Caudal vena cava thrombosis in cattle in Southern Brazil: clinical and pathological aspects of 30 cases / Tromboembolismo da veia cava caudal em bovinos no Sul do Brasil: aspectos clínicos e patológicos de 30 casos

Hemoptysis associated with respiratory disorders are some findings of caudal vena cava thrombosis (CVCT) in cattle. Nevertheless, CVCT may be accompanied by a broad spectrum of clinical signs and gross lesions. This study reported the frequency of CVCT in cattle necropsied in Southern Brazil and described its clinical signs, as well as pathological findings. From a total of 1,976 postmortem examination reports in cattle in Southern Brazil, there were 30 cases (1.5%) of CVCT. In the clinical evaluation, the main clinical course was chronic (13/30), followed by peracute (7/30), acute (4/30), and subacute (5/30). Hemoptysis (17/30), dyspnea (8/30), and anorexia or hyporexia (7/30) were the most reported clinical signs. Septic thrombophlebitis of the caudal vena cava (24/30), hepatic abscesses (24/30), pulmonary hemorrhage (23/30), and embolic pneumonia (19/30) were the main lesions observed at the necropsy. We concluded that CVCT is a relevant cause of death in bovines from Santa Catarina state, mainly in adult dairy cows. The disease is characterized by a wide range of clinical signs and lesions, requiring attention from veterinarians for the correct diagnosis. Furthermore, the association between the clinical history, clinical signs, and lesions is essential for the diagnosis of CVCT in cattle.

Hemoptise associada a sinais respiratórios são achados típicos de tromboembolismo da veia cava caudal (TVCC) em bovinos. Todavia, o TVCC pode estar acompanhado de um amplo espectro de sinais clínicos e lesões macroscópicas. Esse estudo tem por objetivo relatar a frequência do diagnóstico de TVCC em bovinos necropsiados no sul do Brasil e descrever os sinais clínicos, assim como achados patológicos dessa condição. De um total de 1.976 exames post-mortem realizados em bovinos no Sul do Brasil, 30 casos de TVCC foram diagnosticados (1,5%). No exame clínico, o principal curso clínico observado foi crônico (13/30), seguido do hiperagudo (7/30), agudo (4/30) e subagudo (5/30), em um caso o histórico clínico não foi fornecido. Hemoptise (17/30), dispneia (8/30) e anorexia ou hiporexia (7/30) foram os sinais clínicos mais comumente relatados. Tromboflebite séptica da veia cava caudal (24/30), abscessos hepáticos (24/30), hemorragia pulmonar (23/30) e pneumonia embólica (19/30) foram as principais lesões observadas na necropsia. Com esse trabalho conclui-se que TVCC é uma causa relevante de morte em bovinos no estado de Santa Catarina, principalmente em vacas leiteiras adultas. A doença é caracterizada por uma variedade de sinais clínicos e lesões, necessitando de atenção dos veterinários para o correto diagnóstico. Ainda, a associação entre o histórico clínico, sinais clínicos e lesões de necropsia é essencial para o diagnóstico de TVCC em bovinos.

Hemosiderosis pulmonar idiopática, caso clínico en México. Importancia de un diagnóstico y tratamiento oportuno / Idiopathic pulmonary hemosiderosis, clinical case in Mexico. The relevance of performed an early diagnosis and treatment

La hemosiderosis pulmonar idiopática (HPI) es una patología poco frecuente; su distribución geográfica, su incidencia y prevalencia se desconocen de manera exacta a nivel mundial. Tiene una fuerte asociación con condiciones autoinmunes y una adecuada respuesta al tratamiento inmunosupresor. A pesar de ser una patología grave, presenta una tasa de morbilidad y mortalidad mediana, siempre que se realice un diagnóstico y tratamiento precoz. Se presenta el caso clínico de una paciente femenina con diagnóstico de HPI quien cursó con la triada clásica de esta enfermedad: hemoptisis, anemia ferropénica e infiltrados pulmonares difusos. Se descartaron otras causas de hemorragia pulmonar difusa y se realizó el diagnóstico por biopsia pulmonar. Se trató con esteroides sistémicos e inhalados y azatioprina. Tras casi 2 años después del diagnóstico, estando sin tratamiento por 3 meses, presentó una exacerbación con hemorragia pulmonar masiva ocasionando el fallecimiento de la paciente.

Idiopathic pulmonary hemosiderosis (IPH) is a rare pathology; its geographic distribution, incidence and prevalence are not accurately known worldwide. It has a strong association with autoimmune conditions and has an adequate response to immunosuppressive treatment. Despite being a serious pathology, it has a medium morbidity and mortality rate, provided that early diagnosis and treatment is performed. We present the clinical case of a female patient diagnosed with IPH who presented with the classic triad of this disease: hemoptysis, iron deficiency anemia and diffuse pulmonary infiltrates. Other causes of diffuse pulmonary hemorrhage were ruled out and the diagnosis was made by lung biopsy. She was managed with systemic and inhaled steroids and azathioprine. After almost 2 years before the diagnosis, being without treatment for 3 month she had a massive pulmonary hemorrhage, causing the death of the patient.

Síndrome pulmón-riñón en pacientes con hallazgos incidentales de agentes infecciosos / Pulmonary-renal syndrome in patients with incidental findings of infectious agents

