Multidisciplinary approach in the diagnosis of acute leptospirosis in dogs naturally infected by Leptospira interrogans serogroup Icterohaemorrhagiae: A prospective study.

Leptospirosis, a zoonotic disease with worldwide distribution, is caused by spirochetes of the genus Leptospira. In dogs, this disease is frequently misdiagnosed. Few studies have attempted to associate the detection of Leptospira spp. infection with clinicopathological and renal histopathological findings using a multidisciplinary approach. The present study isolated and characterized Leptospira spp. obtained from naturally infected dogs and described relevant clinical and histopathological findings. Blood and urine were collected from 57 dogs with clinical symptomatology suggestive of leptospirosis; 38 cases were confirmed by PCR in urine or by culture or microscopic agglutination testing (titers ≥800). A total of 12 strains of pathogenic Leptospira were isolated from the studied dogs (seven in blood, four in urine and one in both blood and urine samples). All isolates were characterized as Leptospira interrogans serogroup Icterohaemorrhagiae. Of the confirmed cases, almost one-third of the animals had been vaccinated. Our analysis of laboratory testing revealed that azotemia and proteinuria were statistically significant predictors of infection. The main histopathological findings seen in kidney tissues were necrosis, degeneration, tubular regeneration, mononuclear inflammatory infiltrate and congestion. A multidisciplinary approach involving clinicopathological and histopathological characterization of renal involvement can aid in the identification of acute leptospirosis infection.

Investigation of chronic infection by Leptospira spp. in asymptomatic sheep slaughtered in slaughterhouse.

The study aimed to evaluate the histopathological characteristics of renal lesions in chronically infected sheep and with low titers of anti-Leptospira antibodies from a slaughterhouse. In the serological analysis, 24.74% (48/194) presented seroreactivity with a titer equal to or greater than 100. Among these seroreactive sheep, titers of 100 were predominant (58.33%, 28/48), with the highest titer being 1,600 (2.08%, 1/48). Serogroup Sejroe (sv. Hardjo) was the most frequent at 35.42% (17/48). Leptospiral DNA was verified in 4.12% (8/194) of the kidney samples tested, and no urine sample was positive. All the samples corresponded to the pathogenic species L. interrogans. The eight amplicons with 202-nucleotides were identical with two mismatches (presented 100% of identity) using the PCR targeting to secY gene. Histological sections of PCR-positive kidneys were submitted to direct detection by the anti-LipL32 immunohistochemistry (IHC) technique. The Leptospira spp. antigen was evident in 62.5% (5/8) of the kidneys. Positive staining was observed in the cytoplasm of tubular cells and in the form of brownish aggregates that adhered to tubular epithelial cells and projected into the lumen. Inflammatory lymphoplasmacytic infiltrate, ranging from mild to moderate, with multifocal distribution, was the predominant finding in seroreactive animals (33.33%, 16/48). The demonstration of the leptospiral antigen lining the renal tubules through IHC of naturally infected sheep confirmed by PCR characterizes renal colonization in a species with the presence of histological changes compatible with leptospirosis.

Fatores associados à diarreia em uma unidade de terapia intensiva: estudo de coorte / Factors associated with diarrhea in a unit of intensive therapy: cohort study

Introdução: A diarreia é considerada uma das complicações mais frequentes em pacientes de unidade de terapia intensiva (UTI). A variação dos dados sobre sua incidência pode ser resultado da inconsistência das definições adotadas. As causas são complexas e multifatoriais, mas vários fatores contribuintes são descritos. Objetivos: Determinar a incidência e fatores associados à diarreia nos pacientes internados em uma UTI de um hospital público. Métodos: Trata-se de um estudo analítico tipo coorte prospectivo, cuja população foi composta por 103 pacientes adultos (≥ 18 anos) em uso de terapia nutricional enteral exclusiva internados em UTI adulta clínica em hospital público de urgência. A ocorrência da diarreia foi definida como a presença de 3 ou mais evacuações líquidas ou pastosas em 24 horas e os possíveis fatores associados foram: terapia nutricional, presença de febre, infecção, hipoalbuminemia, medicamentos em uso. A análise estatística descritiva e cálculo do risco relativo foram realizados utilizando o programa Epiinfo (R) versão 7. Para comparações entre os grupos utilizouse o teste t de Student e o teste qui quadrado ou exato de Fischer, quando apropriado, com nível de significância estatística estabelecido em P <0,05. Resultados: Do total de 103 pacientes, 46,6% (48) apresentaram diarreia com duração média de 1,3 dias (±2,1). O grupo com diarreia teve um tempo de permanência maior do que os pacientes sem diarreia - 37 x 20,3 dias (p=0,002). Os fatores de risco que estiveram associados com o desenvolvimento de diarreia foram: presença de febre (RR=1,96), presença de hipoalbuminemia (RR=1,54), uso de procinético (RR=1,86), uso de carbapenêmicos (RR=1,71) e glicopeptídeos (RR=2,1). Conclusão: A incidência de diarreia nos pacientes em uso de terapia nutricional na unidade pesquisada foi alta, mas semelhante a outros dados reportados na literatura

