RESUMO
Leptospirosis is an infectious illness encountered mostly in tropical climates and has been of particular concern in Haiti after natural disasters. Heavy rainfalls and natural disasters in combination with scarce resources to control and identify clusters of infections make certain populations and countries vulnerable. In some cases, patients who contract this disease may need air medical transport to hospitals that have a higher level of care. In this case report, a trio of cases is highlighted from an outbreak that required air transport to transfer patients to a facility with the availability of an intensive care unit. The goal of highlighting these cases is to increase the awareness of physicians and air transport providers to the manifestation and treatment of this disease and to provide pearls to stabilize patients during transport.
Assuntos
Resgate Aéreo , Leptospirose , Humanos , Surtos de Doenças , Haiti/epidemiologia , Leptospirose/diagnóstico , Leptospirose/epidemiologia , Leptospirose/terapiaRESUMO
OBJECTIVE: To describe a severe case of infection by Leptospira in a woman in the northwest of Mexico. CASE REPORT: A 55-yearold woman from Sonora, México arrived at the Intensive Care Unit due to severe multiple organ failure primarily affecting the respiratory, renal and hepatic systems. Diagnostic tests were performed, and they were positive for anti-Leptospira antibodies, IgM and IgG; and spirochetes were observed on dark field microscopy and confirmed by Polymerase Chain Reaction (PCR). Doxycycline and platelet apheresis transfusion were used as treatment, which led to a very slow recovery. CONCLUSION: The information presented in this study may help in the identification of pathology caused by spirochetes. This case report is the first to present a case of severe leptospirosis in Sonora, México.
Assuntos
Leptospira , Leptospirose , Insuficiência de Múltiplos Órgãos/microbiologia , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Doxiciclina/uso terapêutico , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Unidades de Terapia Intensiva , Leptospira/genética , Leptospira/crescimento & desenvolvimento , Leptospirose/complicações , Leptospirose/diagnóstico , Leptospirose/microbiologia , Leptospirose/terapia , México , Microscopia/métodos , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Transfusão de Plaquetas , Reação em Cadeia da Polimerase , Índice de Gravidade de DoençaRESUMO
Cães são importantes reservatórios para Leptospira spp, na transmissão humana e disseminação em ambientes urbanos. A infecção ocorre principalmente pelos sorovares Canicola e Icterohaemorrhaghiae, podendo ser infectados por outros sorovares incidentais. A manifestação pode ser desde uma forma assintomática a quadros clínicos graves, com síndromes ictérica, hemorrágica, urêmica e reprodutivas. Diversas técnicas estão disponíveis para o diagnostico, sendo realizado principalmente por meio da soroaglutinação microscópica (SAM), isolamento em cultura ou reação em cadeia da polimerase (PCR). O tratamento com antibióticos são eficazes na fase leptospirêmica e leptospirúrica, e, consequentemente, na prevenção e controle da disseminação da bactéria no ambiente.
Dogs are important reservoirs for Leptospira spp, human transmission and dissemination in urban environments. The infection occurs mainly by serovars Canicola and Icterohaemorrhaghiae, and can be infected by other incident serovars. A manifestation can be made asymptomatically in severe clinical conditions, with icteric, hemorrhagic, uremic and reproductive syndromes. Several techniques available for diagnosis, being carried out mainly by means of microscopic soroagglutination (MAT), isolation in culture or polymerase chain reaction (PCR). Treatment with antibiotics is initiated in the leptospiremic and leptospirurgical phase and, consequently, in the prevention and control of the spread of the bacteria in the environment.
