Antibodies to Rickettsia rickettsii, Rickettsia typhi, Coxiella burnetii, Bartonella henselae, Bartonella quintana, and Ehrlichia chaffeensis among healthy population in Minas Gerais, Brazil

Rickettsial diseases except those belonging to spotted fever group rickettsioses are poorly studied in South America particularly in Brazil where few epidemiological reports have been published. We describe a serosurvey for Rickettsia rickettsii, R. typhi, Coxiella burnetii, Bartonella henselae, B. quintana, and Ehrlichia chaffeensis in 437 healthy people from a Brazilian rural community. The serum samples were tested by indirected micro-immunoflourescence technique and a cutoff titer of 1:64 was used. The seroprevalence rates for R. rickettsii, R. typhi, C. burnetii, B. henselae, B. quintana, and E. chaffeensis were respectively 1.6 percent (7 samples); 1.1 percent (5 samples); 3.9 percent (17 samples); 13.7 percent (60 samples); 12.8 percent (56 samples), and 10.5 percent (46 samples). Frequent multiple/cross-reactivity was observed in this study. Age over 40 years old, urban profession, and rural residence were significantly associated with some but not all infections rate. Low seropositivity rates for R. rickettsii, R. typhi, and C. burnetii contrasted with higher rates of seropositivity for B. quintana, B. henselae, and E. chaffeensis. These results show that all tested rickettsial species or antigenically closely related possible exist in this particular region.

Atypical fulminant Rickettsia rickettsii infection (Brazilian spotted fever) presenting as septic shock and adult respiratory distress syndrome

Brazilian spotted fever, caused by Rickettsia rickettsii, has been increasingly reported in Brazil especially in the southeastern states. The severe and fulminant forms of the disease are not unusual but most of the reported fatal cases have shown some typical clinical clue, which leads the attending physician to a correct diagnosis. We report a probable case of atypical fulminant Brazilian spotted fever that presented full-blown septic shock associated with Adult Respiratory Distress Syndrome (ARDS) and delayed uncharacteristic rash with an over four-fold increase in reciprocal IgM, but not IgG titer against Rickettsia rickettsii. Brazilian practitioners should be aware of the possibility of Brazilian spotted fever as a cause of fulminant primary sepsis with ARDS; improved laboratory methods are necessary for the rapid diagnosis of such cases.

Isolamento de crioglobulina no soro e líquido sinovial em paciente com artrite associada a crioglobulina do tipo I, macroglobulinemia de Waldenström e amiloidose / Isolation of cryoglobulin in serum and synovial fluid in a patient with arthritis associated with type I cryoglobulinemia, Waldenström macroglobulinemia and amyloidosis

A associaçäo entre macroglobulinemia de Waldenström e crioglobulinemia IgM monoclonal é relativamente frequente, muito embora sejam incomuns os sintomas secundários à crioglobulinemia nesses casos. É relatado um caso de macroglobulinemia de Waldenström associado a crioglobulinemia, amiloidose e monoartrite com extenso derrame articular, em que foi isolada no sangue e líquido sinovial uma crioglobulina IgM lambda monoclonal. Tendo em vista a ausência de relatos na literatura sobre a associaçäo entre crioglobulinemia monoclonal e monoartrite com detecçäo da crioglobulina no líquido sinovial, os médicos devem estar atentos para esta possibilidade, especialmente porque näo existem dificuldades técnicas adicionais para a pesquisa e detecçäo de crioglobulinas no líquido sinovial

Crioglobulinemia: estudo imunoquímico de três pacientes / Cryoglobulinemia: immunochemical study of three patients

As crioglobulinas säo proteínas que se precipitam ao a frio e podem ser encontradas em várias doenças humanas. Sua detecçäo e estudo imunoquímico podem ser úteis para o diagnóstico e compreensäo de muitos estados patológicos. Säo descritos três diferentes casos de crioglobulenemia, cada um representativo dos tipos clássicos de Brouet. Um paciente apresentava crioglobulinemia do tipo I e linfoma plasmocitóide; näo tinha sintomas de criobulinemia propriamente ditos, a despeito dos altos níveis de crioglobulinas circulantes (IgG 3 K monoclonal). O paciente com crioglobulinemia do tipo II, crioglobulinemia essencial mista (IgM lambida monoclonal e IgG policlonais) era portador de leishmaniose mucocutânea. Näo foram encontradas hiperviscosidade sérica ou cristalocrioglobulinas em nenhum do casos. A temperatura de crioprecipitaçäo situou-se sempre abaixo de 20 graus e a concentraçäo das hipocrioglobulinas foi diferentes das respctivas crioglobulinas em dois pacientes, näo havendo relatos na literatura sobre este tipo de achado