Leptospirosis in Latin America.

Leptospirosis is a common disease in Latin America. Transmission to humans occurs by contact with water or soil contaminated with the urine of rodents, dogs, or livestock. Pathogenesis is still poorly understood, and bacterial toxin or virulence factors are probably responsible for many features of the disease. The anicteric form is the most frequent presentation, and its clinical picture resembles influenza or other acute febrile diseases. Icterohemorrhagic leptospirosis, or Weil's syndrome, represents the severe form of the disease. Its clinical picture is similar to bacterial sepsis and multiple organ involvement occurs, mainly in kidneys and lungs, and causes great morbidity and mortality. Death is often related to multiple organ failure and pulmonary hemorrhages. Diagnosis is based on serology or blood, cerebrospinal fluid and urine cultures in specific media. Treatment involves a combination of antibiotics and supportive measures.

Acute myocardial infarction in a 34-year-old HIV-positive female patient while undergoing active antiretroviral therapy containing a protease inhibitor

We describe the case of a young HIV-positive patient undergoing three-drug antiretroviral therapy that included a protease inhibitor for 9 months, who was admitted to the hospital with an acute myocardial infarction. A coronary angiogram revealed occlusion caused by a thrombus in the proximal third of the anterior descending artery. Complete recanalization was obtainedafter an angioplasty was performed. At the time of the infarction, only the triglyceride levels were found to be high. Metabolic alterations associated with the prolonged use of protease inhibitors have been described such as an increase in the triglyceride and the cholesterol serum levels, diabetes, resistence to insulin, lipodystrophy, and pancreatitis. The consequences of chronic hyperlipidemia are well known in the medical literature, especially premature coronary artery disease. No family history of coronary disease was identified in this patient. Whether the genesis of this localized thrombosis was due to a change in the metablism of the vascular endothelium caused by the protease inhibitors, or by related dyslipidemia, is still to be determined. In this case, the data suggest a strong link between coronary insufficiency and prolonged use of the protese inhibitor.

Infecçäo humana por Hantavirus no sul e sudeste do Brasil / Human infection by Hantavirus in southern and southeastern Brazil

Descrevem-se os resultados de inquérito sorológico para pesquisa de anticorpos de Hantavírus conduzido de fevereiro de 1986 a agosto de 1990, em grupos populacionais humanos dos Estados de Säo Paulo e Paraná, que apresentavam estreito contato com ratos urbanos ou com roedores e outros pequenos mamíferos silvestres. OBJETIVO. Identificar infecçäo humana causada por Hantavírus, agentes etiológicos da febre hemorrágica com síndrome renal. MÉTODOS. Os soros de 1.063 pessoas foram examinados com técnica imunoenzimática para detecçäo de anticorpos IgG e IgM utilizando-se antígenos dos vírus Hantaan, Seoul e Puumala. Nos soros positivos realizou-se teste de neutralizaçäo com reduçäo em placa para os mesmos antígenos e imunofluorescência indireta para o antígeno do vírus Hantaan. RESULTADOS. Observou-se presença de anticorpos anti-Hantavirus em 32 pessoas, evidenciados por testes imunoenzimáticos e de imunofluorescência. Em cinco delas foram positivos os testes de neutralizaçäo com reduçäo em placa (três para o vírus Scoul e dois para o vírus Pumala). Uma dessas pessoas apresentou alto título em todos os testes para o vírus Seoul. Trata-se de um morador da zona rural da regiäo do vale do Ribeira, que nasceu, sempre viveu no local e nunca viajou para fora do Estado de Säo Paulo. CONCLUSOES. Há evidências sorológicas de infecçäo causada por Hantavírus em moradores de área rural da Ilha do Amparo, Baia de Paranaguá, e da regiäo do Vale do Ribeira, Estado de Säo Paulo, em portuários de Paranaguá, Estado do Paraná, e em doentes internados com suspeita de leptospirose no Hospital Emílio Ribas, Säo Paulo

[Human infection by Hantavirus in southern and southeastern Brazil]. / Infecção humana por Hantavírus no Sul e Sudeste do Brasil.