Assuntos
Animais , Cães , Doenças do Cão , Leptospira , Leptospirose/diagnóstico , Leptospirose/terapia , Leptospirose/veterináriaRESUMO
Cães são importantes reservatórios para Leptospira spp, na transmissão humana e disseminação em ambientes urbanos. A infecção ocorre principalmente pelos sorovares Canicola e Icterohaemorrhaghiae, podendo ser infectados por outros sorovares incidentais. A manifestação pode ser desde uma forma assintomática a quadros clínicos graves, com síndromes ictérica, hemorrágica, urêmica e reprodutivas. Diversas técnicas estão disponíveis para o diagnostico, sendo realizado principalmente por meio da soroaglutinação microscópica (SAM), isolamento em cultura ou reação em cadeia da polimerase (PCR). O tratamento com antibióticos são eficazes na fase leptospirêmica e leptospirúrica, e, consequentemente, na prevenção e controle da disseminação da bactéria no ambiente.(AU)
Dogs are important reservoirs for Leptospira spp, human transmission and dissemination in urban environments. The infection occurs mainly by serovars Canicola and Icterohaemorrhaghiae, and can be infected by other incident serovars. A manifestation can be made asymptomatically in severe clinical conditions, with icteric, hemorrhagic, uremic and reproductive syndromes. Several techniques available for diagnosis, being carried out mainly by means of microscopic soroagglutination (MAT), isolation in culture or polymerase chain reaction (PCR). Treatment with antibiotics is initiated in the leptospiremic and leptospirurgical phase and, consequently, in the prevention and control of the spread of the bacteria in the environment.(AU)
Assuntos
Animais , Cães , Leptospirose/diagnóstico , Leptospirose/terapia , Leptospirose/veterinária , Doenças do Cão , LeptospiraRESUMO
RESUMEN Fiebre amarilla (FA) y leptospirosis son zoonosis endémicas subdiagnosticadas de las regiones tropicales de África y Sudamérica. Ambas, pueden ser clínicamente indistinguibles y presentarse como síndrome febril icterohemorrágico agudo. Reportamos el caso de un varón de 20 años, procedente del departamento de Amazonas que se presentó con nueve días de enfermedad caracterizada por falla multiorgánica (compromiso neurológico, renal, hepático, respiratorio, y hematológico). Recibió tratamiento antibiótico, soporte transfusional, dialítico, hemodinámico, y ventilatorio; y a pesar de la gravedad del cuadro clínico, evolucionó favorablemente. Se confirmó FA por Rt-PCR y se obtuvo serología positiva para leptospira por ELISA y microaglutinación. Sin embargo, no se pudo demostrar, desde el punto de vista laboratorial, coinfección real por FA y leptospira. Este caso de FA severa con desenlace no fatal enfatiza la importancia del diagnóstico sindrómico adecuado, y un tratamiento de soporte precoz y agresivo que puede salvar la vida del paciente.
ABSTRACT Yellow fever (YF) and leptospirosis are under-diagnosed endemic zoonoses of the tropical regions of Africa and South America. Both may be clinically indistinguishable and present as an acute icterohemorrhagic febrile syndrome. We report the case of a 20-year-old male from the department of Amazonas who presented with nine days of disease characterized by multiorgan failure (neurological, renal, hepatic, respiratory, and hematological involvement). He received antibiotic treatment, as well as, transfusion, dialysis, hemodynamic, and ventilatory support. Despite the severity of the clinical condition, he evolved favorably. YF was confirmed by Rt-PCR and positive serology was obtained for leptospira by ELISA and microagglutination. However, from a laboratory point of view, real co-infection by yellow fever and leptospira could not be demonstrated. This case of severe YF with non-fatal outcome emphasizes the importance of adequate syndromic diagnosis, and early and aggressive supportive treatment that can save a patient's life.
Assuntos
Animais , Humanos , Masculino , Adulto Jovem , Febre Amarela , Febre , Leptospirose , Peru , Febre Amarela/diagnóstico , Febre Amarela/terapia , Índice de Gravidade de Doença , Zoonoses/diagnóstico , Zoonoses/terapia , Febre/etiologia , Coinfecção , Leptospirose/diagnóstico , Leptospirose/terapiaRESUMO
Yellow fever (YF) and leptospirosis are under-diagnosed endemic zoonoses of the tropical regions of Africa and South America. Both may be clinically indistinguishable and present as an acute icterohemorrhagic febrile syndrome. We report the case of a 20-year-old male from the department of Amazonas who presented with nine days of disease characterized by multiorgan failure (neurological, renal, hepatic, respiratory, and hematological involvement). He received antibiotic treatment, as well as, transfusion, dialysis, hemodynamic, and ventilatory support. Despite the severity of the clinical condition, he evolved favorably. YF was confirmed by Rt-PCR and positive serology was obtained for leptospira by ELISA and microagglutination. However, from a laboratory point of view, real co-infection by yellow fever and leptospira could not be demonstrated. This case of severe YF with non-fatal outcome emphasizes the importance of adequate syndromic diagnosis, and early and aggressive supportive treatment that can save a patient's life.
