Hemorragia alveolar por leptospirosis en tiempos de COVID-19. Acerca de un caso / Alveolar hemorrhage due to Leptospirosis in times of Covid 19. About a Case.

La leptospirosis es una enfermedad zoonótica prevalente y generalizada de la cual no existen cifras fiables de incidencia mundial. Es una enfermedad con subregistro que puede generar una cifra importante de morbimortalidad. La incidencia de afectación pulmonar en la leptospirosis varía del 20 % al 70 %, y la hemorragia alveolar que se presenta con disnea y hemoptisis es su principal manifestación pulmonar, generando una mortalidad que puede ser mayor al 50 % si no se detecta y maneja a tiempo. Presentamos el caso de un paciente de 30 años de edad con sintomatología respiratoria y fiebre que hizo pensar en COVID-19 por las imágenes radiológicas y por época de pandemia, con antecedente de ser recolector de botellas, con descenso brusco de hemoglobina sin un sitio preciso de sangrado, considerándose como posibilidad hemorragia alveolar. Se le realizó serología por Leptospira siendo esta positiva y pudo ser tratado oportunamente. En conclusión, un buen interrogatorio sobre las actividades diarias junto con un buen juicio clínico e interpretación de exámenes laboratoriales nos debe hacer sospechar en hemorragia alveolar por leptospirosis.

Leptospirosis is a prevalent and generalized zoonotic disease, for which there are no reliable figures of world incidence. It is an underreported disease that can generate a significant number of morbidity and mortality. The incidence of pulmonary involvement in leptospirosis varies from 20% to 70%, and alveolar hemorrhage that presents with dyspnea and hemoptysis is the main pulmonary manifestation in leptospirosis, generating mortality that can be greater than 50% if it is not detected and drive on time. We present the case of a 30-year-old patient with respiratory symptoms and fever that suggested Covid 19 due to radiological images and due to the pandemic, with a history of being a bottle collector, who due to the sudden drop in hemoglobin without a precise site of bleeding was thought to be alveolar hemorrhage, serology was performed for leptospira, which was positive, and he could be treated in a timely manner. In conclusion, a good questioning about daily activities together with good clinical judgment and interpretation of laboratory tests should make us suspect alveolar hemorrhage due to leptospirosis.

Evidencia molecular de Leptospira interrogans sensu stricto en Cavia porcellus (cuyes) destinados para el consumo humano en el municipio de Pasto, Nariño / Molecular evidence of Leptospira interrogans sensu stricto in Cavia porcellus (guinea pig) grown for human consumption in Pasto, Nariño

Introducción: La leptospirosis es una zoonosis emergente, endémica en Colombia, que afecta tanto animales domésticos como silvestres. Es considerada de riesgo laboral, ya que la transmisión al ser humano está asociada a la exposición con animales o ambientes infectados. En el departamento de Nariño, la producción de cuyes para el consumo humano se realiza en sistemas de crianza tradicionales que podrían favorecer la infección por Leptospira interrogans en esta especie. Objetivo: Detectar molecularmente la infección natural por especies patógenas del género Leptospira en cuyes que son destinados para el consumo humano en el municipio de Pasto. Materiales y métodos: Se tomaron 270 muestras de tejido renal en cuyes sacrificados en dos mataderos. Las muestras fueron analizadas mediante Reacción en Cadena de la Polimerasa (PCR) convencional y coloración diferencial de Warthin Starry (W-S). Resultados: En la evaluación de las 270 muestras, 4 (1,5%) fueron positivas para PCR y una de las muestras demostró la presencia de Leptospira bajo tinción W-S. Conclusiones: Mediante el uso de técnicas moleculares se evidenció L. interrogans en el tejido renal de Cavia porcellus. La circulación del patógeno en esta población representa un riesgo de infección para humanos y animales domésticos en contacto con estos sistemas productivos.

Introduction: Leptospirosis is an emerging zoonosis that is endemic in Colombia and affects both domestic and wild animals. It is considered an occupational risk since human transmission is associated with exposure to infected animals or environments. In the department of Nariño, the production of guinea pigs for human consumption applies traditional rearing systems that could cause animals to get infected with Leptosipira interrogans. Objective: To molecularly identify natural infection by pathogenic species of the genus Leptospira in guinea pigs used for human consumption in the municipality of Pasto (Colombia). Materials and methods: 270 kidney tissue samples were taken from guinea pigs slaughtered in two facilities. Samples were analyzed through conventional polymerase chain reaction (PCR) and Warthin Starry (W-S) differential staining. Results: While 4 (1.5%) out of the 270 samples were categorized as positive using PCR, only 1 sample showed the presence of Leptospira through W-S staining. Conclusions: Molecular techniques were useful to identify L. interrogans in kidney tissue of Cavia porcellus. Dissemination of this pathogen within this population represents an infection risk for humans and domestic animals that are in close proximity to these productive systems.