El síndrome pulmón-riñón (SPR) o síndrome reno-pulmonar es la combinación de glomerulonefritis aguda rápidamente progresiva (GNARP) y hemorragia alveolar difusa (HAD) de causa autoinmune. El SPR fue inicialmente descrito por Goodpasture en el contexto del síndrome anti-membrana basal glomerular (MBG). Actualmente, las vasculitis asociadas a ANCA (VAA) explican el 60% (rango 56­77.5%) de casos, el síndrome de Goodpasture el 15% (12.5­17.5%), y un 10% de casos se deben a otras causas. El SPR presenta un gran espectro clínico, desde la capilaritis pulmonar fulminante con HAD y falla respiratoria aguda, hasta formas más sutiles de enfermedad sólo detectables mediante lavado bronquio-alveolar (LBA). El objetivo de este estudio es presentar la primera serie peruana de SPR asociada a agentes infecciosos. Reportamos 3 casos, dos correspondieron a lupus eritematoso sistémico y uno a vasculitis asociada a poliangeítis microscópica. El primer caso se asoció a sobreinfección por C. tropicalis; el segundo caso a A. fumigatus y C. albicans; y el tercero a infestación por A. lumbricoides. Todos los casos se presentaron en mujeres, requirieron soporte ventilatorio invasivo y hemodiálisis, y dos resultaron letales. Concluimos que, el SPR es una condición clínica grave comúnmente asociada a sobreinfecciones o infestaciones, y que conlleva una elevada morbilidad y mortalidad. Puesto que no existen características clínicas específicas, resulta crucial tener un alto índice de sospecha. Las investigaciones pertinentes­pruebas inmunológicas, imagenológicas, y biopsia cutánea, renal y/o pulmonar­para precisar la etiología deben realizarse sin demora ya que el tratamiento precoz puede cambiar el pronóstico de estos pacientes(AU)

Pulmonary-renal syndrome (PRS) or reno-pulmonary syndrome is the combination of acute rapidly progressive glomerulonephritis (RPGNARP) and autoimmune diffuse alveolar hemorrhage (DAH). RPS was initially described by Goodpasture in the context of anti-glomerular basement membrane (GBM) syndrome. Currently, ANCA-associated vasculitides (AAV) explain 60% (range 56­77.5%) of cases, Goodpasture syndrome 15% (12.5­17.5%), and 10% of cases are due to other causes. PRS presents a wide clinical spectrum, from fulminant pulmonary capillaritis with ADH and acute respiratory failure, to subtler forms of disease that can only be detected by bronchoalveolar lavage (BAL). The objective of this study is to present the first Peruvian series of SPR associated with infectious agents. We report 3 cases, two corresponded to systemic lupus erythematosus and one to vasculitis associated with microscopic polyangiitis. The first case was associated with superinfection by C. tropicalis; the second case to A. fumigatus and C. albicans; and the third to infestation by A. lumbricoides. All cases occurred in women, required invasive ventilatory support and haemodialysis, and two were fatal. We conclude that SPR is a serious clinical condition commonly associated with superinfections or infestations, and that it carries high morbidity and mortality. Since there are no specific clinical features, a high index of suspicion is crucial. Relevant investigations­immunological tests, imaging tests, and skin, kidney, and/or lung biopsies­to specify the etiology should be carried out without delay, since early treatment can change the prognosis of these patients(AU)

Síndrome hemorrágica pulmonar em cão associada à leptospirose / Pulmonary haemorrhagic syndrome in dog associated with leptospirosis

Background: Leptospirosis is probably the most widespread and prevalent zoonosis in the world, being classified as an emerging infectious disease for humans and dogs. Sporadically, dogs may present with cough and dyspnea, indicative of pulmonary involvement, associated with interstitial pneumonia and pulmonary hemorrhage with alveolar consolidation. Such changes stem from pulmonary haemorrhagic syndrome, which has emerged as a fatal complication, being documented in some areas in Europe and little described in North America. In this sense, the present study aims to report pulmonary hemorrhagic syndrome in a dog with leptospirosis.Case: A dog with no defined breed, aged 45 days, weighing 2.2 kg, with a history of apathy, anorexia, jaundice, hematochezia and vocalisation with a two day evolution was seen. Physical examination revealed a rectal temperature of 37.2°C, icteric mucosa, capillary filling time of two seconds, respiratory rate of 80 movements per minute and heart rate of 140 beats per minute, dehydration rate estimated at 8%, prostration, adequate body score, normal cardiac sounds and clean lung fields, in addition to petechiae in the abdominal region, whose palpation evidenced the presence of fluid in intestinal loops. The blood sample sent to the macroscopic serum agglutination was reagent for the serovar Icterohaemorragiae, titration of 200. Blood count revealed leukocytosis due to neutrophilia, with left-sided deviation, eosinopenia, presence of rare hypersegmentated neutrophils, rare toxic neutrophils, mild cytoplasmic basophilia and rare reactive lymphocytes. Platelet estimation demonstrated thrombocytopenia. No haemoparasites were seen. Regarding the biochemical evaluation, there were changes in liver enzymes and markers of renal failure. Fluid therapy was used with 0.9% NaCl solution, 5 mg/ kg doxycycline intravenously every 12 h and nasogastric probe for administration of nutritional support...(AU)

Síndrome hemorrágica pulmonar em cão associada à leptospirose / Pulmonary haemorrhagic syndrome in dog associated with leptospirosis

Background: Leptospirosis is probably the most widespread and prevalent zoonosis in the world, being classified as an emerging infectious disease for humans and dogs. Sporadically, dogs may present with cough and dyspnea, indicative of pulmonary involvement, associated with interstitial pneumonia and pulmonary hemorrhage with alveolar consolidation. Such changes stem from pulmonary haemorrhagic syndrome, which has emerged as a fatal complication, being documented in some areas in Europe and little described in North America. In this sense, the present study aims to report pulmonary hemorrhagic syndrome in a dog with leptospirosis.Case: A dog with no defined breed, aged 45 days, weighing 2.2 kg, with a history of apathy, anorexia, jaundice, hematochezia and vocalisation with a two day evolution was seen. Physical examination revealed a rectal temperature of 37.2°C, icteric mucosa, capillary filling time of two seconds, respiratory rate of 80 movements per minute and heart rate of 140 beats per minute, dehydration rate estimated at 8%, prostration, adequate body score, normal cardiac sounds and clean lung fields, in addition to petechiae in the abdominal region, whose palpation evidenced the presence of fluid in intestinal loops. The blood sample sent to the macroscopic serum agglutination was reagent for the serovar Icterohaemorragiae, titration of 200. Blood count revealed leukocytosis due to neutrophilia, with left-sided deviation, eosinopenia, presence of rare hypersegmentated neutrophils, rare toxic neutrophils, mild cytoplasmic basophilia and rare reactive lymphocytes. Platelet estimation demonstrated thrombocytopenia. No haemoparasites were seen. Regarding the biochemical evaluation, there were changes in liver enzymes and markers of renal failure. Fluid therapy was used with 0.9% NaCl solution, 5 mg/ kg doxycycline intravenously every 12 h and nasogastric probe for administration of nutritional support...

