Leptospirosis among patients presenting with dengue-like illness in Puerto Rico.

Leptospirosis is difficult to distinguish from dengue fever without laboratory confirmation. Sporadic cases/clusters of leptospirosis occur in Puerto Rico, but surveillance is passive and laboratory confirmation is rare. We tested for leptospirosis using an IgM ELISA on sera testing negative for dengue virus IgM antibody and conducted a case-control study assessing risk factors for leptospirosis, comparing clinical/laboratory findings between leptospirosis (case-patients) and dengue patients (controls). Among 730 dengue-negative sera, 36 (5%) were positive for leptospirosis. We performed post mortem testing for leptospirosis on 12 available specimens from suspected dengue-related fatalities; 10 (83%) tested positive. Among these 10 fatal cases, pulmonary hemorrhage and renal failure were the most common causes of death. We enrolled 42 case-patients and 84 controls. Jaundice, elevated BUN, hyperbilirubinemia, anemia, and leukocytosis were associated with leptospirosis (p < .01 for all). Male sex, walking in puddles, rural habitation, and owning horses were independently associated with leptospirosis. Epidemiological, clinical, and laboratory criteria may help distinguish leptospirosis from dengue and identify patients who would benefit from early antibiotic treatment.

Middle latency auditory evoked potentials to tones of different frequency.

The scalp distributions of middle latency auditory evoked potentials (MAEPs) elicited by tone bursts of 250 and 4000 Hz were compared in two experiments. Na (19.9 ms), Pa (29.8 ms), and Pb (51.4 ms) components elicited by tones of either frequency had fronto-central distributions, whereas the Nb component (38.4 ms) was maximal at parietal sites. Although the distributions of MAEP components varied as a function of the ear of stimulation, no significant differences were found as a function of tone frequency. The results are consistent with suggestions that MAEPs reflect activation of non-tonotopically organized generators.

Frequency-related differences in the speed of human auditory processing.

Three experiments were performed, two comparing the peak latencies of auditory evoked potentials (AEPs) elicited by 250 Hz and 4000 Hz tone pips and a third comparing simple reaction times (RTs) to the same stimuli. In the AEP experiments, the latencies of brainstem, middle and long-latency components were delayed following 250 Hz tone pips in comparison with the latencies of the same components evoked by loudness-matched 4000 Hz tones. Frequency-related latency differences increased with component latency, ranging from less than 1.0 ms for wave V of the brainstem AEP, to more than 20.0 ms for the cortical N1 component. Interpeak latency differences were also significantly lengthened following the 250 Hz tone pips. In the behavioral study, RTs were 14.6 ms slower following 250 than 4000 Hz tone pips. The results suggest that the time required for the sensory analysis of auditory signals varies inversely with their frequency.