INTRODUCTION: Leptospirosis is a zoonotic disease found in tropical and temperate countries, and its clinical diagnostic confusion with arboviruses (dengue fever, oropouche fever and yellow fever), Brazilian spotted fever, viral hepatitis and hantaviruses has been an ongoing public health concern. The aim of this observational study was to demonstrate an association between findings of atypical lymphocytosis and the progression of endemic leptospirosis. METHODS: A retrospective analysis was performed on the demographic, epidemiological, clinical and laboratory aspects of 27 human leptospirosis cases that occurred over a period of 13 years (1996-2009) with no reported epidemic outbreaks in Rio de Janeiro, Brazil. RESULTS: The overall mortality rate was 11.1% in our cohort of hospitalized cases. However, there was no mortality among patients with atypical lymphocytosis (OR = 11.1; 95% CI = 1.12-110.9; p = 0.04). Two patients who were in the septicemic phase showed signs of expansion of γδ T cell responses in peripheral blood. CONCLUSIONS: Atypical lymphocytosis may be observed in patients with leptospirosis. Our observations suggest that these atypical leukocyte subsets are associated with partial protection during the disease course of leptospirosis.
A leptospirose é uma das zoonoses mais disseminadas mundialmente. Sua sintomatologia precoce inespecífica associada à variedade de apresentações clínicas pode levar a erros no diagnóstico e à conseqüente sub-notificação da doença. O presente estudo descreve a importância do diagnóstico de casos de leptospirose anictérica, associados à exposição ocupacional de aguadores de arroz em Santa Vitória do Palmar, região agrícola no sul do Brasil. O trabalho relata ainda o isolamento de uma cepa de Leptospira pertencente ao sorogrupo Pomona, a partir de uma hemocultura.
Staphylococcus aureus encoding Panton-Valentine leukocidin (PVL) genes has become the cause of life-threatening infections.We describe a case of carotid cavernous fistula after bacteremia in a 12-year-old male, caused by a methicillin-susceptible S. aureus isolate carrying the pvl, fnbA, and ebpS genes and related to sequence type 25 (ST25). The patient's condition was complicated by pleural empyema and osteomyelitis in the right femur. The patient was discharged in good clinical condition after 160 days of hospitalization. CASE REPORTA previously healthy 12-year-old male who practices kung fu was admitted on 5 December 2009 to the adolescent unit of a hospital located in Rio de Janeiro, Brazil. He was admitted with a history of 7 days of fever and muscle pain in his right thigh. Clinical signs and symptoms observed at the time of admission revealed severe sepsis and pyomyositis. During a physical examination, his axillar temperature was 37.9°C, with blood pressure of 180/90 mm Hg, a pulse of 136 beats per min, and respiration of 60 per min. Jaundice, abdominal pain, and dehydration were also observed. There was also focal pain in the right ankle and thigh. On admission, the laboratory findings revealed leukocytosis with 22,000 cells/mm 3 (90% polymorphonuclear leukocytes [PMN] with 23% bands), a hematocrit level of 25%, a hemoglobin level of 8.4 g/dl, and a platelet count of 140,000/mm 3 . The blood biochemical test results were as follows: glucose, 62 mg/dl; aspartate aminotransferase, 52 U/liter; alanine aminotransferase, 40 U/liter; bilirubin total level, 9.73 mg/dl, with conjugate at 6.45 mg/dl; urea, 62 mg/dl; creatinine, 1.2 mg/dl. Amylase, ␥-glutamyltransferase, alkaline phosphatase, and creatine phosphokinase (CPK) were normal. Arterial blood gas results were as follows: carbon dioxide tension (pCO 2 ), 31; oxygen tension (pO 2 ), 66; HCO 3 , 20; base excess (BE ϩ ), 2.8; oxyhemoglobin saturation (sat O 2 ), 93%; pH (hydrogen ionic potential), 7.43. A chest X-ray showed bilateral interstitial infiltrate. After blood cultures and serologic tests (cytomegalovirus [CMV], Epstein-Barr virus [EBV], HIV, hepatitis viruses, syphilis, and toxoplasmosis) were obtained, intravenous therapy was initiated with vancomycin at 1 g every 12 h (q12h), ceftriaxone at 1 g q12h, and clindamycin at 600 mg q6h. Continuous positive airway pressure (CPAP) was started for ventilatory support. Additional exams with computed tomography (CT) scan imaging showed multiple areas of pulmonary consolidation and pleural effusion. Ultrasonography confirmed myositis in the right thigh, and a transthoracic echocardiogram showed no valve vegetation. In the second day after his admission, a S. aureus strain (confirmed by catalase and coagulase tests) was isolated from two blood culture sets. Antimicrobial susceptibility testing (3) revealed that the isolates were susceptible to all the antimicrobials tested, including oxacillin. The antibiotics were changed to oxacillin. As the patient persisted with fever, tachypnea, and focal pain, he wa...