Avaliação endoscópica das vias aéreas, do perfil de gases, dos eletrólitos e do equilíbrio ácido-base em equinos submetidos ao treinamento de três tambores / Endoscopic airway, blood gas, electrolytes, and acid-base in equine submitted to three-barrel training

O objetivo deste estudo foi avaliar as vias aéreas por endoscopia, o perfil de gases, de eletrólitos e o equilíbrio ácido-base de equinos da raça Quarto de Milha (QM) antes e após o exercício de três tambores. Dezesseis cavalos, divididos em dois grupos de oito animais, treino regular (TR - cinco vezes) e treino esporádico (TE - duas vezes por semana), foram utilizados no experimento. A endoscopia foi realizada antes e 90 min após o exercício. Foram realizadas duas coletas de sangue por punção da artéria facial transversa antes do aquecimento (M0) e imediatamente após o exercício (M1), e as leituras foram realizadas com o I-Stat(r). Foram determinadas PCO2, PO2, SO2, pH, BE, HCO3 e TCO2, Na+, K+, iCa, glicose, Hg e Ht. Foi utilizada ANOVA com medidas repetidas no tempo para comparações dos grupos e dos momentos (P<0,05). A HFL acometeu em grau leve (1-2) os animais de ambos os grupos, com 8/8 (100%) no TR e 5/8 (62,5%) no TE. Observou-se presença de secreção serosa na traqueia em 4/8 (50%) para ambos os grupos. A HPIE acometeu em grau leve (1-2) os animais de ambos os grupos, com 4/8 (50%) no grupo TR e 3/8 (37,5%) no grupo TE. Os animais com grau 2 de HPIE apresentaram leve hipoxemia e hipercapnia pós-exercício. SO2, PCO2, pH, HCO3, BE, K e iCa+ não diferiram estatisticamente (P>0,05) entre os grupos. Os cavalos da raça QM submetidos ao exercício de TT apresentam HPIE e acidose metabólica.(AU)

The aim of this study was to evaluate the airways by endoscopy, gas profile, electrolytes and acid-base balance of horses in the Quarter Horse (QM) race before and after training three drums. Sixteen horses divided into two groups of 8 animals, with regular training (RT - 5 times a week) and sporadic training (ET - 2 times a week) were used in the experiment. Endoscopy was performed before and 90 min after training. Two blood samples were taken by puncturing the transverse facial artery before heating (M0) and immediately after training (M1), and the readings were performed with the I-Stat(r). PCO2, PO2, SO2, pH, BE, HCO3 and TCO2, Na +, K +, iCa, Glucose, Hg, and Ht were determined. ANOVA was used with repeated measures over time for comparisons of groups and time (P<0.05). The HFL befell was mild (1-2), the animals from both groups with 8/8 (100%) in the TR and 5/8 (62.5%) for the TE. There was presence of serous trachea 4/8 (50%) for both groups. The EIPH befell was mild (1-2) in the animals from both groups with 4/8 (50%) in the RT group and 3/8 (37.5%) for the TE group. Animals with grade 2 EIPH had mild hypoxemia and hypercapnia after exercise. The SO2, PCO2, pH, HCO3, BE, K, and iCa did not differ P <0.05 between groups. QM race submitted to TT exercise have EIPH and metabolic acidosis.(AU)

Avaliação endoscópica das vias aéreas, do perfil de gases, dos eletrólitos e do equilíbrio ácido-base em equinos submetidos ao treinamento de três tambores / Endoscopic airway, blood gas, electrolytes, and acid-base in equine submitted to three-barrel training

O objetivo deste estudo foi avaliar as vias aéreas por endoscopia, o perfil de gases, de eletrólitos e o equilíbrio ácido-base de equinos da raça Quarto de Milha (QM) antes e após o exercício de três tambores. Dezesseis cavalos, divididos em dois grupos de oito animais, treino regular (TR - cinco vezes) e treino esporádico (TE - duas vezes por semana), foram utilizados no experimento. A endoscopia foi realizada antes e 90 min após o exercício. Foram realizadas duas coletas de sangue por punção da artéria facial transversa antes do aquecimento (M0) e imediatamente após o exercício (M1), e as leituras foram realizadas com o I-Stat(r). Foram determinadas PCO2, PO2, SO2, pH, BE, HCO3 e TCO2, Na+, K+, iCa, glicose, Hg e Ht. Foi utilizada ANOVA com medidas repetidas no tempo para comparações dos grupos e dos momentos (P<0,05). A HFL acometeu em grau leve (1-2) os animais de ambos os grupos, com 8/8 (100%) no TR e 5/8 (62,5%) no TE. Observou-se presença de secreção serosa na traqueia em 4/8 (50%) para ambos os grupos. A HPIE acometeu em grau leve (1-2) os animais de ambos os grupos, com 4/8 (50%) no grupo TR e 3/8 (37,5%) no grupo TE. Os animais com grau 2 de HPIE apresentaram leve hipoxemia e hipercapnia pós-exercício. SO2, PCO2, pH, HCO3, BE, K e iCa+ não diferiram estatisticamente (P>0,05) entre os grupos. Os cavalos da raça QM submetidos ao exercício de TT apresentam HPIE e acidose metabólica.(AU)

The aim of this study was to evaluate the airways by endoscopy, gas profile, electrolytes and acid-base balance of horses in the Quarter Horse (QM) race before and after training three drums. Sixteen horses divided into two groups of 8 animals, with regular training (RT - 5 times a week) and sporadic training (ET - 2 times a week) were used in the experiment. Endoscopy was performed before and 90 min after training. Two blood samples were taken by puncturing the transverse facial artery before heating (M0) and immediately after training (M1), and the readings were performed with the I-Stat(r). PCO2, PO2, SO2, pH, BE, HCO3 and TCO2, Na +, K +, iCa, Glucose, Hg, and Ht were determined. ANOVA was used with repeated measures over time for comparisons of groups and time (P<0.05). The HFL befell was mild (1-2), the animals from both groups with 8/8 (100%) in the TR and 5/8 (62.5%) for the TE. There was presence of serous trachea 4/8 (50%) for both groups. The EIPH befell was mild (1-2) in the animals from both groups with 4/8 (50%) in the RT group and 3/8 (37.5%) for the TE group. Animals with grade 2 EIPH had mild hypoxemia and hypercapnia after exercise. The SO2, PCO2, pH, HCO3, BE, K, and iCa did not differ P <0.05 between groups. QM race submitted to TT exercise have EIPH and metabolic acidosis.(AU)

[Pulmonary hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations and prognosis]. / Hemorragia pulmonar en pacientes con lupus eritematoso sistémico. Características clínicas y pronóstico.

