Pulmonary hemorrhage in horses seropositive to leptospirosis / Hemorragia pulmonar em cavalos soropositivos para leptospirose

The aim of this study was to verify the occurrence and severity of pulmonary hemorrhage (PH) in horses seropositive or not to leptospirosis. A total of 84 training horses were tested for anti-Leptospira antibodies and submitted to endoscopy of the upper airways 30-60 minutes after exercise. Forty-nine (46.4 percent) horses were seropositive (titer>100) to serovar Copenhageni. Seventeen horses (20.2 percent) presented PH in different grades, significantly more commonly observed in seropositives (34.7 percent) than seronegatives (8.6 percent) (p<0.05), and also more severe in the first. Additionally, a seropositive horse is 4.26 times more likely (OR) to present PH than a seronegative one. Fifteen days after specific antibiotic treatment for leptospirosis a significant improvement in grade of hemorrhage was observed. Therefore it is suggested that leptospirosis may potentiate the severity of PH and that specific antibiotic treatment directed towards leptospirosis may help to control the disease.

O objetivo foi estudar a ocorrência e severidade de hemorragia pulmonar (HP) em cavalos soropositivos ou não à leptospirose. Um total de 84 cavalos em treinamento foi testado para anticorpos anti-Leptospira e submetidos à endoscopia das vias aéreas superiores de 30-60 minutos após exercício. Quarenta e nove (46,4 por cento) animais foram soropositivos (títulos>100) para o serovar Copenhageni. Dezessete cavalos (20,2 por cento) apresentaram HP, significativamente mais observada em soropositivos (34,7 por cento) do que em soronegativos (8,6 por cento) (p<0,05) e também mais grave nos primeiros. Adicionalmente, um cavalo soropositivo tem 4,26 mais chances (OR) de apresentar PH do que um soronegativo. Quinze dias após o tratamento com antibiótico específico para leptospirose uma melhoria significativa no grau de hemorragia foi observada. Portanto, sugere-se que a leptospirose pode potencializar a severidade da HP e que o tratamento com antibióticos específicos recomendados para leptospirose pode ajudar a controlá-la.

Hematologic disorders in trauma patients during parenteral alimentation with lipids

Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions. In the course of intravenous alimentation of six adults admitted for traumatic lesions, eosinophilia with or without leukocytopenia was noticed after periods of four days to five weeks. Principal clinical events and hematologic derangements were documented in this population. Sepsis was not always present in the patients by the time of the complication, and in those that did require antibiotics and other drugs, the prescription remained unchanged along the episode. Discontinuation of the nutritional regimen with lipids was followed by normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash in two occasions reinforces this hypothesis, and the possibility of hemophagocytosis merits consideration in two of the cases who displayed reversible acute leukocytopenia. It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.