Tendência temporal da leptospirose e sua associação com variáveis climáticas e ambientais em Santa Catarina, Brasil / Temporal trends in leptospirosis incidence and association with climatic and environmental factors in the state of Santa Catarina, Brazil

Resumo A leptospirose é uma zoonose que apresenta potencial epidêmico, principalmente após fortes chuvas que acarretam inundações, alagamentos e enxurradas. Algumas características da região costeira de Santa Catarina, localizada no Sul do Brasil, influenciam nesses processos. Portanto, a partir do estudo da leptospirose nos seis municípios do estado com as maiores incidências e picos epidêmicos de 2000 a 2015, buscou-se conhecer a tendência dessa doença e as variáveis climáticas e ambientais associadas à sua ocorrência, ajustando dois modelos com resposta binomial negativa. As maiores incidências foram encontradas em 2008 e 2011, com picos no mesmo mês ou no posterior aos eventos de desastres. A incidência apresentou forte comportamento sazonal, sendo maior nos meses do verão. Observou-se tendência de queda na incidência dos municípios estudados, estimada em 3,21% ao ano. Os fatores climáticos e ambientais mais fortemente associados foram o número de dias de chuva, a temperatura máxima e a presença de enxurrada e de inundação, com diferentes impactos entre os municípios. Houve interações significativas, indicando que o efeito de inundações na incidência não é o mesmo em todos os municípios e que as diferenças nas incidências entre os municípios dependem da ocorrência ou não de inundações.

Abstract Leptospirosis is a zoonosis with epidemic potential, especially after heavy rainfall causing river, urban and flash floods. Certain features of Santa Catarina's coastal region influence these processes. Using negative binomial regression, we investigated trends in the incidence of leptospirosis in the six municipalities with the highest epidemic peaks between 2000 and 2015 and the climatic and environmental variables associated with the occurrence of the disease. Incidence was highest in 2008 and 2011, and peaks occurred in the same month or month after disasters. Incidence showed a strong seasonal trend, being higher in summer months. There was a decrease trend in incidence across the six municipalities (3.21% per year). The climatic and environmental factors that showed the strongest associations were number of rainy days, maximum temperature, presence of flash floods, and river flooding. The impact of these variables varied across the municipalities. Significant interactions were found, indicating that the effect of river flooding on incidence is not the same across all municipalities and differences in incidence between municipalities depend on the occurrence of river flooding.

Ocorrência de sorogrupos/sorovares de Leptospira spp. em cães com suspeita clínica de leptospirose em Santa Maria ­ RS / Occurrence of serogroups/serovars of Leptospira spp. in dogs with clinical suspicion of leptospirosis in Santa Maria ­ RS

A leptospirose é uma zoonose de distribuição mundial que pode acometer cães e ser altamente letal para a espécie. No Brasil, tal enfermidade tem caráter endêmico na espécie canina e configura-se como um sério problema de saúde pública. Objetivou-se verificar a ocorrência dos sorogrupos/sorovares de Leptospira spp. que mais acometem cães com suspeita clínica de leptospirose na cidade de Santa Maria ­ RS, Brasil, analisando sua titulação de anticorpos. No estudo, utilizou-se os laudos dos exames de soroaglutinação microscópica (SAM) para leptospirose de 218 cães provenientes da cidade de Santa Maria ­ RS durante o período de janeiro de 2015 a dezembro de 2019. Todos os laudos foram emitidos pelo Laboratório de Leptospirose (LabLepto - UFSM). Das 218 amostras de soro processadas nos cinco anos, 101 (46,33%) resultaram positivas para, pelo menos, um sorogrupo/sorovar testado. Este estudo demonstrou maior ocorrência do sorogrupo Icterohaemorrhagiae (53,37%) contemplado pelas sorovares Copenhageni e Icterohaemorrhagiae, com 49 (30,06%) e 38 (23,31%) soros reagentes, respectivamente. As titulações variaram de 100 a 6400, sendo que a mais recorrente encontrada nas amostras deste estudo foi 100, representando 47,85% dos títulos de anticorpos. Os dados obtidos neste estudo são de grande valia para o conhecimento dos sorogrupos/sorovares circulantes na região e sua epidemiologia podendo, inclusive, auxiliar para futuras formulações vacinais considerando sorogrupos/sorovares mais frequentemente detectados, contribuindo, assim, com a saúde pública.

Leptospirosis is a worldwide distribution zoonosis that can affect dogs and be highly lethal for the species. In Brazil, this disease is endemic in the canine species and represents a serious public health problem. The aim of this study was to verify the occurrence of Leptospira spp. that most affect dogs with clinical suspicion of leptospirosis in the city of Santa Maria ­ RS, Brazil, analyzing their antibody titers. In the study, we used the reports of microscopic agglutination tests (MAS) for leptospirosis in 218 dogs from the city of Santa Maria - RS during the period from January 2015 to December 2019. All reports were issued by the Leptospirosis Laboratory (LabLepto - UFSM). Of the 218 serum samples processed over the five years, 101 (46.33%) were positive for at least one serogroup/serovar tested. This study showed a higher occurrence of serogroup Icterohaemorrhagiae (53.37%) covered by serovars Copenhageni and Icterohaemorrhagiae, with 49 (30.06%) and 38 (23.31%) reagent sera, respectively. The titers ranged from 100 to 6400, and the most recurrent found in the samples in this study was 100, representing 47.85% of the antibody titers. The data obtained in this study are of great value for understanding the serogroups/serovars circulating in the region and their epidemiology, and may even contribute to future vaccine formulations considering the most frequently detected serogroups/serovars, thus contributing to public health.