BACKGROUND AND OBJECTIVE: Pulmonary hemorrhage (PH) in systemic lupus erythematosus (SLE) is a rare but potentially fatal complication that occurs most frequently in the context of active lupus with involvement of other organs. The objective of this study is to report the clinical features and prognosis of patients with SLE who had PH. METHODS: Patients with SLE (1982 American College of Rheumatology criteria) and PH under monitoring between June 1999 and November 2011 were studied. Demographic, clinical, laboratory, treatment and prognosis data related to PH were analyzed. RESULTS: Eleven patients with SLE developed 14 episodes of PH. PH was the first manifestation of SLE in 2 patients. The most frequent symptoms and clinical signs were dyspnea, fever and cough, which occurred in 12 (85%), 11 (77%) and 7 (50%) patients, respectively. Hemoptysis was also observed in 5 (35%) episodes, tachycardia in 2 (14%), pallor in one (7%) and chest pain in one (7%). All patients had other concomitant organ involvement, and were treated with glucocorticoids. In addition, intravenous cyclophosphamide was indicated in 12 episodes and plasma exchange in 4. Overall mortality was 64%. Factors associated with mortality were infection, mechanical ventilation and dialysis. CONCLUSIONS: PH continues to be a rare and severe complication of SLE. Its suspected presence forces us to quickly study these patients, since early diagnosis and aggressive treatment have been shown to improve survival in them.

Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns / Prevalência, fatores de risco e prognóstico associados à hemorragia pulmonar em recém-nascidos

OBJECTIVES: to determine the prevalence of pulmonary hemorrhage in newborns and evaluate the associated risk factors and outcomes. METHODS: this was a retrospective case-control study involving 67 newborns who met the criteria for pulmonary hemorrhage. A control was selected for each case: the next-born child of the same gender, similar weight (± 200 g) and gestational age (± 1 week), with no previous pulmona ry hemorrhage and no malformation diagnosis. Factors previous to pulmonary hemorrhage onset, as well as aspects associated to the condition, were assessed. RESULTS: the prevalence was 6.7 for 1,000 live births, and the rates observed were: 8% among newborns < 1,500 g, and 11% among newborns < 1,000 g. Intubation in the delivery room (OR = 7.16), SNAPPE II (OR = 2.97), surfactant use (OR = 3.7), and blood components used previously to pulmonary hemorrhage onset (OR = 5.91) were associated with pulmonary hemorrhage. In the multivariate logistic regression model, only intubation in delivery room and previous use of blood components maintained the association. Children with pulmonary hemorrhage had higher mortality (OR = 7.24). Among the survivors, the length of stay (p < 0.01) and mechanical ventilation time were longer (OR = 25.6), and oxygen use at 36 weeks of corrected age was higher (OR = 7.67). CONCLUSIONS: pulmonary hemorrhage is more prevalent in premature newborns, and is associated with intubation in the delivery room and previous use of blood components, leading to high mortality and worse clinical evolution. .

OBJETIVOS : determinar a prevalência de hemorragia pulmonar entre os recém-nascidos internados no serviço e avaliar os fatores de risco e prognóstico associados. MÉTODOS: estudo retrospectivo caso-controle com 67 recém-nascidos que preencheram os critérios pré-estabelecidos de hemorragia pulmonar. Para cada caso, foi selecionado um controle: a próxima criança nascida do mesmo sexo, com semelhantes peso (± 200 g), idade gestacional (± 1 semana) e sem hemorragia pulmonar ou malformações. Foram estudados fatores prévios à ocorrência da hemorragia pulmonar e aspectos decorrentes do evento. RESULTADOS: a prevalência foi de 6,7 a cada 1.000 nascidos vivos, sendo de 8% entre os recém-nascidos menores que 1.500 g e de 11% entre os recém-nascidos menores que 1.000 g. A necessidade de intubação (IOT) em sala de parto (OR = 7,16), uso de hemoderivados previamente à ocorrência de hemorragia pulmonar (OR = 5,91), uso de surfactante (OR = 3,7) e SNAPPEII > 30 (OR = 2,97) foram associados à hemorragia pulmonar. No modelo de regressão logística multivariado, a necessidade de IOT (OR = 5,12) e uso de hemoderivados (OR = 4,2) mantiveram essa associação. As crianças com hemorragia pulmonar apresentaram maior mortalidade (OR = 7,24), entre as sobreviventes, maior tempo de internação (p < 0,01), mais uso de oxigênio com 36 semanas (OR = 7,67) e maior duração da ventilação mecânica (OR = 35,6). CONCLUSÃO: a hemorragia pulmonar é uma doença de maior prevalência em recém-nascidos pré-termos, e está associada à intubação em sala de parto e ao uso prévio de hemoderivados, acarretando maior mortalidade e pior evolução clínica das crianças. .

Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns.

OBJECTIVES: to determine the prevalence of pulmonary hemorrhage in newborns and evaluate the associated risk factors and outcomes. METHODS: this was a retrospective case-control study involving 67 newborns who met the criteria for pulmonary hemorrhage. A control was selected for each case: the next-born child of the same gender, similar weight (± 200g) and gestational age (± 1 week), with no previous pulmonary hemorrhage and no malformation diagnosis. Factors previous to pulmonary hemorrhage onset, as well as aspects associated to the condition, were assessed. RESULTS: the prevalence was 6.7 for 1,000 live births, and the rates observed were: 8% among newborns <1,500g, and 11% among newborns <1,000g. Intubation in the delivery room (OR=7.16), SNAPPE II (OR=2.97), surfactant use (OR=3.7), and blood components used previously to pulmonary hemorrhage onset (OR=5.91) were associated with pulmonary hemorrhage. In the multivariate logistic regression model, only intubation in delivery room and previous use of blood components maintained the association. Children with pulmonary hemorrhage had higher mortality (OR=7.24). Among the survivors, the length of stay (p ≤ 0.01) and mechanical ventilation time were longer (OR=25.6), and oxygen use at 36 weeks of corrected age was higher (OR=7.67). CONCLUSIONS: pulmonary hemorrhage is more prevalent in premature newborns, and is associated with intubation in the delivery room and previous use of blood components, leading to high mortality and worse clinical evolution.