Fiebre amarilla (FA) y leptospirosis son zoonosis endémicas subdiagnosticadas de las regiones tropicales de África y Sudamérica. Ambas, pueden ser clínicamente indistinguibles y presentarse como síndrome febril icterohemorrágico agudo. Reportamos el caso de un varón de 20 años, procedente del departamento de Amazonas que se presentó con nueve días de enfermedad caracterizada por falla multiorgánica (compromiso neurológico, renal, hepático, respiratorio, y hematológico). Recibió tratamiento antibiótico, soporte transfusional, dialítico, hemodinámico, y ventilatorio; y a pesar de la gravedad del cuadro clínico, evolucionó favorablemente. Se confirmó FA por Rt-PCR y se obtuvo serología positiva para leptospira por ELISA y microaglutinación. Sin embargo, no se pudo demostrar, desde el punto de vista laboratorial, coinfección real por FA y leptospira. Este caso de FA severa con desenlace no fatal enfatiza la importancia del diagnóstico sindrómico adecuado, y un tratamiento de soporte precoz y agresivo que puede salvar la vida del paciente.
Assuntos
Febre , Leptospirose , Febre Amarela , Animais , Humanos , Masculino , Adulto Jovem , Coinfecção , Febre/etiologia , Leptospirose/diagnóstico , Leptospirose/terapia , Peru , Índice de Gravidade de Doença , Febre Amarela/diagnóstico , Febre Amarela/terapia , Zoonoses/diagnóstico , Zoonoses/terapiaRESUMO
OBJECTIVE: To characterize the transport of severely ill patients with extracorporeal respiratory or cardiovascular support. METHODS: A series of 18 patients in the state of São Paulo, Brazil is described. All patients were consecutively evaluated by a multidisciplinary team at the hospital of origin. The patients were rescued, and extracorporeal membrane oxygenation support was provided on site. The patients were then transported to referral hospitals for extracorporeal membrane oxygenation support. Data were retrieved from a prospectively collected database. RESULTS: From 2011 to 2017, 18 patients aged 29 (25 - 31) years with a SAPS 3 of 84 (68 - 92) and main primary diagnosis of leptospirosis and influenza A (H1N1) virus were transported to three referral hospitals in São Paulo. A median distance of 39 (15 - 82) km was traveled on each rescue mission during a period of 360 (308 - 431) min. A median of one (0 - 2) nurse, three (2 - 3) physicians, and one (0 - 1) physical therapist was present per rescue. Seventeen rescues were made by ambulance, and one rescue was made by helicopter. The observed complications were interruption in the energy supply to the pump in two cases (11%) and oxygen saturation < 70% in two cases. Thirteen patients (72%) survived and were discharged from the hospital. Among the nonsurvivors, there were two cases of brain death, two cases of multiple organ dysfunction syndrome, and one case of irreversible pulmonary fibrosis. CONCLUSIONS: Transportation with extracorporeal support occurred without serious complications, and the hospital survival rate was high.
OBJETIVO: Caracterizar pacientes graves transportados em suporte respiratório ou cardiovascular extracorpóreo. MÉTODOS: Descrição de uma série de 18 casos registrados no Estado de São Paulo. Todos os pacientes foram consecutivamente avaliados por uma equipe multidisciplinar no hospital de origem. Os pacientes foram resgatados, sendo a oxigenação por membrana extracorpórea instalada in loco. Os pacientes foram, então, transportados para os hospitais referenciados já em oxigenação por membrana extracorpórea. Os dados foram recuperados de um banco de dados prospectivamente coletado. RESULTADOS: De 2011 até 2017, 18 pacientes com 29 (25 - 31) anos, SAPS3 de 84 (68 - 92), com principais diagnósticos de leptospirose e influenza A (H1N1) foram transportados no Estado de São Paulo para três hospitais referenciados. Uma distância mediana de 39 (15 - 82) km foi percorrida em cada missão, em um tempo de 360 (308 - 431) minutos. As medianas de um (0 - 2) enfermeiro, três (2 - 3) médicos e um (0 - 1) fisioterapeuta foram necessárias por missão. Dezessete transportes foram realizados por ambulância e um por helicóptero. Existiram intercorrências: em duas ocasiões (11%), houve falha de fornecimento de energia para a bomba e, em duas ocasiões, queda da saturação de oxigênio < 70%. Treze pacientes (72%) sobreviveram para a alta hospitalar. Dos pacientes não sobreviventes, dois tiveram morte encefálica; dois, disfunção de múltiplos órgãos; e um, fibrose pulmonar considerada irreversível. CONCLUSÕES: O transporte com suporte extracorpóreo ocorreu sem intercorrências maiores, com uma sobrevida hospitalar alta dos pacientes.
