183.4 📌 章末速記

• Leptospira interrogans — hooked spirochete, animal urine → water → human
• Risk: tropical, 颱風/洪水, 農業, 戶外水上, 動物接觸
• Phase 1: 急 fever + conjunctival suffusion + calf myalgia
• Severe: Weil’s disease (黃疸 + AKI + 出血), mortality 5-15%
• SPHS Asia variant — ARDS + alveolar hemorrhage 50% mortality
• Hypokalemia + disproportionate bilirubin = clue
• Dx: MAT paired serology, PCR blood (early) / urine (late), IgM ELISA
• Tx: doxy 100 bid (mild); ceftriaxone 1-2 g IV qd or PCN G IV (severe) × 7d
• Doxy-PEP 200 mg weekly high-risk
• 颱風後 fever + AKI + 黃疸 → 必 lepto workup