **
• Hamagara ** 999 ** kubimenyetso bikomeye cyangwa ** NHS 111 ** kugirango usuzume byihutirwa ibimenyetso bisa nibicurane muminsi 30 uhereye ** koga kumazi (Thames/river triathlons, rowing, kayaking), akazi ko gufunga imiyoboro, gusukura imyuzure, cyangwa imbeba **. ** Ikigo gishinzwe umutekano mu Bwongereza (UKHSA) Laboratoire idasanzwe kandi itumizwa mu mahanga (RIPL Porton Hasi) ** itanga PCR yigihugu hamwe na serologiya.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi: **
• Hamagara ** 112 **. Ikurikiranwa n’ikigo cya ** gishinzwe gukumira no kurwanya indwara (ECDC) ** (with seasonal peaks after summer flash floods, agricultural harvesting, and freshwater triathlons in France, Germany, the Netherlands, Italy, and Spain).
• ** Ositaraliya na Nouvelle-Zélande: **
• ** Australiya: ** Hamagara ** 000 **. Ikwirakwizwa cyane muri ** tropique y'Amajyaruguru ya Queensland (banana and dairy farming, sugar cane, and post-cyclone flooding) ** na ** Intara y'Amajyaruguru **; kwipimisha kubinyujije kuri ** OMS / FAO / OIE Ikigo gishinzwe gukorana nubushakashatsi kuri Leptospirose (Queensland Health Forensic and Scientific Services, Brisbane) **.
• ** Nouvelle-Zélande: ** Hamagara ** 111 . Inka zitanga amata, intama, hamwe n’abakozi b’inyamanswa / abattoir bahura nimwe mu ndwara zikunze kugaragara mu bihugu byateye imbere ( Te Whatu Ora / WorkSafe NZ Amabwiriza ya Leptospirose **).
• ** Ubuhinde, Filipine, Burezili, Ubuyapani, na Aziya-Pasifika: **
• Mugihe c'imvura na serwakira mwuzure muri ** Ubuhinde (Kerala, Mumbai/Maharashtra, Tamil Nadu, Gujarat - Ibihe byihutirwa: 112 / 108) **, ** Philippines (Metro Manila - Ibihe byihutirwa: 911) **, na ** Burezili (Rio Grande do Sul, Sao Paulo, Rio de Janeiro - Ibihe byihutirwa: 192 SAMU. Reba nimero yihutirwa.

Ibibazo bikunze kubazwa¶

"Guhuza conjunctival" bisa bite, kandi bitandukaniye he na pinkeye isanzwe (conjunctivitis)?¶

** Guhuza ibibyimba ** ni kimwe mu bimenyetso byizewe ku buriri bwa leptospirose, bigaragara nko ku munsi wa 3 cyangwa 4 wa feri. Iyo urebye umweru w'amaso yumurwayi, utuntu duto duto twamaraso hakurya ya conjunctiva turabyimba kandi umutuku cyangwa umutuku-orange (orange) (`often most intense around the edges of the cornea`), ** ariko bitandukanye na virusi cyangwa bagiteri pinkeye (`conjunctivitis`), hari ZERO ifashe umuhondo / icyatsi kibisi, ZERO ijisho ryijimye mugitondo, kandi nta gutitira bikabije **. Iyo jaundice ikuze mugice cya 2 (`Weil's disease`), guhuza imiyoboro y'amaraso itukura hejuru ya sclera y'umuhondo biha amaso umwihariko wa ** urumuri rwiza rwa orange **.

Ni ukubera iki ari bibi cyane gufata Ibuprofen (Inama), Naproxen (Aleve), cyangwa Aspirin kubera umuriro n'ububabare bw'inyana nyuma yo kuzerera mu mazi y'umwuzure?¶

Ibimenyetso bibiri byangiza ubuzima bwa leptospirose (`as well as dengue fever, which often circulates at the same time after tropical storms`) ni ** gukomeretsa bikabije impyiko (`interstitial nephritis and tubular damage`) ** na ** guta amaraso ya platine (`thrombocytopenia`) **. Gufata Ibiyobyabwenge Bitari Steroidal Kurwanya Indurwe (`NSAIDs like ibuprofen, naproxen, diclofenac, or aspirin`) igabanya imiyoboro y'amaraso ya afferent igaburira impyiko - zishobora gusunika impyiko zanduye muri ** kunanirwa gukabije kwimpyiko ** - mugihe icyarimwe guhagarika imikorere yimitsi ya platine, ishobora gutera ** kuva amaraso yica ibihaha byica (`hemoptysis`) cyangwa kuva mu gifu **. Buri gihe ushake kwisuzumisha kwa antibiotique (`Doxycycline or Azithromycin`) mbere yo gufata imiti igabanya ububabare.