Assuntos
Resgate Aéreo , Ambulâncias , Oxigenação por Membrana Extracorpórea/métodos , Transporte de Pacientes/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Bases de Dados Factuais , Feminino , Humanos , Influenza Humana/epidemiologia , Influenza Humana/terapia , Leptospirose/epidemiologia , Leptospirose/terapia , Masculino , Equipe de Assistência ao Paciente , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
RESUMO Objetivo: Caracterizar pacientes graves transportados em suporte respiratório ou cardiovascular extracorpóreo. Métodos: Descrição de uma série de 18 casos registrados no Estado de São Paulo. Todos os pacientes foram consecutivamente avaliados por uma equipe multidisciplinar no hospital de origem. Os pacientes foram resgatados, sendo a oxigenação por membrana extracorpórea instalada in loco. Os pacientes foram, então, transportados para os hospitais referenciados já em oxigenação por membrana extracorpórea. Os dados foram recuperados de um banco de dados prospectivamente coletado. Resultados: De 2011 até 2017, 18 pacientes com 29 (25 - 31) anos, SAPS3 de 84 (68 - 92), com principais diagnósticos de leptospirose e influenza A (H1N1) foram transportados no Estado de São Paulo para três hospitais referenciados. Uma distância mediana de 39 (15 - 82) km foi percorrida em cada missão, em um tempo de 360 (308 - 431) minutos. As medianas de um (0 - 2) enfermeiro, três (2 - 3) médicos e um (0 - 1) fisioterapeuta foram necessárias por missão. Dezessete transportes foram realizados por ambulância e um por helicóptero. Existiram intercorrências: em duas ocasiões (11%), houve falha de fornecimento de energia para a bomba e, em duas ocasiões, queda da saturação de oxigênio < 70%. Treze pacientes (72%) sobreviveram para a alta hospitalar. Dos pacientes não sobreviventes, dois tiveram morte encefálica; dois, disfunção de múltiplos órgãos; e um, fibrose pulmonar considerada irreversível. Conclusões: O transporte com suporte extracorpóreo ocorreu sem intercorrências maiores, com uma sobrevida hospitalar alta dos pacientes.
ABSTRACT Objective: To characterize the transport of severely ill patients with extracorporeal respiratory or cardiovascular support. Methods: A series of 18 patients in the state of São Paulo, Brazil is described. All patients were consecutively evaluated by a multidisciplinary team at the hospital of origin. The patients were rescued, and extracorporeal membrane oxygenation support was provided on site. The patients were then transported to referral hospitals for extracorporeal membrane oxygenation support. Data were retrieved from a prospectively collected database. Results: From 2011 to 2017, 18 patients aged 29 (25 - 31) years with a SAPS 3 of 84 (68 - 92) and main primary diagnosis of leptospirosis and influenza A (H1N1) virus were transported to three referral hospitals in São Paulo. A median distance of 39 (15 - 82) km was traveled on each rescue mission during a period of 360 (308 - 431) min. A median of one (0 - 2) nurse, three (2 - 3) physicians, and one (0 - 1) physical therapist was present per rescue. Seventeen rescues were made by ambulance, and one rescue was made by helicopter. The observed complications were interruption in the energy supply to the pump in two cases (11%) and oxygen saturation < 70% in two cases. Thirteen patients (72%) survived and were discharged from the hospital. Among the nonsurvivors, there were two cases of brain death, two cases of multiple organ dysfunction syndrome, and one case of irreversible pulmonary fibrosis. Conclusions: Transportation with extracorporeal support occurred without serious complications, and the hospital survival rate was high.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Oxigenação por Membrana Extracorpórea/métodos , Ambulâncias , Transporte de Pacientes/métodos , Resgate Aéreo , Equipe de Assistência ao Paciente , Índice de Gravidade de Doença , Brasil , Estudos Prospectivos , Bases de Dados Factuais , Influenza Humana/terapia , Influenza Humana/epidemiologia , Leptospirose/terapia , Leptospirose/epidemiologiaRESUMO
Leptospirosis is a zoonosis caused by a gram negative aerobic spirochete of the genus Leptospira. It is acquired by contact with urine or reproductive fluids from infected animals, or by inoculation from contaminated water or soil. The disease has a global distribution, mainly in tropical and subtropical regions that have a humid, rainy climate and is also common in travelers returning from these regions. Clinical suspicion is critical for the diagnosis and it should be included in the differential diagnosis of any patient with a febrile hepatorenal syndrome in, or returning from endemic regions. The leptospiremic phase occurs early and thereafter there is an immunologic phase in which the most severe form, Weil's disease, occurs. In the latter, multiple organ dysfunction predominates. The appropriate diagnostic test depends on the stage of the disease and consists of direct and indirect detection methods and cultures. Severely ill patients need to be monitored in an ICU with appropriate anti-bacterial agents and early, aggressive and effective organ support. Antibiotic therapy consists of penicillins, macrolides or third generation cephalosporins.
