RESUMO
This study describes the clinical, parasitological and laboratory findings of four patients who lived in the district of Alto Nanay, Maynas, Loreto, Peru and were infected with Mansonella ozzardi microfilariae. Clinical examinations by ophthalmologists, cardiologists and nephrologists were performed. In case 1, the presence of 2 subcutaneous lumps was the most important finding, one at dorsal level and the other in the lower third of the left leg; in case 2, there was a sensation of tingling or coldness in the legs; in case 3, an associated chronic hepatitis B infection was found, and in case 4, a large lump was detected in the left lumbar region. All 4 patients were infected with Mansonella ozzardi and had eosinophilia, 3 of them in percentages of 20%. The lump found in case 4 was due to a herniation of bowel content. Further clinical studies and an evaluation of the actual pathogenic effect of microfilariae are to be performed. A study of the genetic diversity of filariae in the Peruvian Amazon would also be important.
Assuntos
Mansonella , Mansonelose/diagnóstico , Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PeruRESUMO
El presente estudio describe los hallazgos clínicos, parasitológicos y de laboratorio de cuatro pacientes residentes en el distrito de Alto Nanay, Maynas, Loreto, Perú; infectados con microfilarias de Mansonella ozzardi. La evaluación clínica incluyó las especialidades de oftalmología, cardiología y nefrología. En el caso 1, destaca la presencia de dos tumoraciones subcutáneas, una a nivel dorsal y la otra en el tercio inferior de la pierna izquierda; en el caso 2, la sensación de hormigueo o frío en las piernas; en el caso 3 se encontró asociada una infección crónica por hepatitis B y en el caso 4 una tumoración de gran tamaño en región lumbar izquierda. En los cuatro pacientes se encontró Mansonella ozzardi y eosinofilia, tres presentaron valores mayores a 20%. La tumoración en el caso 4 correspondió a una hernia de contenido intestinal. Es necesario ejecutar más estudios clínicos y evaluar su verdadero efecto patógeno, es también pertinente estudiar la diversidad genética de filarias de la Amazonia peruana.
This study describes the clinical, parasitological and laboratory findings of four patients who lived in the district of Alto Nanay, Maynas, Loreto, Peru and were infected with Mansonella ozzardi microfilariae. Clinical examinations by ophthalmologists, cardiologists and nephrologists were performed. In case 1, the presence of 2 subcutaneous lumps was the most important finding, one at dorsal level and the other in the lower third of the left leg; in case 2, there was a sensation of tingling or coldness in the legs; in case 3, an associated chronic hepatitis B infection was found, and in case 4, a large lump was detected in the left lumbar region. All 4 patients were infected with Mansonella ozzardi and had eosinophilia, 3 of them in percentages of 20%. The lump found in case 4 was due to a herniation of bowel content. Further clinical studies and an evaluation of the actual pathogenic effect of microfilariae are to be performed. A study of the genetic diversity of filariae in the Peruvian Amazon would also be important.
Assuntos
Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mansonella , Mansonelose/diagnóstico , PeruRESUMO
Objetivo: Describir las características clínicas y patológicas de pacientes con glomerulonefritis mesangial proliferativa primaria atendidos en el Hospital Nacional Arzobispo Loayza. Métodos: Se realizó un estudio descriptivo de tipo serie de casos. Se estudiaron todos los casos de glomerulonefritis mesangial proliferativa primaria que se diagnosticaron en el Hospital Nacional Arzobispo Loayza durante el periodo comprendido entre enero de 1993 y diciembre de 2005. Se revisaron archivos de los informes de biopsia renal y las historias clínicas de cada uno de los casos, con el propósito de caracterizar las manifestaciones clínicas y de laboratorio de la enfermedad. Resultados: Se estudiaron 33 casos. 26 mujeres (78.8%) y siete varones (21.2%). La mediana de la edad fue 34 años (rango entre 15 y 57 años). La mediana del tiempo de enfermedad fue de tres meses (rango entre uno y 32 meses). Todos pacientes presentaron edema y 24.2% hipertensión arterial. La albúmina sérica tuvo una mediana de 1.9 mg/dl (rango de 1.15 û 3.9 mg/dl). La hematuria microscópica se presentó en el 51.5% de los pacientes. Los depósitos mesangiales observados mediante inmunofluorescencia presentaron la siguiente distribución: IgM 45.5%, IgG 39.4%, IgA18.2%, IgG + IgM 24.2%, IgM + IgA 18.2%, IgG + IgA 12.1%, IgG + IgM + IgA 12.1%. Conclusiones: El perfil más frecuente del paciente con glomerulonefritis mesangial proliferativa primaria que se atiende en el Hospital Nacional Arzobispo Loayza, es el de una mujer mayor de 30 años, con síndrome nefrótico, acompañado de hipoalbuminemia e hipercolesterolemia. El progreso alcanzado en la comprensión de los mecanismos inmunológicos de la lesión glomerular y el reconocimiento temprano del cuadro clínico permite hacer un diagnóstico temprano del daño glomerular.
Objective: To describe the clinical and pathological features of patients with primary proliferative mesangial glomerulonephritis treated at the Archbishop Loayza National Hospital. Methods: A descriptive study of case series was carried out. We studied all the cases of primary mesangial proliferative glomerulonephritis diagnosed at Hospital Nacional Arzobispo Loayza (HNAL) during the period between January 1993 and December 2005. Files of renal biopsy reports were reviewed as well as medical records of individual cases in order to characterize the clinical and laboratory manifestations of the disease. Results: We studied 33 cases. Twenty six were women (78.8%). Median age was 34 years (range 15 to 57 years). Median disease duration was three months (range 1 to 32 months). All patients had edema and 24.2% hypertension. Serum albumin had a mean of 1.9 mg/dl (range 1.15-3.9 mg/dl). Microscopic hematuria was present in 51.5% of patients. Mesangial deposits seen by immunofluorescence showed the following distribution: 45.5% IgM, 39.4 % IgG, 18.2% IgA, 24.2% IgG + IgM, 18.2% IgA + IgM, 12.1% IgG + IgA and finally 12.1% for IgG + IgM + IgA. Conclusions: The most common profile of patients with primary mesangial proliferative glomerulonephritis seen at HNAL, was that of a woman over 30 years, with nephrotic syndrome, accompanied by hypoalbuminemia and hypercholesterolemia. Progress in understanding the immunologic mechanisms of glomerular injury and early recognition of the clinical picture allows early diagnosis of glomerular damage.