ABSTRACT
The prevalence of anti-Leishmania donovani antibodies was investigated in 1,500 Brazilian blood donors and multiply transfused hemodialysis patients. Sera were tested using the fucose-mannose ligand (FML) ELISA, which was shown to have 100% sensitivity and 96% specificity for kala-azar. Among 1,194 volunteer blood donors, seroreactivity was 9%, increasing to 25% in a periurban kala-azar focus. However, higher positivity (37%) was found in multiply transfused hemodialysis patients from Natal, where kala-azar is constantly present in low numbers (endemic), with sporadic outbreaks in localized regions (endemic and epidemic). Risk factors included blood transfusion, which was significantly associated with the presence of anti-Leishmania antibodies (chi2 = 8.567, P < 0.005), but did not include potential exposure to sandfly bites (chi2 = 0.033, P > 0.1). The prevalence significantly decreased to 7% in hemodialysis patients from Rio de Janeiro, where kala-azar is only occasionally seen, and was 0% in patients undergoing continuous ambulatorial peritoneal dialysis. The prospective analysis of 27 FML-seroreactive donors from Natal revealed amastigotes of Leishmania in the bone marrow of one subject while four had clinical complaints, including splenomegaly and hepatosplenomegaly. Our results point to the need for control of blood transfusion as a possible route for transmission of kala-azar in endemic areas.
Subject(s)
Antibodies, Protozoan/analysis , Leishmania donovani/immunology , Leishmaniasis, Visceral/epidemiology , Animals , Blood Donors , Bone Marrow/parasitology , Brazil/epidemiology , Enzyme-Linked Immunosorbent Assay/methods , Humans , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/immunology , Liver/parasitology , Prevalence , Psychodidae/parasitology , Renal Dialysis/adverse effects , Risk Factors , Sensitivity and Specificity , Seroepidemiologic Studies , Spleen/parasitology , Transfusion ReactionABSTRACT
Emergency surgery is aimed at achieving the same results as elective surgery, but still has specific limitations in the case of CDDC, in spite of significant progress. We describe the physiopathological bases of the emergent treatment of the septic, occlusive and hemorrhagic complications of the CDDC, as well as the experience acquired in the Emergency Unit and Department 3 Hospital San José with 54 cases operated since 1981. The modern means of intensive care and preparation, including powerful antibiotics, make primary resection (1) as a principle possible, but do not allow yielding to the temptation of immediately creating an anastomosis as long as the local conditions have not improved. On the other hand, we emphasize the advantages of performing primary resection-anastomosis surgery in elective operations for non-emergent cases.
