Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease)

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3. RESULTS: A total of 374 patients were included, with a mean age of 36.1±15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p = 0.001), epistaxis (5.7% vs. 0.8%, p = 0.033), hematemesis (13% vs. 4.6%, p = 0.006), myalgia (91.5% vs. 84.5%, p = 0.038), hematuria (54.8% vs. 37.6%, p = 0.011), metabolic acidosis (18% vs. 9.2%, p = 0.016) and hypoalbuminemia (17.8% vs. 7.5%, p = 0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p = 0.001) and acute kidney injury (OR: 6.6, p = 0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p = 1.000) or during the hospital stay (12.6% vs. 11.3%, p = 0.748). CONCLUSIONS: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality. .

Tumor cardiaco en un paciente de mediana edad con enfermedad coronaria - una rara asociación / Cardiac tumor in a middle aged patient with coronary disease - a rare association

Se describe una rara asociación de tumor cardíaco y enfermedad coronaria. Un varón de 42 años de edad fue admitido con queja de disnea. El electrocardiograma mostró ritmo sinusal, bloqueo de rama derecha y repolarización anormal de la pared ventricular anterior. El ecocardiograma mostró una estructura con ecogenicidad aumentada dentro de la aurícula izquierda, compatible con tumor cardíaco. El paciente fue enviado a cirugía; se estabilizó y fue dado de alta en el cuarto día post-operatorio sin complicaciones y sin síntomas.

We describe a rare association between cardiac tumor and coronary disease. A 42 years old male was admitted with complaints of dyspnea. The physical examination was unremarkable. The electrocardiogram showed sinus rhythm, with right bundle block and ventricular anterior wall repolarization abnormality. The echocardiogram showed a structure with increased echogenicity inside the left atrium, compatible with cardiac tumor. A surgery was then indicated to remove the tumor. The patient became stable and was discharged in the fourth post-operative day with no symptom and no complication.