Neumonía aguda de la comunidad y hemorragia pulmonar por leptospirosis en el área metropolitana Buenos Aires / Community acquired pneumonia and pulmonary hemorrhage in leptospirosis in the Buenos Aires metropolitan area

El objetivo del trabajo es comunicar los hallazgos epidemiológicos, clínicos y de diagnóstico de la neumonía y hemorragia pulmonar por leptospirosis, en el período enero 2007 a octubre 2009. Un 64% (20/31) de pacientes con diagnóstico de leptospirosis tuvieron neumonía. Quince de ellos (75%) presentaron neumonía grave, de los cuales siete (35%) desarrollaron hemorragia pulmonar. En diez enfermos (32%) el motivo de consulta e inicio del cuadro clínico fue una gastroenteritis secretoria con fiebre y dolor abdominal. La ictericia sólo se manifestó en once pacientes (35%). La técnica de reacción en cadena de la polimerasa (PCR) fue útil para el diagnóstico en muestra obtenida post mortem. De un hemocultivo se aisló una cepa clasificada dentro del serogrupo canicola. Se clasificaron las neumonías en tres tipos: neumonías de curso no grave con escasa repercusión general; neumonías graves asociadas a formas clínicas sistémicas con ictericia, insuficiencia renal, trombocitopenia y hemorragia pulmonar; también de curso grave, no asociada a ictericia, insuficiencia renal o trombocitopenia grave. El tratamiento antibiótico iniciado en los primeros días de enfermedad (promedio 3.2 días) no tuvo influencia en la evolución de las neumonías graves. Se plantea además considerar tres formas clínicas de leptospirosis: anictérica, ictérica (con sus variantes evolutivas) y hemorragia pulmonar.

The aim of this paper is to report the epidemiological, clinical and diagnosis findings of pneumonia and pulmonary hemorrhage observed in patients with leptospirosis in the period January 2007 to October 2009. A 64% (20/31) of patients diagnosed with leptospirosis presented pneumonia. Fifteen of them (75%) had severe pneumonia, of which seven (35%) were pulmonary hemorrhage. In ten patients (32%) reason for consultation and clinical early stage was a secretory gastroenteritis with fever and abdominal pain. Jaundice was only expressed in eleven patients (35%). The technique of chain reaction (PCR) was useful for diagnosis in samples obtained post mortem. A strain classified in serogroup canicola was isolated from blood culture. Pneumonia was classified into three types: non-severe pneumonia course with little overall impact; severe pneumonia associated with systemic clinical forms with jaundice, renal failure, thrombocytopenia, and pulmonary hemorrhage, and of serious course, not associated with jaundice, kidney failure or thrombocytopenia. Antibiotic treatment started in the early stages of disease (average 3.2 days) had no influence on the development of severe pneumonia. It is puggested to consider three clinical forms of leptospirosis: anicteric, icteric (with its evolutionary variants) and pulmonary hemorrhage.

Valoración de la variación del PC 20 en pacientes tratados con Zafirlukast / Evaluation of the variation of the PC 20 in patients treated with Zafirlukast

We study the use of zafirlukast in patients with broncial hyperactivity 30 patients during 5 months, non smokers and not receiving oral or inhaled steroids, teophiline, antihistaminics or long action B2 were studied. 15 patients used zafirlukast 10 mg twice a day during 5 months, and 15 patients did not use zafirlukast. Both groups did not change significatively their spirometries and the PC 20 in the Metacholyne test

Hemorragia alveolar difusa / Diffuse alveolar hemorrhage

We report here a critically ill patient with renal-lung syndrome and multiple organ failure who was admitted at our Critical Care Service 40 days after onset. The clinical and biological findings suggested an immunological disorder like a systemic lupus eritematosus (SLE) inmmediate battery of immunological tests was carried out with metilprednisolane therapy and vital support measures. We confirm a SLE by serology after the patient died six days later. prompt diagnosis and treatment of these disorders may be life-preserving but the diagnosis may be complicated by the vagaries of serologic testing and the understandable hesitancy in utilizing invasive procedures, including open or thoracoscopic lung biopsy, fibrobronchoscopy with transbronchial biopsy and lavage in these critically ill patients