Microscopic polyangiitis secondary to silica exposure.

There is sufficient evidence of the capacity of silica to induce autoimmunity in patients with some type of genetic susceptibility. There are several autoimmune diseases related to this exposure (rheumatoid arthritis, Sjögren's syndrome, sarcoidosis, systemic sclerosis). Nodular silicosis (clinical expression of this exposure in lungs) generates apoptosis, inflammation, loss of tolerance and a respiratory burst. There is evidence that relates silica with induction of antineutrophil cytoplasmic antibodies, but, until it is better explained, the reports of systemic vasculitis secondary to silica exposure are inconclusive. We describe a case of a patient with a history of occupational exposure to silica who developed microscopic polyangiitis.

Avanços no conhecimento da imunopatogênese da leptospirose e a aplicação do método do imprint como ferramenta qualitativa e quantitativa de leptospiras / Advances in understanding the immunopathogenesis of leptospirosis and application of the imprint method as a qualitative and quantitative tool leptospires

A leptospirose é uma zoonose causada por espiroquetas patogênicas pertencentes ao gênero Leptospira. O modelo da doença em camundongos tem vantagens devido à ampla gama de ferramentas genéticas e imunológicas disponíveis para pesquisas básicas. A maior limitação na conduta clínica e na pesquisa experimental da leptospirose é o fraco desempenho dos métodos disponíveis para detecção direta e para quantificação de leptospiras. Foi incluído nesta tese um conjunto de três manuscritos que visam investigar o desfecho da infecção pela cepa virulenta de Leptospira interrogans nas linhagens de camundongos selvagens (A, CBA, BALB/c e C57BL/6)...

Leptospirosis is a zoonosis caused by pathogenic spirochaetes belonging to the genus Leptospira. The mouse disease model is advantagous due to the broad array of immunological and genetic tools available for basic research. A major limitation in the clinical management and experimental research of leptospirosis is the poor performance of the available methods in the direct detection and quantification of leptospires. This thesis includes three manuscripts that investigate the outcome of infection by a virulent strain of Leptospira interrogans in wildtype mice strains: A, CBA, BALB/c and C57BL/6; in iNOS knockout (KO) mice, recombination activating gene 1 (RAG1) KO mice and CB17 severe combined immunodeficiency (SCID) mice. To investigate whether the imprint method (IM) of quantification was reliable we compared it with against real time PCR (qPCR) for the detection and quantification of leptospires in kidney samples from rats and hamsters. As expected, none of the wildtype mice were susceptible to lethal leptospirosis. The A and C57BL/6 strains exhibited high leptospiral loads in the kidney samples and the CBA and C57BL/6...

Oxigenación por membrana extracorpórea y plasmaféresis en un paciente con hemorragia pulmonar grave secundaria a poliarteritis nodosa / Extracorporeal membrane oxygenation and plasmapheresis in the treatment of severe pulmonary hemorrhage secondary to nodose polyarteritis

Se comunica el caso de un paciente de 23 meses de edad, con hemorragia pulmonar, hipoxemia refractaria, hipertensión arterial y falla renal secundarias a poliarteritis nodosa (PN) que ha requerido asistencia simultánea con soporte cardiopulmonar extracorpóreo (ECMO), plasmaféresis, hemodiafiltración y surfactante exógeno. La PN es una vasculitis autoinmunitaria que afecta los vasos arteriales de pequeño y mediano calibres. La hipoxemia, refractaria al tratamiento con ventilación mecánica convencional y de alta frecuencia oscilatoria, fue sostenida con ECMO mientras se controló la enfermedad autoinmunitaria mediante plasmaféresis y tratamiento inmunosupresor. La combinación de ECMO con plasmaféresis es infrecuente, pero ha sido descripta en relación al trasplante de órganos, intoxicaciones, fallo cardíaco y sepsis. Existen dos casos descriptos en la bibliografía sobre el uso combinado de estas terapéuticas para el tratamiento de hemorragia pulmonar secundaria a vasculitis autoinmunitaria en niños.(AU)

We report to simultaneous use of extracorporeal life support (ECLS), plasmapheresis, hemodiafiltration and exogenous surfactant for the treatment of pulmonary hemorrhage, arterial hypertension, and renal failure secondary to nodose polyarteritis (NPA) in a 23-month-old patient. NPA is an autoimmune disease that affects small -and medium- caliber muscular arteries. Hypoxemia refractory to treatment with conventional and high frequency oscillatory ventilation was supported by ECMO while awaiting control of the autoimmune disease through the use of plasmapheresis and immunosuppressive treatment. Although the combination of ECLS with plasmapheresis is rare, it has been described during the management of cases of organ transplant, intoxication, cardiac failure, and sepsis. There are only two previous reports describing the use of this combined therapy for the treatment of pulmonary hemorrhage secondary to autoimmune vasculitis in childhood.(AU)

Oxigenación por membrana extracorpórea y plasmaféresis en un paciente con hemorragia pulmonar grave secundaria a poliarteritis nodosa / Extracorporeal membrane oxygenation and plasmapheresis in the treatment of severe pulmonary hemorrhage secondary to nodose polyarteritis

Se comunica el caso de un paciente de 23 meses de edad, con hemorragia pulmonar, hipoxemia refractaria, hipertensión arterial y falla renal secundarias a poliarteritis nodosa (PN) que ha requerido asistencia simultánea con soporte cardiopulmonar extracorpóreo (ECMO), plasmaféresis, hemodiafiltración y surfactante exógeno. La PN es una vasculitis autoinmunitaria que afecta los vasos arteriales de pequeño y mediano calibres. La hipoxemia, refractaria al tratamiento con ventilación mecánica convencional y de alta frecuencia oscilatoria, fue sostenida con ECMO mientras se controló la enfermedad autoinmunitaria mediante plasmaféresis y tratamiento inmunosupresor. La combinación de ECMO con plasmaféresis es infrecuente, pero ha sido descripta en relación al trasplante de órganos, intoxicaciones, fallo cardíaco y sepsis. Existen dos casos descriptos en la bibliografía sobre el uso combinado de estas terapéuticas para el tratamiento de hemorragia pulmonar secundaria a vasculitis autoinmunitaria en niños.

