Clinical Features and Autopsy Findings in Fulminant Hepatic Failure by Exertional Heat Stroke: Case Report.

A healthy 48 year-old man became unconscious suddenly, with a corporal temperature of 43ºC when participating in a strenuous motorcycle off-road competition in the last 2 days in southeastern Brazil on a very hot and humid summer. Once the first 6 hours of in-hospital he had dysfunction of several organ and systems. During the following days, he developed fulminant hepatic failure (FHF), disseminated intravascular coagulation, rhabdomyolysis and multiple organ failure. Despite the use of immediate conventional core body temperature control methods and support of organsystem function, the patient died on 11th day. Autopsy findings: there was significant jaundice impregnation, petechial and hemorrhagic suffusions in the skin and in visceral organs as well as generalized edema. The microscopic exam showed cytotoxic and vasogenic brain edema and encephalic death. The liver and the pancreas were diffusely necrotic and hemorrhagic, besides rhabdomyolysis, cardiac failure and acute tubular necrosis in the kidneys. The immunohistochemistry exam showed diffuse liberation in the lung and other viscera tissue of tumor necrosis factor- (TNF). In spite of being a rare occurrence, FHF should be included in the complications induced by exertion and commonly progresses to death.

Infection by Cryptosporidium parvum in renal patients submitted to renal transplant or hemodialysis

The frequency of infection by Cryptosporidium parvum was determined in two groups of renal patients submitted to immunosuppression. One group consisted of 23 renal transplanted individuals, and the other consisted of 32 patients with chronic renal insufficiency, periodically submitted to hemodialysis. A third group of 27 patients with systemic arterial hypertension, not immunosuppressed, was used as control. During a period of 18 months all the patients were submitted to faecal examination to detect C. parvum oocysts, for a total of 1 to 6 tests per patient. The results showed frequencies of C. parvum infection of 34.8 percent, 25 percent and 17.4 percent, respectively for the renal transplanted group, the patients submitted to hemodialysis and the control group. Statistical analysis showed no significant differences among the three groups even though the frequency of C. parvum infection was higher in the transplanted group. However; when the number of fecal samples containing C. parvum oocysts was taken in account a significantly higher frequency was found in the renal transplanted group