Assuntos
Comitês Consultivos , Antibacterianos/uso terapêutico , Cuidados Críticos , Leptospirose/diagnóstico , Sociedades Médicas , Medicina Tropical , Doença de Weil/diagnóstico , Animais , Cuidados Críticos/normas , Diagnóstico Diferencial , Febre/diagnóstico , Humanos , Leptospirose/terapia , Doença de Weil/terapiaRESUMO
BACKGROUND: This study was conducted to investigate changes in the clinical pattern of leptospirosis over time, analyzing its clinical and laboratory presentations in a metropolitan city of Brazil. METHOD: This was a retrospective study including all patients with leptospirosis admitted to tertiary care hospitals in Fortaleza in the northeast of Brazil, between 1985 and 2015. Patients were divided into three groups according to the year of hospital admission: group I for the years 1985-1995, group II for 1996-2005, and group III for 2006-2015. Demographic, clinical, and laboratory data were compared between the groups. RESULTS: A total of 507 patients were included. Their mean age was 37.3±15.9years and 82.4% were male. The mean time between symptom onset and admission was 7±4 days. There was a linear decrease in the levels of serum urea (190.1±92.7, 135±79.5, and 95.6±73.3mg/dl, respectively, p <0.0001) and creatinine (5.8±2.9, 3.8±2.6, and 3.0±2.5mg/dl, respectively, p <0.0001) in each decade, while levels of hemoglobin (10.31±1.9, 10.8±2.0, and 11.5±2.1g/dl, respectively, p <0.0001) and platelets (57.900±52.650, 80.130±68.836, and 107.101±99.699×109/l, respectively, p<0.0001) increased. There was a tendency towards a linear decrease in mortality (22%, 14%, and 11.6%, respectively, p=0.060). CONCLUSIONS: Leptospirosis showed significant changes over time in this region. The main changes point to a decrease in disease severity and complications, such as acute kidney injury. Mortality has decreased, being close to 11%.
Assuntos
Injúria Renal Aguda/etiologia , Leptospirose/diagnóstico , Injúria Renal Aguda/terapia , Adulto , Brasil , Creatinina/sangue , Estudos Transversais , Demografia , Feminino , Hospitalização , Humanos , Leptospirose/complicações , Leptospirose/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/complicações , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/terapia , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto JovemRESUMO
The occurrence of leptospirosis has defied epidemiology even when using different analysis technologies at local geographical levels. This cross-sectional and descriptive study sought to identify spatial correlations between social and environmental risk factors and leptospirosis in Belém in the State of Pará from 2007 to 2013. Epidemiological data were obtained from the Information System for Notifiable Diseases of the Pará State Department of Public Health and the environmental, demographic and cartographical data from the Brazilian Institute of Geography and Statistics. Men aged 20 to 39 of unknown profession and mixed ethnicity were the most affected. Laboratory diagnosis (82%) and hospital care (67.22%) confirmed satisfactory access to the Unified Health System. Numerical Kriging indicated the highest concentrations of the disease in the Guamá and Jurunas neighborhoods in lower lying areas near canals. The Buffer technique showed higher concentrations of the disease in areas with no domestic solid garbage collection service (26%), sewage (22%), piped water (38%), with unpaved roads (20%) and street flooding (65%). The Moran technique revealed a direct spatial correlation between these variables (p = 0.01543). The general trend showed the decrease of the disease.