Nshobora gufata Leptospirose ku mbwa yanjye bwite nubwo nta mwuzure wabayeho?¶

** Yego. ** Imbwa zo murugo zirashobora kwandura * Leptospira * (`serovars Canicola, Grippotyphosa, Pomona, or Icterohaemorrhagiae`) mukunywa mumazi yinyuma, ibyuzi, cyangwa ibyatsi bitose aho imbeba zo mwishyamba, marcoons, opossum, cyangwa skunks zagiye. Nubwo imbwa isa nkaho irwaye byoroheje (`or after it recovers`), irashobora kumena ubuzima * Leptospira * bacteri mu nkari zayo ibyumweru. Niba usukuye inkari z'imbwa mu nzu ukoresheje amaboko yambaye ubusa cyangwa ukagabanya amaboko, urashobora kwandura. Buri gihe ujye wambara uturindantoki twa rubber / nitrile mugihe cyoza inkari zamatungo, koza intoki neza ukoresheje isabune namazi, hanyuma ubaze veterineri wawe urukingo rwumwaka wa ** 4-serovar Canine Leptospirose **.

Kuki umuriro wumurwayi umaze iminsi ibiri hanyuma ukaza gutontoma ufite amaso yumuhondo ninkari zijimye?¶

Ngiyo umutego wa ** biphasic ("ibyiciro bibiri") umutego wa leptospirose **. Mugihe ** Icyiciro cya 1 (`Days 1 to 7`) **, bagiteri izenguruka mu maraso, itera umuriro mwinshi, gukonja, amaso atukura, n'ububabare bw'inyana. Ahagana ku munsi wa 5 kugeza ku wa 7, sisitemu y’umubiri itanga antibodiyite zivana bagiteri mu maraso, bityo ** umuriro ukamanuka mugihe gito muminsi 1 kugeza 3 **. Hanyuma ** Icyiciro cya 2 (`the Immune Phase`) ** itangira: mubihe bikomeye (`Weil's Disease`), ubudahangarwa bukabije bw'umubiri bukubita umwijima, impyiko, n'ibihaha, bigatera ** jaundice itunguranye (`yellow/orange eyes`), kunanirwa kw'impyiko (`scant or dark tea urine`), meningite, cyangwa gukorora amaraso **. Ntuzigere na rimwe wibwira ko umuriro nyuma y’umwuzure urangiye kugeza igihe umuganga ayivuye hamwe na antibiotike yuzuye.

Amazi yumunyu winyanja atwara * Leptospira *?¶

* Leptospira * spirochette ni ** amazi meza n'ibinyabuzima bitose-butaka **: ntibishobora kubaho igihe kirekire mumazi yinyanja-yuzuye-umunyu mwinshi (`35 parts per thousand`). ** Icyakora **, nyuma yimvura nyinshi yumuyaga cyangwa inkubi y'umuyaga, imigezi itemba yamazi meza ninzuzi zumuyaga zisuka amazi yimbeba-inkari zanduye mumigezi ya ** yinyanja, imigezi yinzuzi, imigezi, inkombe, n’amazi yuzuye y’umuhanda **, aho byombi ** amazi meza * Leptospira *** na ** marine [* Vibrio vulnificus *](hemorrhagic-bullae-vibrio-vulnificus-warm-seawater-wound-infection-and-raw-oyster-septicemia-in-liver-disease.md)** irashobora kwanduza aboga hamwe nabarokotse umwuzure icyarimwe.

• Aka gatabo gatanga amakuru y’ubuvuzi bwihutirwa kandi ntigasimbuza ubuvuzi bwihutirwa bwibitaro byumwuga, gusuzuma indwara zanduza, cyangwa ubuyobozi bwa nephrology / ICU. Kubera ko indwara ya Weil hamwe na leptospiral pulmonary hemorhage ishobora gutera kunanirwa kwimpyiko no gufatwa nubuhumekero, turasaba cyane ko twafata ibyemezo byambere byihutirwa hamwe namasomo ya CPR muri Croix-Rouge, Ambulance ya St John, cyangwa abatanga amahugurwa yemewe. *

Kuyobora¶

• Vibrio vulnificus ("kurya inyama" amazi ashyushye yo mu nyanja hamwe n'indwara ya oyster mbisi)
• Indwara ya Hantavirus Indwara (HPS): gusukura wet-byakuya hamwe no gukama byumye.
• Gukomeretsa impyiko, rhabdomyolysis, hamwe ninkari zijimye
• Hemoptysis: gukorora amaraso hamwe no kuva amaraso menshi
• Inomero zihutirwa

Inkomoko nubuyobozi¶

• ** Umuryango mpuzamahanga wita ku buzima (WHO) & Umuryango mpuzamahanga wa Leptospirose (ILS): * * LPHS, na Antibiyotike Porotokole) *.
• ** Ibigo bishinzwe kurwanya no gukumira indwara (CDC Ishami ryihariye rya bagiteri ishami ry’Amerika, Amerika): ** * Urupapuro rwerekana ibimenyetso by’ubuvuzi bwa Leptospirose: Abashinzwe ubuzima: Kumenyekanisha amazi y’umwuzure nyuma y’umuyaga, Gusuzuma PCR na MAT Igihe, no kuvura Doxycycline / Ceftriaxone (cdc.gov/leptospirosis) *.
• ** Ishami ry’ubuzima muri Amerika Pan (PAHO): * *
• ** Ikigo gishinzwe umutekano mu Bwongereza (UKHSA) & Serivisi ishinzwe ubuzima (NHS.
• ** Ubuzima bwa Queensland / OMS ikorana n’ubushakashatsi n’ubushakashatsi kuri Leptospirose (Ositaraliya): ** * Amabwiriza y’ubuvuzi agenga imicungire ya Leptospirose y’umuntu na Syndrome ikabije y’ibihaha *.