Introduction: Diarrhea is considered one of the most frequent complications in intensive care unit (ICU) patients. The variation of the data on its incidence may be a result of the inconsistency of the definitions adopted. The causes are complex and multifactorial, but several contributing factors are described. Objectives: To determine the incidence and factors associated with diarrhea in patients admitted to an ICU of a public hospital. Methods: This is a prospective cohort-type study, whose population was composed of 103 adult patients (≥ 18 years old) using exclusive enteral nutritional therapy hospitalized in a clinical adult ICU at a public emergency hospital. The occurrence of diarrhea was defined as the presence of 3 or more liquid or pasty stools in 24 hours and the possible associated factors were: nutritional therapy, presence of fever, infection, hypoalbuminemia, medications in use. Descriptive statistical analysis and relative risk calculation were performed using the Epi-info(R) version 7 program. For comparisons between the groups, Student's t-test and chi-square or Fischer's exact test were used, where appropriate, with level of statistical significance established at P <0.05. Results: Out of 103 patients, 46.6% (48) presented diarrhea with a mean duration of 1.3 days (± 2.1). The group with diarrhea had a longer residence time than patients without diarrhea - 37 x 20.3 days (p = 0.002). Risk factors associated with diarrhea were: presence of fever (RR = 1.96), presence of hypoalbuminemia (RR = 1.54), prokinetic use (RR = 1.86), use of carbapenems (RR = 1.71) and glycopeptides (RR = 2.1). Conclusion: The incidence of diarrhea in patients using nutritional therapy in the unit studied was high, but similar to other data reported in the literature

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Avaliação da infecção por leptospiras patogênicas em primatas silvestres mantidos em cativeiro em Salvador, Bahia, Brasil / Evaluation of infection by pathogenic Leptospira in wild primates kept in captivity in Salvador, Bahia, Brazil

Estima-se que 70% das doenças infecciosas emergentes em humanos estão relacionados a exposição a animais silvestres. Estudos envolvendo infecções em primatas não humanos e o seu papel na epidemiologia da leptospirose são escassos.Uma instrução normativa do Ministério do Meio Ambiente(179 de 25/06/2008)recomenda o uso de teste de microaglutinação (MAT) para detecção de anticorpos aglutinantes anti-Leptospira em espécies silvestres em programas de reintrodução à vida livre. Neste contexto, o presente projeto propôs investigar a evidência de prévia exposição e a ocorrência do estado de portador de leptospira patogênicas em primatas silvestres residentes no Parque Zoobotânico Getúlio Vargas de Salvador (PZBGV) e recebidos pelo Centro de Triagem de Animais Silvestres Chico Mendes (CETAS). Foram analisados 42 amostras de soro e sangue total de 42 primatas do PZBGV e 16 amostras de soros de 16 primatas do CETAS pelo teste de aglutinação microscópica (MAT) e PCR respectivamente. Amostras de urina de 3 de primatas do PZBGV e 13 do CETAS também foram submetidas à PCR. A soroprevalência encontrada no PZGV foi de 2%(1/42)enquanto que no CETAS foi de 31%(5/16). O único primata do PZBGV positivo na MAT foi um Allouata caraya (bugio preto) fêmea, adulta, que apresentou reação mista para os sorogrupos Australis e Icterohaemorrhagiae. As cinco amostras positivas do CETAS ocorreram em macacos-prego(Cebus sp.)e foram distribuídos nos sorogrupos: Ballum(1:100), Semaranga (1:200), Grippotyphos (1:100),Cynopeteri(1:100) e uma reação mista Tarassovi / Autumnalis (1:100). Todas as amostras de sangue total e urina analisadas por PCR foram negativas. Conclui-se que a soroprevalência de anticorpos anti-Leptospira foi baixa no PZBGV de Salvador, apesar da alta frequência de roedores na área e endemicidade da leptospirose humana em Salvador. A prevalência elevada foi observada entre os animais resgatados do comércio ilegal no estado da Bahia e esta evidência sorológica de exposição sugere um risco potencial de transmissão da leptospirose ao se adotar estes primatas como animais de estimação

It is estimated that 70% of emerging infectious diseases in humans are related to exposure to wild animals. Studies involving infections in nonhuman primates and their role in the epidemiology of leptospirosis are scarce. A normative statement of the Ministry of the Environment (179 of 25/06/2008) recommends the use of microscopic agglutination test (MAT) for antibodies binding anti-Leptospira in wild species reintroduction programs in the wild. Positive tests indicate the need for quarantine and antimicrobial treatment. In this context, this project proposes to investigate the evidence of prior exposure and the occurrence of carrier status of pathogenic Leptospira in wild primates living in the Parque Vargas Zoobotânico Salvador (PZBGV) and received by the Center for Wildlife Screening Chico Mendes (CETAS). We analyzed 42 serum samples and 42 whole blood PZBGV primates and 16 sera from 16 primates CETAS by microscopic agglutination test (MAT) and PCR respectively. Urine samples of 3 primates PZBGV CETAS and 13 were also subjected to PCR. The seroprevalence in PZBGV was 2% (1/42) while the CETAS was 31% (5/16). The only positive was a primate Allouata caraya (black howler monkey) female, adult, which showed mixed reaction to serogroups Australis and Icterohaemorrhagiae. The five samples positive from CETAS occurred in monkeys (Cebus sp.) And were divided into serogroups: Ballum (1:100), Semaranga (1:200), Grippotyphosa (1:100), Cynopeteri (1:100) and mixed reaction Tarassovi / Autumnalis (1:100). All blood samples and urine samples were analyzed by PCR negative. It is concluded that the seroprevalence of anti- Leptospira antibodies was low in the Zoo of Salvador, despite the high frequency of rodents in the area and endemicity of leptospirosis in Salvador...