Assuntos
Acessibilidade aos Serviços de Saúde , Leptospirose/epidemiologia , Saneamento/estatística & dados numéricos , Esgotos/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Inundações/estatística & dados numéricos , Resíduos de Alimentos , Humanos , Leptospirose/etiologia , Leptospirose/terapia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise Espaço-Temporal , Adulto JovemRESUMO
BACKGROUND: Leptospirosis is a health problem worldwide. Its most severe form is a classic model of sepsis, provoking acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), with associated mortality that remains unacceptably high. We previously demonstrated that early initiation of sustained low-efficiency dialysis (SLED) followed by daily SLED significantly decreases mortality. However, the mode of clearance can also affect dialysis patient outcomes. Therefore, the objective of this study was to compare the effects of SLED with traditional (diffusive) clearance, via hemodialysis, and SLED with convective clearance, via hemodiafiltration (SLEDf), in patients with severe leptospirosis. METHODS: In this prospective study, conducted in the intensive care unit (ICU) from 2009 through 2012, we compared two groups-SLED (n = 19) and SLEDf (n = 20)-evaluating demographic, clinical, and biochemical parameters, as well as serum levels of interleukins, up to the third day after admission. All patients received dialysis early and daily thereafter. RESULTS: During the study period, 138 patients were admitted to our ICU with a diagnosis of leptospirosis; 39 (36 males/3 females) met the criteria for ARDS and AKI. All patients were on mechanical ventilation and were comparable in terms of respiratory parameters. Mortality did not differ between the SLEDf and SLED groups. However, post-admission decreases in the serum levels of interleukin (IL)-17, IL-7, and monocyte chemoattractant protein-1 were significantly greater in the SLEDf group. Direct bilirubin and the arterial oxygen tension/fraction of inspired oxygen ratio were significantly higher in the SLED group. We identified the following risk factors (sensitivities/specificities) for mortality in severe leptospirosis: age ≥ 55 years (67%/91%); serum urea ≥ 204 mg/dl (100%/70%); creatinine ≥ 5.2 mg/dl (100%/58%); Acute Physiology and Chronic Health Evaluation II score ≥ 39.5 (67%/88%); Sequential Organ Failure Assessment score ≥ 20.5 (67%/85%); and inspiratory pressure ≥ 31 mmHg (84%/85%). CONCLUSIONS: The mode of dialysis clearance might not affect outcomes in severe leptospirosis.
Assuntos
Hemodiafiltração , Mediadores da Inflamação/sangue , Leptospirose/terapia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/complicações , Injúria Renal Aguda/terapia , Adulto , Idoso , Quimiocina CCL2/sangue , Feminino , Humanos , Unidades de Terapia Intensiva , Interleucina-17/sangue , Interleucina-7/sangue , Leptospirose/sangue , Leptospirose/patologia , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório/sangue , Síndrome do Desconforto Respiratório/complicações , Síndrome do Desconforto Respiratório/terapia , Sepse/sangue , Sepse/complicações , Sepse/terapia , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
The interest in commercial use of wild animals is increasing, especially regarding raising of capybaras. Although this wild species is potentially lucrative for the production of meat, oil and leather, it is suggested as a probable reservoir of leptospires. Methods Due to the economic importance of this species and the lack of studies concerning leptospirosis, the presence of anti-leptospirosis agglutinins was assayed in 55 serum samples of capybaras (Hydrochoerus hydrochaeris) from commercial and experimental breeding flocks located in São Paulo state, Paraná state, and Rio Grande do Sul state, Brazil. Samples were obtained through cephalic or femoral venipunction (5 to 10 mL). Microscopic agglutination test was used according to the Brazilian Health Ministry considering as cut-off titer of 100. Results Out of the 55 samples analyzed, 23 (41.82 %) tested positive. The most prevalent serovar was Icterohaemorrhagiae (56.52 %) in 13 samples, followed by Copenhageni in nine samples (39.13 %), Pomona in four samples (17.39 %), Djasiman and Castellonis in three samples each (13.04 %), Grippotyphosa, Hardjo, Canicola, and Cynopteri in two samples each (8.7 %), and Andamana and Bratislava in one sample each (4.34 %). Conclusions These results suggest the evidence of exposure toLeptospira spp. and the need of new studies to evaluate a higher number of capybaras from different regions to better understand the importance of leptospirosis infection in these animals and verify the zoonotic role of this species as a possible source of infection to humans and other animals.(AU)
Assuntos
Animais , Aglutininas/administração & dosagem , Aglutininas/análise , Leptospirose/terapia , Leptospirose/veterinária , Roedores/microbiologiaRESUMO
Resumo A ocorrência da leptospirose tem desafiado a epidemiologia na utilização de diferentes tecnologias de análises em escalas geográficas locais. Este estudo transversal e descritivo objetivou identificar correlações espaciais de fatores de risco socioambientais com a leptospirose em Belém, Pará, entre 2007 e 2013. Os dados epidemiológicos foram obtidos no Sistema de Informação de Agravos de Notificação, da Secretaria do Estado de Saúde Pública e os ambientais, demográficos e territoriais no Instituto Brasileiro de Geografia e Estatística. Homens, 20 a 39 anos, ocupação indeterminada, etnia parda, foram os mais acometidos. O diagnóstico laboratorial (82%) e o atendimento hospitalar (67,22%) demonstraram acesso satisfatório ao Sistema de Saúde. A Krigagem numérica mostrou a maior concentração da doença nos bairros Guamá e Jurunas, em áreas de menores cotas altimétricas, próximas a canais. A técnica de Buffer apontou maior concentração da doença em áreas de ausência de coleta de resíduos sólidos domiciliares (26%), esgoto (22%), água encanada (38%), e com arruamento não pavimentado (20%) e alagamento de rua (65%). A técnica de Moran demonstrou uma correlação espacial direta entre estas variáveis (p = 0,01543). A tendência geral expressou o decréscimo da doença.
