与重症钩端螺旋体病相关的急性肾损伤:拉丁美洲再次出现的致命疾病

Elber Osorio-Rodríguez, Dairo Rodelo-Barrios, C. Rebolledo-Maldonado, Alberto Polo-Barranco, Jhonny Patiño-Patiño, Mauricio Aldana-Roa, Valeria Sánchez-Daza, Emily Sierra-Ordoñez, Alfonso Bettin-Martínez
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引用次数: 0

摘要

钩端螺旋体病是一种重新出现的人畜共患疾病,对世界上大多数国家的卫生系统造成了前所未有的影响。其症状多种多样,通常从无症状病例到多器官功能障碍的严重表现,并伴有黄疸、出血、脑膜炎和急性肾损伤,需要重症监护辅助治疗。虽然早期抗生素治疗通常有效,但在严重病例中,可能需要肾脏替代疗法、侵入性机械通气、血管活性支持和侵入性血液动力学监测,从而增加了死亡风险。在拉丁美洲,急性肾损伤造成的实际负担尚不清楚,而且可能被低估,原因是该疾病进展迅速,与其他病媒人畜共患病类似,而且初级保健中的诊断检测覆盖率较低,尤其是在农村地区。因此,我们将在下文回顾临床方面的情况,并描述钩端螺旋体属急性肾损伤的科学、临床和治疗证据及其与拉丁美洲严重钩端螺旋体病患者的相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin America
Leptospirosis is a re-emerging zoonotic disease that has had an unprecedented impact on most health systems in the world. The spectrum of symptoms is variable and usually ranges from asymptomatic cases to severe manifestations involving multiple organ dysfunction accompanied by jaundice, hemorrhage, meningitis, and acute kidney injury that requires the need for intensive care assistance. Although early antibiotic treatment is usually effective, in severe cases, it may require renal replacement therapy, invasive mechanical ventilation, vasoactive support, and invasive hemodynamic monitoring, increasing the risk of death. In Latin America, the real burden of acute kidney injury in this condition is unknown and may be underestimated due to the rapid progression of the disease, similar to other vector zoonoses, and the low coverage of diagnostic tests in primary care, especially in rural regions. Therefore, below, we review the clinical aspects and describe the scientific, clinical, and therapeutic evidence of acute kidney injury attributed to Leptospira spp. and its relevance in patients with severe leptospirosis in Latin America.
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