We report to simultaneous use of extracorporeal life support (ECLS), plasmapheresis, hemodiafiltration and exogenous surfactant for the treatment of pulmonary hemorrhage, arterial hypertension, and renal failure secondary to nodose polyarteritis (NPA) in a 23-month-old patient. NPA is an autoimmune disease that affects small -and medium- caliber muscular arteries. Hypoxemia refractory to treatment with conventional and high frequency oscillatory ventilation was supported by ECMO while awaiting control of the autoimmune disease through the use of plasmapheresis and immunosuppressive treatment. Although the combination of ECLS with plasmapheresis is rare, it has been described during the management of cases of organ transplant, intoxication, cardiac failure, and sepsis. There are only two previous reports describing the use of this combined therapy for the treatment of pulmonary hemorrhage secondary to autoimmune vasculitis in childhood.

Hemorragia pulmonar en enfermedades del tejido conectivo y comparación con lo descripto en la literatura / Pulmonary hemorrhage in connective tissue diseases and comparison with previous literature reports

Introducción: La hemorragia pulmonar difusa se caracteriza clínicamente por la presencia de disnea y hemoptisis, infiltrados alveolares bilaterales y difusos en la Rx de tórax y caída brusca de los valores de hemoglobina. Esta hemorragia puede ocurrir en el contexto de una enfermedad autoinmune (poliangeítis microscópica, enfermedad de Wegener, LES, síndrome de Goodpasture), síndrome antifosfolípidos, enfermedades infecciosas (leptospirosis y neumonía necrotizante), uremia, insuficiencia cardíaca congestiva, infarto pulmonar, desórdenes de la coagulación y secundaria a drogas (penicilamina). Dada su alta mortalidad y la escasez de síntomas (mucho mayor en pacientes inmunocomprometidos) es necesario un alto índice de sospecha y un rápido tratamiento. Objetivo: Comparar las manifestaciones clínicas, radiológicas y de laboratorio de los pacientes con hemorragia de pulmón con otras series publicadas. Material y métodos: Estudio retrospectivo y descriptivo, realizado revisando las historias clínicas de los pacientes con diagnóstico de hemorragia de pulmón secundaria a enfermedades autoinmunes. Criterios de inclusión (adaptados de Barile y cols.): caída en la hemoglobina de por lo menos 1,5 g/dl o anemia (Hb menor o igual a 11 g/dl), ambas relacionadas al evento; insuficiencia respiratoria de comienzo agudo; hemoptisis; infiltrados en Ñ de los campos pulmonares; hipoxemia y lavado bronquioloalveolar con al menos 20% de macrófagos con hemosiderina o sangre por tubo endotraqueal. Criterios de exclusión: infecciones, tromboembolismo de pulmón, falta de confirmación por lavado bronquioloalveolar o tubo endotraqueal. Resultados: 19 pacientes con hemorragia de pulmón. 5 de ellos excluidos por la presencia de tromboembolismo de pulmón en uno y ausencia de método confirmatorio de hemorragia de pulmón en 4...(AU)

Introduction: Pulmonary or diffuse alveolar hemorrhage is clinicallycharacterized by the presence of dypsnea and hemoptysis, bilateraland diffuse alveolar infiltrates on chest X-ray and sudden drop in bloodhemoglobin. This hemorrhage may occur in the setting of autoimmunediseases (microscopic polyarteritis, WegenerÆs disease, systemic lupuserythematosus, Goodpasture syndrome), antiphospholipid syndrome,infectious diseases (such as leptospirosis and necrotizing pneumonia),uremia, congestive heart failure, pulmonary infarction, coagulation disordersand hemorrhages secondary to drugs (such as penicilamina).Due to its high mortality and the paucity of symptoms (mostly in theinmunocompromise patients), it is necessary a high index of suspiciousto promptly treat...(AU)Objective: To compare the clinical, radiological and lab tests findings ofthe patients selected with the published series.Material and Method: A retrospective and descriptive analysis wasperformed on the records of all patients with a diagnosis of pulmonaryhemorrhage secondary to autoimmune diseases. Inclusion criteria(adapted of Barile et al): Fall in hemoglobin of at least 1.5 g/dl or anemia(hemoglobin 11 g/dl or less), both related to the event, respiratoryfailure of rapid onset, hemoptysis, dense infiltrates in Ñ or more of thelung fields, hypoxemia and bronchoalveolar lavage, with at least 20% ofmacrophages with hemosiderin inside or the presence of blood in endotrachealtube. Exclusion criteria: Pulmonary infections, tromboembolismdisease, lack of confirmation by method of pulmonary haemorrhage...(AU)

Hemorragia pulmonar en enfermedades del tejido conectivo y comparación con lo descripto en la literatura / Pulmonary hemorrhage in connective tissue diseases and comparison with previous literature reports