The results of serological investigation on Hantavírus antibodies carried out between February 1986 and August 1990 in human populations of the States of São Paulo and Paraná, Brazil, which had close contact with urban rats or wild rodents and others small mammals are described. OBJECTIVE--To identify the human infection caused by Hantavíruses, which are the etiological agents of Hemorrhagic fever with renal syndrome. METHODS--Sera from 1063 persons were tested by enzyme immunoassay (ELISA) to Hantaan, Seoul and Puumala antigens. Plaque reduction neutralization test to the same antigens and indirect immunofluorescent test to Hantaan antigen were performed in the positive sera. RESULTS--Antibodies to Hantaan, Seoul or Puumala viruses were detected in 32 persons by enzyme immunoassay (ELISA) and immunofluorescent test. Plaque reduction neutralization test performed in these 32 sera were positive in 5 (3 for Puumala and 2 for Seoul viruses). One serum reacted with high titer to Seoul virus in all tests. It was from a male resident in the rural area of Ribeira Valley, State of São Paulo, where he was born and has always lived. He had only travelled inside the State of São Paulo. CONCLUSION--There are serological evidences of Hantavírus infections in residents of the rural areas of the Amparo Island, Paranaguá Bay, State of Paraná and the Ribeira Valley, State of São Paulo; in employees of the port of Paranaguá, State of Paraná and in patients of the Emílio Ribas Hospital, São Paulo, State of São Paulo, who had a presumptive diagnosis of leptospirosis.

[The serovars of Leptospira interrogans isolated from cases of human leptospirosis in São Paulo, Brazil]. / Sorovares de Leptospira interrogans isolados de casos de leptospirose humana em São Paulo, Brasil.

Eighteen strains of L. interrogans isolated from human cases were serotyped by the agglutinin-absorption test at Instituto Adolfo Lutz in São Paulo, Brazil. Fourteen were identified as serovar copenhageni (icterohaemorrhagiae serogroup), 2 as canicola (canicola serogroup), 1 as castellonis (Ballum serogroup) and 1 as pomona serogroup (serovar not yet defined). The frequency of serovar copenhageni in 100% of the isolates in icterohaemorrhagiae serogroup is emphasized and more studies to verify the real serovars prevalence as subsidy to the epidemiology of this infection are suggested by the authors.

Acute renal failure of leptospirosis: nonoliguric and hypokalemic forms.

Acute renal failure induced by leptospirosis was studied in 56 patients. A higher frequency of nonoliguric renal failure was observed with lower morbidity and mortality rates than in oliguric forms. In addition, 45% of the patients in this series were hypokalemic, and no hyperkalemic patients were seen. A prospective study in 11 patients showed an initially elevated urinary fractional potassium excretion that fell simultaneously with the high urinary fractional sodium excretion and the urinary K/Na ratio, suggesting an increased distal potassium secretion due to an increased distal sodium delivery consequent to functional impairment of the proximal reabsorption of sodium.

Cefoxitin penetration into cerebrospinal fluid in patients with purulent meningitis.

The penetration of cefoxitin into cerebrospinal fluid (CSF) was studied in 25 patients with purulent meningitis treated with antibiotics other than cefoxitin. Each patient received three 2-g doses of cefoxitin at 6-h intervals. Blood and CSF samples were obtained before and at 2, 4, or 6 h after the first and third doses. CSF cefoxitin concentrations were found in all patients and varied between 1.2 and 22.0 microgram/ml, with a majority of the concentrations falling within a range from 1.2 to 6.2 microgram/ml. The concentrations tended to be higher in CSF samples drawn after the third cefoxitin dose than in those drawn after the first cefoxitin dose, indicating an accumulation of cefoxitin in CSF with repeated doses. Peak cefoxitin concentrations in CSF seemed to occur between 2 and 6 h after intravenous administration of the drug since the highest concentrations were found in patients from whom CSF samples were taken 4 h after the doses. In patients with bacterial meningitis, it should be possible to achieve therapeutic cefoxitin levels in CSF by using nontoxic doses of the antibiotic.