Клініко-епідеміологічна характеристика лептоспірозу в Одеській області (за даними багаторічного спостереження)

Abstract

Для епідемічного процесу лептоспірозу в Одеській області на сучасному етапі характерний виражений спад захворюваності з середнім темпом – на 10,00% щорічно, з високим рівнем летальності. Достатня частота госпіталізації в перший день після звернення в 37,88% випадків супроводжується помилковим первинним діагнозом. Хворіють переважно чоловіки працездатного віку, але, в більшості випадків, безробітні (45,21%). Серед хворих переважають сільські жителі – 65,75%. Зараження відбувалося, головним чином, водним (80,82%) і контактним (5,48%) шляхами, у 49,32% джерелом інфекції були гризуни. Клінічна картина лептоспірозу була типовою, з важким (77,78%) та середньо-важким (22,22%) перебігом, однак характерний для лептоспірозу симптом – біль в литкових м’язах зустрічався лише в 44,44% випадків.

The purpose of the work: to study the clinical and epidemiological manifestations of the epidemic process (long-term dynamics of morbidity and mortality, gender and age distribution, prevalence among urban and rural population, socio-occupational groups) in the Odessa region during 2009-2017. The object and methods of research. The object of the study is the epidemic process of leptospirosis. The research used the following methods: a retrospective epidemiological analysis of the relevant forms of sectoral statistical reporting of the Odessa region for the period from 2009 to 2017 (f-40, f-391 / o, f-003 / o); statistical (using software packages “Microsoft Excel 2010” and computer program “STATISTICA 5”); analytical. Results of researches and their discussion. In the period from 2000 to 2017, in the Odessa region, 266 people became ill with leptospirosis. The incidence rate in the region ranged from 1.63 to 100 thousand in 2001 to 0.13 in 2015-2016 (M = 0.64 ± 0.1). For the Odessa region there is a pronounced tendency to decrease the incidence of diseases with an average rate of decline of 10.00% annually. In the analyzed period, high lethality with uneven distribution was revealed: in 2000-2008 – 19.01%; in 2009-2017, the much lower level is 9.67%. During the period studied, the majority of patents (90.41%) were hospitalized the first day after the diagnosis, but in 37.88% of cases with an erroneous primary diagnosis. A fairly large part (35.62%) of the diagnosis was set on the third day and later. Most often, leptospirosis was affected by men (98.63%), age groups 30-39 years old (24.66%), who live in rural areas (65.75%), most often without professional ties, in conditions of unemployment (45.21%). It was established that the infection was mainly caused by water (80.82%) and contact (5.48%) by way of swimming, fishing or agricultural work in humid areas. In 78,08% of cases, these were natural cells. A specific source of infection in half of the cases were rodents (49.32%), in half of the cases (49.32%) the source of infection could not be established. The clinical picture of leptospirosis was typical, with a severe (77.78%) and median (22.22%) course of the disease. All patents had acute onset of the disease with fever up to 38.5-40. 0ᵒC and intoxication syndrome, which in 33.33% (3/9) of cases was accompanied by nausea and vomiting. Hepatomegaly, jaundice, and hepatorenal syndrome were noted in 88.89% (8/9) of cases and, accordingly, correlated with the severity of the course of the disease. The typical symptom for leptospirosis – pain in gastrocnemius muscles was found only in 44.44% (4/9) cases. Conclusions. The epidemic process of leptospirosis in the Odessa region at the present stage is characterized by a pronounced decline in the incidence rate with an average rate of 10.00% annually, with a high level of mortality. A rather high rate of hospitalization on the first day after going to a doctor in 37.88% of cases is accompanied by an erroneous primary diagnosis. The sick are mostly men of working age, but, in most cases, unemployed men (45.21%). Among patents, rural residents predominate – 65.75%. Infection occurred mainly through water (80.82%) and contact (5.48%) routes of infection, in 49.32% of cases the source of infection was rodents, and in the same number of cases the source of infection was not established. The clinical picture of leptospirosis was typical, with severe (77.78%) and median (22.22%) course of the disease, but the typical symptom for leptospirosis – pain in the gastrocnemius muscles – was found only in 44.44% (4/9) cases.

Для эпидемического процесса лептоспироза в Одесской области на современном этапе характерен выраженный спад заболеваемости со средним темпом – на 10,00% ежегодно, с высоким уровнем летальности. Достаточно высокая частота госпитализации в первый день после обращения в 37,88% случаев сопровождается ошибочным первичным диагнозом. Болеют преимущественно мужчины трудоспособного возраста, но, в большинстве случаев, безработные (45,21%). Среди больных преобладают сельские жители – 65,75%. Заражение происходило, главным образом, водным (80,82%) и контактным (5,48%) путями, в 49,32% источником инфекции были грызуны. Клиническая картина лептоспироза была типичной, с тяжелым (77,78%) и среднетяжелым (22,22%) течением, однако характерный для лептоспироза симптом – боль в икроножных мышцах встречался только в 44,44% случаев.