Abstract The occurrence of leptospirosis has defied epidemiology even when using different analysis technologies at local geographical levels. This cross-sectional and descriptive study sought to identify spatial correlations between social and environmental risk factors and leptospirosis in Belém in the State of Pará from 2007 to 2013. Epidemiological data were obtained from the Information System for Notifiable Diseases of the Pará State Department of Public Health and the environmental, demographic and cartographical data from the Brazilian Institute of Geography and Statistics. Men aged 20 to 39 of unknown profession and mixed ethnicity were the most affected. Laboratory diagnosis (82%) and hospital care (67.22%) confirmed satisfactory access to the Unified Health System. Numerical Kriging indicated the highest concentrations of the disease in the Guamá and Jurunas neighborhoods in lower lying areas near canals. The Buffer technique showed higher concentrations of the disease in areas with no domestic solid garbage collection service (26%), sewage (22%), piped water (38%), with unpaved roads (20%) and street flooding (65%). The Moran technique revealed a direct spatial correlation between these variables (p = 0.01543). The general trend showed the decrease of the disease.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Esgotos/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Leptospirose/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Fatores de Risco , Inundações/estatística & dados numéricos , Análise Espaço-Temporal , Resíduos de Alimentos , Leptospirose/etiologia , Leptospirose/terapiaRESUMO
The interest in commercial use of wild animals is increasing, especially regarding raising of capybaras. Although this wild species is potentially lucrative for the production of meat, oil and leather, it is suggested as a probable reservoir of leptospires. Methods Due to the economic importance of this species and the lack of studies concerning leptospirosis, the presence of anti-leptospirosis agglutinins was assayed in 55 serum samples of capybaras (Hydrochoerus hydrochaeris) from commercial and experimental breeding flocks located in São Paulo state, Paraná state, and Rio Grande do Sul state, Brazil. Samples were obtained through cephalic or femoral venipunction (5 to 10 mL). Microscopic agglutination test was used according to the Brazilian Health Ministry considering as cut-off titer of 100. Results Out of the 55 samples analyzed, 23 (41.82 %) tested positive. The most prevalent serovar was Icterohaemorrhagiae (56.52 %) in 13 samples, followed by Copenhageni in nine samples (39.13 %), Pomona in four samples (17.39 %), Djasiman and Castellonis in three samples each (13.04 %), Grippotyphosa, Hardjo, Canicola, and Cynopteri in two samples each (8.7 %), and Andamana and Bratislava in one sample each (4.34 %). Conclusions These results suggest the evidence of exposure toLeptospira spp. and the need of new studies to evaluate a higher number of capybaras from different regions to better understand the importance of leptospirosis infection in these animals and verify the zoonotic role of this species as a possible source of infection to humans and other animals.
Assuntos
Animais , Aglutininas/administração & dosagem , Aglutininas/análise , Leptospirose/terapia , Leptospirose/veterinária , Roedores/microbiologiaRESUMO
PURPOSE OF REVIEW: In the past years, the importance of studying leptospirosis in a translational context has become more evident. This review addresses recent findings in the study of leptospirosis infection, focusing on those applicable to public health, or that will affect management and diagnosis of cases of leptospirosis. RECENT FINDINGS: We review here recent findings regarding translational aspects of leptospirosis research. Briefly, PCR or a combination of serology and PCR seem to have a higher sensitivity than the current gold standard (microagglutination test). More clinical trials are needed to determine the best treatment for mild and severe leptospirosis. Dendritic cells and γδ T cells seem to have an important role in the immune response to leptospirosis. Environmental assessment is emerging as a very useful tool. SUMMARY: In order to understand leptospirosis, multiple aspects need to be considered, including host, pathogen and environment. In this review, we will address newer diagnostics, current advances in immunology and treatment and the growing role of environmental assessment.
