ABSTRACT
Chagasic cardiomyopathy is a common disease in Latin America, however similar clinical pictures exist that can be confused with this, as they give negative results to the tests that detects T. cruzi, like non Chagasic rural endemic chronic cardiopathy, highly common in Venezuela. Using histopathology techniques, "idiopathic cardiomyopathy" is frequently found as the cause of death when the etiology of this disease is not known. This paper presents the case of a man of 26-years-old who died of dilated cardiomyopathy secondary to leptospirosis. Clinically, in addition to the cardiac failure, jaundice, hyperbilirubinemia, transaminases increase, proteinuria and hematuria were present. Initially it was suspected Chagasic cardiomyopathy but the epidemiologic background and the parasitologic and serologic tests for T. cruzi gave negative results. The dark field microscopy videorecording of blood and urine samples, argentic impregnation and immunohistochemistry tests as well as haemoculture in EMJH medium were positive for L. interrogans serovar Pomona. Postmortem we confirmed the presence of leptospira in different tissues through of histopathology, argentic impregnation, indirect immunofluorescence and immunohistochemistry.
Subject(s)
Adult , Humans , Male , Cardiomyopathy, Dilated , Leptospirosis , Fatal Outcome , Mexico , Severity of Illness IndexABSTRACT
Chagasic cardiomyopathy is a common disease in Latin America, however similar clinical pictures exist that can be confused with this, as they give negative results to the tests that detects T. cruzi, like non Chagasic rural endemic chronic cardiopathy, highly common in Venezuela. Using histopathology techniques, "idiopathic cardiomyopathy" is frequently found as the cause of death when the etiology of this disease is not known. This paper presents the case of a man of 26-years-old who died of dilated cardiomyopathy secondary to leptospirosis. Clinically, in addition to the cardiac failure, jaundice, hyperbilirubinemia, transaminases increase, proteinuria and hematuria were present. Initially it was suspected Chagasic cardiomyopathy but the epidemiologic background and the parasitologic and serologic tests for T. cruzi gave negative results. The dark field microscopy videorecording of blood and urine samples, argentic impregnation and immunohistochemistry tests as well as haemoculture in EMJH medium were positive for L. interrogans serovar Pomona. Postmortem we confirmed the presence of leptospira in different tissues through of histopathology, argentic impregnation, indirect immunofluorescence and immunohistochemistry.
Subject(s)
Cardiomyopathy, Dilated/microbiology , Leptospirosis/complications , Adult , Fatal Outcome , Humans , Male , Mexico , Severity of Illness IndexABSTRACT
Two cases of chronic leptospirosis in bicitopenic and pancitopenic patients, respectively, with mucocutaneous and visceral bleedings were presented. They were diagnosed myeloblastic leukemia M3 and acute lymphoblastic leukemia L2 by bone marrow aspiration and they were treated as such at the hematology department of a general hospital. Both patients died after one of them had considerably improved on being treated with sodium crystalline penicillin at high doses. The histopathological studies could not demonstrate the presence of neoplastic cells in bone marrow but leptospiras were found by means of silver stained preparations (Warthin - Starry) and immunofluorescence, both in this organ and in other tissues studied: kidney., spleen, liver and lungs. The histopathological diagnoses were generalized leptospirosis with medullary aplasia and generalized leptospirosis with myelodisplastic syndrome, respectively. It was reviewed the possibility that leptospira could cause leukemoid syndromes and/or leukemia. Based on these results, it is recommended to hematologists, infectologists, pathologists, and others, to use again the technques of argentic impregnation, immunohystochemistry and immunofluorescence to study the bone marrow and other tissues in order to detect the possible presence of leptospira that would allow to treat the patients more effectively, particularly, patients like these that had serological titres considered negatives so as to avoid the false security existing in the official health institutions about the minimum or null impact that leptospirosis cause in public health, which imply the absence of control systems for this spirochetosis.
Subject(s)
Leptospirosis/complications , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/etiology , Aged , Aged, 80 and over , Bone Marrow/microbiology , Bone Marrow Examination , Chronic Disease , Fluorescent Antibody Technique , Humans , Kidney/microbiology , Leptospira/isolation & purification , Leptospirosis/diagnosis , Leptospirosis/pathology , Leukemia, Myeloid, Acute/mortality , Lung/microbiology , Male , Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality , Silver StainingABSTRACT
Objetivo. Observar el efecto de la vigilancia epidemiológica de infección de la herida quirúrgica en una unidad de cirugía general. Sede. Unidad 305 del Hospital General de México. México, D.F. Diseño. Estudio prospectivo, longitudinal, comparativo de dos grupos de pacientes; formaron el grupo 1 los operados durante el año 1995 y el grupo 2 los operados en 1996. Se registraron los casos procedentes de herida limpia, limpia contaminada, contaminada y sucia. Resultados. El grupo 1 lo conformaron 700 pacientes operados de cirugía electiva y el 2 estuvo compuesto por 667 pacientes. En el primer grupo la cifra total de infecciones fue de 28/700 = 4.0 por ciento, en cirugía limpia 16/413 = 3.87 por ciento; limpia contaminada 5/197 = 2.54 por ciento, en el grupo 2 el número fue de 9/667 = 1.34 por ciento, cirugía limpia 7/401 = 1.74 por ciento y limpia contaminada 2/212 = 0.94 por ciento; en la prueba exacta de Fisher hubo reducción con validez estadística en cifra total con valor de 0.001 y no significativas en herida limpia (0.08) y limpia contaminada (0.26). En el grupo 2 se registró cambio en las bacterias causales al disminuir el guarismo de casos infectados por gérmenes procedentes de flora fecal. Conclusión. En el segundo grupo la vigilancia epidemiológica ejerció efecto de reducción de la cifra global de infección de herida quirúrgica y se observó cambio en la flora bacteriana