Introducción: La hemorragia pulmonar difusa se caracteriza clínicamente por la presencia de disnea y hemoptisis, infiltrados alveolares bilaterales y difusos en la Rx de tórax y caída brusca de los valores de hemoglobina. Esta hemorragia puede ocurrir en el contexto de una enfermedad autoinmune (poliangeítis microscópica, enfermedad de Wegener, LES, síndrome de Goodpasture), síndrome antifosfolípidos, enfermedades infecciosas (leptospirosis y neumonía necrotizante), uremia, insuficiencia cardíaca congestiva, infarto pulmonar, desórdenes de la coagulación y secundaria a drogas (penicilamina). Dada su alta mortalidad y la escasez de síntomas (mucho mayor en pacientes inmunocomprometidos) es necesario un alto índice de sospecha y un rápido tratamiento. Objetivo: Comparar las manifestaciones clínicas, radiológicas y de laboratorio de los pacientes con hemorragia de pulmón con otras series publicadas. Material y métodos: Estudio retrospectivo y descriptivo, realizado revisando las historias clínicas de los pacientes con diagnóstico de hemorragia de pulmón secundaria a enfermedades autoinmunes. Criterios de inclusión (adaptados de Barile y cols.): caída en la hemoglobina de por lo menos 1,5 g/dl o anemia (Hb menor o igual a 11 g/dl), ambas relacionadas al evento; insuficiencia respiratoria de comienzo agudo; hemoptisis; infiltrados en ¾ de los campos pulmonares; hipoxemia y lavado bronquioloalveolar con al menos 20% de macrófagos con hemosiderina o sangre por tubo endotraqueal. Criterios de exclusión: infecciones, tromboembolismo de pulmón, falta de confirmación por lavado bronquioloalveolar o tubo endotraqueal. Resultados: 19 pacientes con hemorragia de pulmón. 5 de ellos excluidos por la presencia de tromboembolismo de pulmón en uno y ausencia de método confirmatorio de hemorragia de pulmón en 4...

Introduction: Pulmonary or diffuse alveolar hemorrhage is clinicallycharacterized by the presence of dypsnea and hemoptysis, bilateraland diffuse alveolar infiltrates on chest X-ray and sudden drop in bloodhemoglobin. This hemorrhage may occur in the setting of autoimmunediseases (microscopic polyarteritis, Wegener’s disease, systemic lupuserythematosus, Goodpasture syndrome), antiphospholipid syndrome,infectious diseases (such as leptospirosis and necrotizing pneumonia),uremia, congestive heart failure, pulmonary infarction, coagulation disordersand hemorrhages secondary to drugs (such as penicilamina).Due to its high mortality and the paucity of symptoms (mostly in theinmunocompromise patients), it is necessary a high index of suspiciousto promptly treat...(AU)Objective: To compare the clinical, radiological and lab tests findings ofthe patients selected with the published series.Material and Method: A retrospective and descriptive analysis wasperformed on the records of all patients with a diagnosis of pulmonaryhemorrhage secondary to autoimmune diseases. Inclusion criteria(adapted of Barile et al): Fall in hemoglobin of at least 1.5 g/dl or anemia(hemoglobin 11 g/dl or less), both related to the event, respiratoryfailure of rapid onset, hemoptysis, dense infiltrates in ¾ or more of thelung fields, hypoxemia and bronchoalveolar lavage, with at least 20% ofmacrophages with hemosiderin inside or the presence of blood in endotrachealtube. Exclusion criteria: Pulmonary infections, tromboembolismdisease, lack of confirmation by method of pulmonary haemorrhage...

Pulmonary hemorrhage in horses seropositive to leptospirosis / Hemorragia pulmonar em cavalos soropositivos para leptospirose

The aim of this study was to verify the occurrence and severity of pulmonary hemorrhage (PH) in horses seropositive or not to leptospirosis. A total of 84 training horses were tested for anti-Leptospira antibodies and submitted to endoscopy of the upper airways 30-60 minutes after exercise. Forty-nine (46.4 percent) horses were seropositive (titer>100) to serovar Copenhageni. Seventeen horses (20.2 percent) presented PH in different grades, significantly more commonly observed in seropositives (34.7 percent) than seronegatives (8.6 percent) (p<0.05), and also more severe in the first. Additionally, a seropositive horse is 4.26 times more likely (OR) to present PH than a seronegative one. Fifteen days after specific antibiotic treatment for leptospirosis a significant improvement in grade of hemorrhage was observed. Therefore it is suggested that leptospirosis may potentiate the severity of PH and that specific antibiotic treatment directed towards leptospirosis may help to control the disease.(AU)

O objetivo foi estudar a ocorrência e severidade de hemorragia pulmonar (HP) em cavalos soropositivos ou não à leptospirose. Um total de 84 cavalos em treinamento foi testado para anticorpos anti-Leptospira e submetidos à endoscopia das vias aéreas superiores de 30-60 minutos após exercício. Quarenta e nove (46,4 por cento) animais foram soropositivos (títulos>100) para o serovar Copenhageni. Dezessete cavalos (20,2 por cento) apresentaram HP, significativamente mais observada em soropositivos (34,7 por cento) do que em soronegativos (8,6 por cento) (p<0,05) e também mais grave nos primeiros. Adicionalmente, um cavalo soropositivo tem 4,26 mais chances (OR) de apresentar PH do que um soronegativo. Quinze dias após o tratamento com antibiótico específico para leptospirose uma melhoria significativa no grau de hemorragia foi observada. Portanto, sugere-se que a leptospirose pode potencializar a severidade da HP e que o tratamento com antibióticos específicos recomendados para leptospirose pode ajudar a controlá-la.(AU)

Pulmonary hemorrhage in horses seropositive to leptospirosis / Hemorragia pulmonar em cavalos soropositivos para leptospirose

The aim of this study was to verify the occurrence and severity of pulmonary hemorrhage (PH) in horses seropositive or not to leptospirosis. A total of 84 training horses were tested for anti-Leptospira antibodies and submitted to endoscopy of the upper airways 30-60 minutes after exercise. Forty-nine (46.4 percent) horses were seropositive (titer>100) to serovar Copenhageni. Seventeen horses (20.2 percent) presented PH in different grades, significantly more commonly observed in seropositives (34.7 percent) than seronegatives (8.6 percent) (p<0.05), and also more severe in the first. Additionally, a seropositive horse is 4.26 times more likely (OR) to present PH than a seronegative one. Fifteen days after specific antibiotic treatment for leptospirosis a significant improvement in grade of hemorrhage was observed. Therefore it is suggested that leptospirosis may potentiate the severity of PH and that specific antibiotic treatment directed towards leptospirosis may help to control the disease.