Assuntos
Leptospirose/diagnóstico , Leptospirose/terapia , Pesquisa Translacional Biomédica , Animais , Humanos , Zoonoses/microbiologiaRESUMO
This study presents a Brazilian goat herd with reproductive failure over 2009-2010, in which there were abortions (22/50; 44%), embryonic resorption (6/50; 12%) and neonatal deaths (2/50; 4%). A diagnosis of leptospirosis was made, based on serology (microscopic agglutination test - MAT), bacterial culture, and polymerase chain reaction (PCR). Antibiotic therapy, specific vaccination protocols and changes in management practices were instigated. One year after the outbreak, diagnostic methods were repeated and reproductive performance re-analysed. Soon after the outbreak, 61/125 (48.8%) of the goats were seropositive for Leptospira. Pure isolates of Leptospira were not obtained, but Leptospira PCR testing was positive in 48/50 (96%) urine samples. After 1 year only 4.2% were seropositive and the occurrence of reproductive problems decreased roughly 10-fold, although five goats (10.4%) remained PCR-positive. A broad-based management approach, including serological and molecular diagnostic methods, vaccination, antibiotic treatment, and alteration of some environmental aspects, were critical to the control of this outbreak, thereby minimising subsequent reproductive failures and economic losses.
Assuntos
Anticorpos Antibacterianos/urina , Surtos de Doenças/veterinária , Doenças das Cabras/diagnóstico , Doenças das Cabras/terapia , Leptospira/imunologia , Leptospirose/veterinária , Aborto Animal/diagnóstico , Aborto Animal/epidemiologia , Aborto Animal/terapia , Testes de Aglutinação/veterinária , Criação de Animais Domésticos/métodos , Animais , Antibacterianos/uso terapêutico , Vacinas Bacterianas/uso terapêutico , Brasil/epidemiologia , Sulfato de Di-Hidroestreptomicina/uso terapêutico , Perda do Embrião/diagnóstico , Perda do Embrião/epidemiologia , Perda do Embrião/terapia , Feminino , Doenças das Cabras/epidemiologia , Cabras , Leptospira/isolamento & purificação , Leptospirose/diagnóstico , Leptospirose/epidemiologia , Leptospirose/terapia , Reação em Cadeia da Polimerase/veterinária , Estudos Soroepidemiológicos , Vacinas de Produtos Inativados/uso terapêuticoRESUMO
Atualmente, no Brasil, 28 por cento dos casos notificados de leptospirose estão relacionados a áreas rurais. Nessas áreas, a transmissão da leptospirose ocorre de forma indireta, normalmente, ligada ao processo de trabalho das pessoas que lidam com produção de grãos e cereais. Em 2008 no município de Várzea Alegre, CE ocorreu um surto de leptospirose em agricultores envolvidos com o cultivo de arroz. Na ocasião foi desenvolvido um estudo seccional no qual foram levantadas algumas hipóteses e dentre elas que o adoecimento por leptospirose ocorreu devido à atividade laboral desenvolvida pelos trabalhadores na lavoura de arroz. O objetivo deste trabalho foi identificar fatores de risco para o adoecimento por leptospirose, relacionados à atividade laboral, em surto do município de Várzea Alegre a partir de um estudo de caso controle (1:2) de base populacional do período de janeiro a julho de 2008. Considerou-se caso confirmado de leptospirose o indivíduo que apresentou titulação de anticorpos para leptospirose maior ou igual a 1:100 pelo método da soroaglutinação microscópica e controle o indivíduo sadio com resultado laboratorial negativo para anticorpos para leptospirose pelo mesmo método. Foram desenvolvidas análises bi e multivariadas. Dois modelos teóricos foram elaborados e avaliados. No primeiro modelo teórico, os fatores de risco associados foram ser do sexo masculino e ter trabalhado na lavoura do arroz. Sendo assim, para identificar quais os fatores de risco, intrinsicamente, ligados a lavoura do arroz puderam estar relacionados ao desfecho, decidiu-se por realizar um segundo modelo entre os casos que relataram ter trabalhado na lavoura...
Assuntos
Humanos , Surtos de Doenças , Leptospirose/diagnóstico , Leptospirose/epidemiologia , Leptospirose/transmissão , População Rural , Estudos de Casos e Controles , Leptospirose/etiologia , Leptospirose/patologia , Leptospirose/terapia , Fatores de Risco , Saúde da População RuralRESUMO
The role of plasmapheresis on the treatment of Leptospirosis has not been define, although it has already been used with beneficial effects in the reported case mentioned above, where was possible to contribute to the resolution of the toxic effects on the tubular renal cells. This case report show how plasma exchange prevents the multiorganic failure.