A leptospirose é uma das zoonoses mais disseminadas mundialmente. Sua sintomatologia precoce inespecífica associada à variedade de apresentações clínicas pode levar a erros no diagnóstico e à conseqüente sub-notificação da doença. O presente estudo descreve a importância do diagnóstico de casos de leptospirose anictérica, associados à exposição ocupacional de aguadores de arroz em Santa Vitória do Palmar, região agrícola no sul do Brasil. O trabalho relata ainda o isolamento de uma cepa de Leptospira pertencente ao sorogrupo Pomona, a partir de uma hemocultura.
Introdução Pacientes internados com diagnóstico de infecção por SARS-CoV-2 apresentam tempo prolongado de internação e variáveis relacionadas ao maior risco infecções secundárias relacionadas à assistência à saúde (IRAS) causadas por bactérias multirresistentes. Material e métodos Estudo prospectivo no Hospital Municipal de Barueri Dr. Francisco Moran, de 01/04 a 31/05/2021, em pacientes com RT-PCR SARS-Cov-2 positivo, em Unidade de Terapia Intensiva (UTI). Foram submetidos consecutivamente à coleta de cultura de vigilância (CVIG) na internação e a cada 7 dias até alta ou óbito e coletadas culturas clínicas. Foram avaliados Gram-negativos produtores de ESβL e carbapenemases. Identificação bacteriana foi realizada por Vitek-MS e perfil de sensibilidade pelo Vitek 2®. Determinação da concentração inibitória mínima de polimixina B por microdiluição em caldo. Pesquisas dos genes de resistência a ESβL e carbapenemases foram determinadas por PCR utilizando primers específicos. Resultados: 86 pacientes foram avaliados com culturas de vigilância. A mortalidade observada foi 75,58%. Positividade da CVIG foi 44%. Os microrganismos isolados foram: 77% K. pneumoniae, 15% A. baumannii e 8% E. faecium; sendo a distribuição durante as semanas: K. pneumoniae ( 1ª - 67%, 2ª - 86%, 3ª- 81%; 4ª- 40%, 5ª - 100%), A. baumannii ( 1ª - 13%, 2ª - 10%, 3 ª- 19%; 4ª- 40%). Entre os isolados de K. pneumoniae foi detectado resistência aos beta-lactâmicos, sendo 33,3%, 12,1% e 24,2% dos isolados resistentes à amicacina, gentamicina e polimixina B, respectivamente. Isolados de K. pneumoniae 90.9% carreavam genes blaKPC e blaCTX-M. Presença dos genes blaOxa-23 foi detectada em 100% dos A. baumannii. Nove pacientes desenvolveram IRAS, sendo 7 pneumonias relacionadas a ventilação mecânica (PAV) e 2 infecções primárias da corrente sanguínea (IPCS), com isolamento de 2 (28,57%) A. baumannii e 5 K. pneumoniae (71,43%) nas PAV e 2 (100%) K. pneumoniae nas IPCS. Em quatro pacientes observamos o isolamento do mesmo microrganismo (mesmo fenótipo) em CVIG e IRAS. Conclusão Observamos alta prevalência de colonização por bactérias produtoras de carbapenemase - K. pneumoniae e A. baumannii - adquiridas precocemente na internação, sendo possivelmente relacionadas a quatro infecções relacionadas ao serviço de saúde.
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