RESUMO
There are six species of Bothriopsis in Latin America, accidents caused by this genus are unusually reported. A 37-year-old man admitted thirty hours after a snakebite to the emergency department of Santarém City Hospital (SCH), northern Brazil. The patient presented local erythema, edema, increased local temperature and blister with serous fluid in the right arm. He developed acute kidney injury (AKI) and prolonged thrombocytopenia. The blood was incoagulable and he was treated with anti-bothropic antivenom and antibiotics. The patient had complete regression of all clinical and laboratory manifestations at varying intervals. The platelet counts returned to normal almost 2 weeks after administration of specific antivenom. The present report is the first accident caused by a snake of forest pit viper (Bothriopsis bilineata) in the Brazilian Amazon forest.
Assuntos
Injúria Renal Aguda/etiologia , Bothrops , Venenos de Crotalídeos/toxicidade , Neurotoxinas/toxicidade , Mordeduras de Serpentes/fisiopatologia , Trombocitopenia/etiologia , Injúria Renal Aguda/prevenção & controle , Adulto , Animais , Antivenenos/uso terapêutico , Braço , Brasil , Terapia Combinada , Venenos de Crotalídeos/antagonistas & inibidores , Florestas , Humanos , Masculino , Neurotoxinas/antagonistas & inibidores , Mordeduras de Serpentes/sangue , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/terapia , Trombocitopenia/prevenção & controle , Resultado do TratamentoRESUMO
The incidence of cutaneous leishmaniasis (CL) is increasing and there is limited surveillance of Leishmania species throughout the world. We identified the species associated with CL in a region of Amazonia, an area recognized for its Leishmania species variability. Clinical findings were analyzed and correlated with the species identified in 93 patients. PCR assays were based on small subunit ribosomal DNA (SSU-rDNA) and G6PD, and were performed in a laboratory located 3,500km away. Leishmania (V.) braziliensis was identified in 53 patients (57%). The other 40 patients (43%) carried a different species (including six cases of L. (L.) amazonensis). Molecular methods can be employed, using special media, to allow transport to distant laboratories. L. (V.) braziliensis is the most common species in the area of Para. The location of ulcers can suggest CL species.
Assuntos
Leishmania braziliensis/genética , Leishmaniose Cutânea/genética , Adolescente , Adulto , Idoso , Animais , Brasil/epidemiologia , Reservatórios de Doenças , Feminino , Genes de RNAr/genética , Humanos , Leishmania braziliensis/classificação , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/classificação , Leishmaniose Cutânea/epidemiologia , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Reação em Cadeia da Polimerase , Análise de Sequência de DNA/métodos , Especificidade da Espécie , Adulto JovemRESUMO
Leukocyte kinetics were investigated in 22 patients undergoing cardiopulmonary bypass to determine the nature of the changes in the white blood cell count associated with this procedure. Both polymorphonuclear leukocytes and lymphocytes were taken up by the lung as pulmonary blood flow was lowered, but only polymorphonuclear leukocytes were taken up as blood flow was restored. The complement 3a level was increased approximately twice the control value within 2 minutes of going on bypass and remained elevated throughout the procedure. The peripheral white blood cell count doubled during the bypass procedure owing to a release of polymorphonuclear leukocytes and their precursors from the bone marrow. The increase in polymorphonuclear leukocytes was prevented by hyperthermia but reappeared quickly when the body temperature was restored to 36 degrees to 37 degrees C.
