Thrombocytopenia in Leptospirosis: The Absence of Evidence for Disseminated Intravascular Coagulation

Edwards, Charles N.; Nicholson, G. D.; Hassell, Trevor; Everard, C. O. R.; Callender, Joy

doi:10.4269/ajtmh.1986.35.352

Cited by 75 publications

(37 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Capillary damage by direct action of a leptospiral toxin has been suggested (POH & SOH, 1970). Coagulation disturbances have been postulated but not conclusively demonstrated (EDWARDS et al, 1986). Low platelet count, a common finding in leptospiral infection (EDWARDS etal., 1982;NICODEMO et al.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

Yersin

Bovet

Mérien

et al. 2000

Transactions of the Royal Society of Tropical Medicine and Hygi

View full text Add to dashboard Cite

We examined the cause of death during a 12-month period (1995196) in all consecutive patients admitted to hospital with leptospiral infection in Seychelles (Indian Ocean), where the disease is endemic. Leptospirosis was diagnosed by use of the microscopic agglutination test and a specific polymerase chain reaction assay on serum samples. Seventy-five cases were diagnosed and 6 patients died, a case fatality of 8%. All 6 patients died within 9 days of onset of symptoms and within 2 days of admission for 5 of them (5 days for the 6th). On autopsy, diffuse bilateral pulmonary haemorrhage (PH) was found in all fatalities. Renal, cardiac, digestive and cerebral haemorrhages were also found in 5,3,3 and 1 case(s), respectively. Incidentally, haemoptysis and lung infiltrate on chest radiographs, which suggest PH, were found in 8 of the 69 non-fatal cases. Dengue and hantavirus infections were ruled out. In conclusion, PH appeared to be a main cause of death in leptospirosis in this population, although haemorrhage in other organs may also have contributed to fatal outcomes. This cause of death contrasts with the findings generally reported in endemic settings.

show abstract

Section: Discussionmentioning

confidence: 99%

Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

Yersin

Bovet

Mérien

et al. 2000

Transactions of the Royal Society of Tropical Medicine and Hygi

View full text Add to dashboard Cite

show abstract

“…As amostras medulares, imediatamente após as coletas, foram estendidas em lâminas 5 A série granulocítica apresentou hipercelularidade relativa em 9 casos (30%) e relativa e absoluta em 9 casos (30%). Em oito doentes (26,6%), a série granulocítica era normocelular.…”

Section: B3 -Mielogramaunclassified

Alterações hematológicas na leptospirose

Nicodemo¹,

Medeiros²,

Negro³

et al. 1989

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

Foram estudadas as alterações hematológicas de 30 pacientes com diagnóstico de leptospirose internados na Clínica de Doenças Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de Sáo Paulo. Verificou-se que mais da metade dos pacientes 16 (53,3%) apresentavam contagem normal de leucócitos no momento da internação; 12 (40%) apresentavam leucócitos e 2 (6,6%) leucopenia. Vinte e cinco doentes (83,3%) apresentavam desvio à esquerda e 29 (96,6%) neutrofilia relativa. Vinte e quatro pacientes tiveram o diagnóstico de anemia. A plaquetopenia ocorreu em 26 (86,6%) dos doentes. Como alterações mais características no mielograma, ressaltamos a alteração da relação G/E (série Granulocítica/série Eritroblástica), às custas de hipercelula-ridade relativa e/ou absoluta da série granulocítica, e/ou hipocelularidade relativa e/ou absoluta da série vermelha; a eritropoese predominantemente microeritroblástica em vários doentes; o encontro de plasmocitose discreta ou moderada e, na série intersticial, o aumento da atividade macrofágica. A análise estatística da série megacariocitária do mielograma dos 30 pacientes revelou não existir relação de dependência significativa entre a celularidade da série megacariocitária e o número de plaquetas no sangue periférico; porém, verificou-se existência da relação de dependência entre a plaquetogênese medular e a contagem de plaquetas no sangue periférico. A possibilidade de haver inibição da plaquetogênese medular por algum produto bacteriano náo pode ser totalmente afastada, porém acreditamos que o exame estático da medula óssea não pode dar-nos uma idéia precisa do mecanismo dinâmico da formação de plaquetas na presença de "consumo periférico".

show abstract

“…JAROONVESAMA et al 14 , EDWARDS et al 8 and NICODEMO et al 22 have described, in case studies of leptospirosis, alterations in coagulation due to prolonged prothrombin, thrombin and partial thromboplastin times. Low platelet counts, alterations in factor V, alterations in fibrinogen degradation products and of fibrinogen levels are also described.…”

Section: Introductionmentioning

confidence: 99%

“…Various systematic studies of the alterations in hemostasis have been published 7,8,14,[19][20][21][22][23][24][25] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of hemostasis disorders and anticardiolipin antibody in patients with severe leptospirosis

Daher

Neto

Ramirez

2002

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

A prospective study was designed to evaluate disorders of hemostasis and levels of anticardiolipin antibodies (ACL) in 30 patients with severe leptospirosis and acute renal failure (ARF) (ARF was defined as serum creatinine > or = 1.5 mg/dL). The patients had been admitted to the Walter Cantídio University Hospital, São José Infectious Diseases Hospital and General Hospital of Fortaleza, Ceará, from August 1999 to July 2001. They all were male, with a mean age of 32 ± 14 years and with clinical and laboratory diagnoses of ARF leptospirosis. The time elapsed between onset of symptoms and the first hemorrhagic manifestation was 9 ± 4 days. Bleeding was observed in 86% of the patients. Laboratory tests showed significantly high levels of urea (181 ±95 mg/dl), fibrinogen, (515 ± 220 mg/dl), prothrombin time (13.3 ± 0.9 seconds) and low platelet counts (69 ± 65x10³/mm³) on admission. There was no elevation in activated partial thromboplastin time or thrombin time. Levels of IgM and IgG ACL concentrations were significantly increased (p < 0.05) in leptospirosis patients when compared to control patients (28.5 ± 32.4 vs. 11.5 ± 7.9MPL U/ml and 36.7 ± 36.1 vs. 6.5 ± 2.5 GPL U/ml), respectively. Vasculitis, thrombocytopenia and uremia should be considered important factors for the pathogenesis of hemorrhagic disturbances and the main cause of death in severe leptospirosis.

show abstract

Thrombocytopenia in Leptospirosis: The Absence of Evidence for Disseminated Intravascular Coagulation

Cited by 75 publications

References 0 publications

Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

Alterações hematológicas na leptospirose

Evaluation of hemostasis disorders and anticardiolipin antibody in patients with severe leptospirosis

Contact Info

Product

Resources

About