Leptospirosis severity may be associated with the intensity of humoral immune response

Abdulkader, Regina C. R. M.; Daher, Elizabeth F.; Camargo, Eide Dias; Spinosa, Claudia; Silva, Marcos Vinícius da

doi:10.1590/s0036-46652002000200005

Cited by 46 publications

(31 citation statements)

References 18 publications

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“…The need of dialysis reported in literature ranges from 6% to 49%. 19,[41][42][43] In the present study, intermittent peritoneal dialysis was performed in 61% and daily hemodialysis in 39% of the patients who underwent in dialytic therapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Daher¹,

Lima²,

Júnior³

et al. 2010

Braz J Infect Dis

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INTRODUCTION: leptospirosis is a zoonosis of worldwide importance. The disease is endemic in Brazil. This study was conducted to describe the clinical and laboratory presentation of leptospirosis in a metropolitan city of Brazil. METHODS: this is a retrospective study including 201 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil, between 1985 and 2006. All patients had clinical and epidemiological data suggestive of leptospirosis, and positive laboratorial test for leptospirosis (microscopic agglutination test, MAT, higher than 1:800). RESULTS: a total of 201 patients were included, with mean age of 38.9 ± 15.7 years; 79.1% were male. The mean length from onset of symptoms to admission was 7 ± 3 days. The main clinical signs and symptoms at admission were fever (96.5%), jaundice (94.5%), myalgia (92.5%), headache (74.6%), vomiting (71.6%) and dehydration (63.5%). Hemorrhagic manifestations were present in 35.8%. Acute kidney injury was found in 87% of the patients. Platelet count was less than 100,000/mm³ in 74.3%. Hematuria was found in 42.9%. Death occurred in 31 cases (15.4%). CONCLUSIONS: leptospirosis is a globally relevant disease with potential fatal outcome. Signs and symptoms suggestive of leptospirosis must be known by any physician in order to institute early adequate treatment to improve outcome. Early indication and daily hemodialysis seems to be beneficial in this group of patients

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Section: Discussionmentioning

confidence: 99%

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Daher¹,

Lima²,

Júnior³

et al. 2010

Braz J Infect Dis

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“…In a Brazilian study, 35 hospitalized patients with Weil's disease had five blood samples drawn, from the 15th day to the 12th month of symptoms, for ELISA-IgM, -IgG and -IgA specific antibody detection. Patients with an IgG titer of 400 (n=13) or more had more severe pulmonary hemorrhage and renal function damage compared with patients with an IgG titer of less than 400 (n=22), suggesting that the severity of Weil's disease may be associated with the intensity of the humoral immune response to leptospire [46].…”

Section: Histological Findings and Pathophysiology In Human Pulmonarymentioning

confidence: 99%

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Dolhnikoff¹,

Mauad²,

Bethlem³

et al. 2007

Braz J Infect Dis

113

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Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70% of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.

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“…É possível que esse seja um achado subrepresentado, devido a sua diϐícil visualização quando frente à hemorragia intensa (Abdulkader et al 2002). Embora capilarite na leptospirose não tenha sido citada por nenhum trabalho cientíϐico ou livro de patologia veterinária, não é incomum observar essa lesão em imagens na literatura (Greene et al 2006), entretanto, interpretada pelos autores com outras denominações, como pneumonia intersticial ou marginação de neutróϐilos em pequenos vasos sanguíneos.…”

Section: Discussionunclassified

Aspectos anatomopatológicos da leptospirose em cães: 53 casos (1965-2011)

et al. 2012

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Os aspectos anatomopatológicos da leptospirose foram estudados em 53 cães que tiveram diagnóstico definitivo confirmado por imuno-histoquímica do tecido renal. Na necropsia, as principais lesões observadas incluíram icterícia (79,2%) e hemorragia (75,5%), principalmente no pulmão (56,6%). Alterações macroscópicas hepáticas (56,6%) e renais (50,9%) foram frequentes e caracterizavam-se principalmente por descolorações (30,2% e 32,1% respectivamente), acentuação do padrão lobular hepático (26,4%) e estriações brancas na superfície de corte dos rins (22,6%). Lesões extrarrenais de uremia ocorreram na metade dos casos (50,9%). Hepatomegalia (11,3%), nefromegalia (9,4%) e irregularidade da superfície capsular dos rins (3,8%) foram menos comuns. Na histologia dos rins (n=53), as lesões encontradas (98,1%) foram quase que exclusivamente agudas ou subagudas (96,2%) e caracterizavam-se por graus variados de nefrose tubular (86,8%) e nefrite intersticial não supurativa (60,4%), com evidente dissociação degenerativo-inflamatória. Na histologia do fígado (n=42), as lesões encontradas (97,6%) eram constituídas principalmente por dissociação dos cordões de hepatócitos (78,6%), colestase intra-canalicular (33,3%) e necrose hepática (31%). Lesões reativas, como hipertrofia das células de Kupffer, leucocitostase sinusoidal e infiltrado inflamatório mononuclear nos espaços porta, foram vistas em muitos casos (42,8%). Na histologia do pulmão (n=28), hemorragia (85,7%) e edema (57,1%) alveolares foram muito prevalentes. Neutrófilos e macrófagos nos espaços alveolares (35,7%) e neutrófilos no interior de pequenos vasos pulmonares (17,9%) também foram achados frequentes. Os resultados aqui demonstrados devem servir de alerta aos patologistas veterinários brasileiros, pois a apresentação anatomopatológica da leptospirose canina em nossa região (Região Central do Rio Grande do Sul, Brasil) não se modificou nos últimos 50 anos, mantendo-se semelhante àquela descrita internacionalmente até a década de 1980, mas muito diferente do que é atualmente reconhecido para os Estados Unidos, o Canadá e parte da Europa Ocidental. Recomendamos que os critérios histopatológicos para o diagnóstico da leptospirose canina devem incluir a presença concomitante de nefrite tubulointersticial aguda ou subaguda, hepatite reativa não específica e lesão alveolar difusa, incluindo hemorragia alveolar difusa com capilarite, em um cão que durante a necropsia demonstre icterícia, hemorragias e lesões extrarrenais de uremia na ausência de esplenomegalia.

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Leptospirosis severity may be associated with the intensity of humoral immune response

Cited by 46 publications

References 18 publications

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Aspectos anatomopatológicos da leptospirose em cães: 53 casos (1965-2011)

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