O objetivo foi estudar a ocorrência e severidade de hemorragia pulmonar (HP) em cavalos soropositivos ou não à leptospirose. Um total de 84 cavalos em treinamento foi testado para anticorpos anti-Leptospira e submetidos à endoscopia das vias aéreas superiores de 30-60 minutos após exercício. Quarenta e nove (46,4 por cento) animais foram soropositivos (títulos>100) para o serovar Copenhageni. Dezessete cavalos (20,2 por cento) apresentaram HP, significativamente mais observada em soropositivos (34,7 por cento) do que em soronegativos (8,6 por cento) (p<0,05) e também mais grave nos primeiros. Adicionalmente, um cavalo soropositivo tem 4,26 mais chances (OR) de apresentar PH do que um soronegativo. Quinze dias após o tratamento com antibiótico específico para leptospirose uma melhoria significativa no grau de hemorragia foi observada. Portanto, sugere-se que a leptospirose pode potencializar a severidade da HP e que o tratamento com antibióticos específicos recomendados para leptospirose pode ajudar a controlá-la.

Neumonía aguda de la comunidad y hemorragia pulmonar por leptospirosis en el área metropolitana Buenos Aires / Community acquired pneumonia and pulmonary hemorrhage in leptospirosis in the Buenos Aires metropolitan area

El objetivo del trabajo es comunicar los hallazgos epidemiológicos, clínicos y de diagnóstico de la neumonía y hemorragia pulmonar por leptospirosis, en el período enero 2007 a octubre 2009. Un 64% (20/31) de pacientes con diagnóstico de leptospirosis tuvieron neumonía. Quince de ellos (75%) presentaron neumonía grave, de los cuales siete (35%) desarrollaron hemorragia pulmonar. En diez enfermos (32%) el motivo de consulta e inicio del cuadro clínico fue una gastroenteritis secretoria con fiebre y dolor abdominal. La ictericia sólo se manifestó en once pacientes (35%). La técnica de reacción en cadena de la polimerasa (PCR) fue útil para el diagnóstico en muestra obtenida post mortem. De un hemocultivo se aisló una cepa clasificada dentro del serogrupo canicola. Se clasificaron las neumonías en tres tipos: neumonías de curso no grave con escasa repercusión general; neumonías graves asociadas a formas clínicas sistémicas con ictericia, insuficiencia renal, trombocitopenia y hemorragia pulmonar; también de curso grave, no asociada a ictericia, insuficiencia renal o trombocitopenia grave. El tratamiento antibiótico iniciado en los primeros días de enfermedad (promedio 3.2 días) no tuvo influencia en la evolución de las neumonías graves. Se plantea además considerar tres formas clínicas de leptospirosis: anictérica, ictérica (con sus variantes evolutivas) y hemorragia pulmonar.

The aim of this paper is to report the epidemiological, clinical and diagnosis findings of pneumonia and pulmonary hemorrhage observed in patients with leptospirosis in the period January 2007 to October 2009. A 64% (20/31) of patients diagnosed with leptospirosis presented pneumonia. Fifteen of them (75%) had severe pneumonia, of which seven (35%) were pulmonary hemorrhage. In ten patients (32%) reason for consultation and clinical early stage was a secretory gastroenteritis with fever and abdominal pain. Jaundice was only expressed in eleven patients (35%). The technique of chain reaction (PCR) was useful for diagnosis in samples obtained post mortem. A strain classified in serogroup canicola was isolated from blood culture. Pneumonia was classified into three types: non-severe pneumonia course with little overall impact; severe pneumonia associated with systemic clinical forms with jaundice, renal failure, thrombocytopenia, and pulmonary hemorrhage, and of serious course, not associated with jaundice, kidney failure or thrombocytopenia. Antibiotic treatment started in the early stages of disease (average 3.2 days) had no influence on the development of severe pneumonia. It is puggested to consider three clinical forms of leptospirosis: anicteric, icteric (with its evolutionary variants) and pulmonary hemorrhage.

Tratamento da hemorragia pulmonar maciça com fator VII recombinante ativado em prematuro de muito baixo peso / Treatment of massive pulmonary hemorrhage with activated recombinant factor VII in a very low birth weight premature

Neste relato, apresenta-se um caso de prematuro com 33 semanas de idade gestacional e 1.310 gramas, nascido de parto cesariano por retardo de crescimento intrauterino e alterações de fluxo uteroplacentário. Na evolução, apresentou sinais de choque séptico, com hipotensão e necessidade de dopamina e adrenalina contínuas. No sextodia de vida, observou-se hipoxemia refratária a altos parâmetros de ventilação mecânica. O quadro evoluiu com insuficiência renal, sem diurese após o uso de furosemida contínuo. Teve hemorragia pulmonar maciça, sem resposta às transfusões de plasma e plaquetas convencionais. Respondeu ao tratamento com dose de 120 μg/kg do fatorVII recombinante ativado. Após o controle do sangramento, foi instalado cateter para diálise peritoneal contínua, e o recém-nascido recuperou-se gradativamente das disfunções de múltiplos órgãos. Recebeu alta da unidade de terapia intensiva aos 49 dias de vida. Em conclusão, o fator VII recombinante ativado é uma alternativa eficaz de agentepan-hemostático para o controle de hemorragias pulmonares agudas graves no recém-nascido que não responde às manobras ventilatórias e ao uso de concentrados de hemocomponentes.

In this report, the authors present the case of a male premature with 33 weeks of gestation and weighing 1,310 grams, born from cesarean section indicated by retarded intrauterine growth and changes in uteroplacental flow. He showed signs of septic shock with hypotension and needed continuous adrenaline and dopamine. On the sixth day oflife, hypoxemia refractory to high mechanical ventilation parameters was observed. He developed renal failure, without diuresis after continuous furosemide. There was massive pulmonary hemorrhage unresponsive to transfusions of plasma and platelets. He responded to treatment with a dose of recombinant factor VIIa (120 μg/kg). After controlof the bleeding, a catheter for continuous peritoneal dialysis was inserted and the baby gradually recovered from multiple organ dysfunction. He was discharged from the neonatal intensive care unit at 49 days of life. Concluding, the recombinant factor VIIa is an effective pan-hemostatic agent for control of severe acute pulmonary hemorrhagein the newborn that does not respond to ventilatory maneuvers and to the use of conventional blood derivates.