Incidence of leptospirosis in Fujian province, 2015-2020 / 中华流行病学杂志

Objective: To analyze the incidence of leptospirosis in Fujian province from 2015 to 2020 and provide the scientific evidences for the risk assessment, prevention and control of leptospirosis. Methods: The incidence data of leptospirosis in Fujian during 2015-2020 were collected from China Information System for Disease Control and Prevention for a descriptive analysis, and software ArcGIS 10.3.1 was used for spatial autocorrelation analysis, and rats were captured in 17 surveillance areas during the same period, and the rat organs were collected for pathogen culture, the level of Leptospira antibody was detected in serum samples of rats, healthy population and the serum samples of patients sent by the hospitals. The infection status of Leptospira in human and rats were analyzed. Results: The incidence of leptospirosis in Fujian showed a downward trend from 2015 to 2020. A total of 176 cases of leptospirosis were reported. There were obvious seasonality and bimodal distribution. The majority of cases were farmers, accounting for 49.43% (87/176). Most cases were aged 30-69 years (85.80%, 151/176). The male to female ratio of the cases was 3.51∶1 (137∶39). Spatial autocorrelation analysis showed that leptospirosis had high or low clustering areas. From 2015 to 2020, the average capture rate of rats in 17 surveillance areas was 6.96% (1 519/21 838), Rattus losea, Rattus flavipectus and Niviventer fulvescens were the main species. The average positive rate of Leptospira antibody in rats was 28.64% (252/880). Java and Autumnalis were the predominant serogroups, accounting for 56.75% (143/252) and 17.46% (44/252), respectively. The average positive rate of Leptospira antibody in healthy population was 16.13% (254/1 575), and Autumnalis and Australis were the predominant serogroups, accounting for 71.65% (182/254). The confirmation rate of leptospirosis in patient serum samples sent by the hospitals was 2.23% (188/8 431), Autumnalis (56.38%, 106/188) and Hebdomadis (19.68%, 37/188) were the major serogroups. Conclusions: The incidence of leptospirosis in Fujian showed a downward trend from 2015 to 2020, there were obvious area clustering and seasonality. The high clustering areas were mainly distributed in northern, western and central Fujian. Java and Autumnalis were the predominant serogroups in rats. The infection rate in healthy population decreased year by year. Autumnalis and Hebdomadis were the main serogroups in population in Fujian.

Caracterização funcional de proteínas hipotéticas de Leptospira interrogans como adesinas e potenciais antígenos vacinais e para diagnóstico / Functional characterization of hypothetical proteins in Leptospira interrogans as adhesins and potential vaccine and diagnostic antigens

Leptospira spp. constitui um grupo de bactérias espiroquetas gram-negativas englobando espécies saprofíticas, intermediárias e patogênicas, sendo as últimas agentes causadores da leptospirose, doença zoonótica de alcance mundial e endêmica em regiões tropicais em desenvolvimento. O crescente número de espécies identificadas de leptospiras destaca ainda mais sua diversidade genética e mecanismos de virulência únicos, muitos deles com função ainda desconhecida. Esforços para o desenvolvimento de novas vacinas com proteção cruzada e efeito duradouro revelaram possíveis candidatos vacinais que necessitam ser adequadamente validados, sendo assim, há ainda uma urgente necessidade de uma vacina universal contra a leptospirose capaz de controlar e reduzir os surtos cada vez mais frequentes da doença. Adesinas são importantes fatores de virulência em diversos patógenos, constituindo antígenos promissores para o desenvolvimento de vacinas contra a leptospirose, assim como para o desenvolvimento de métodos diagnósticos mais rápidos e precisos. Previamente, foram identificadas três proteínas hipotéticas conservadas em L. interrogans pela técnica de phage display, denominadas arbitrariamente como LepA069, LepA962 e LepA388. A expressão do gene codificador da proteína LepA069 apresentou aumento de aproximadamente 70 % em animais infectados por leptospiras virulentas, representando a primeira evidência funcional desta proteína ainda desconhecida. Porções recombinantes da lipoproteína hipotética LepA962 (LepA962_Nt e LepA962_Phg) foram obtidos, sendo demonstrada a forte interação da proteína LepA962_Phg, contendo a sequência identificada por phage display, com laminina, fibronectina plasmática, colágeno I e fibrinogênio de maneira dose-dependente. Adicionalmente, LepA962_Phg apresentou ligação às células VERO e à sua matriz extracelular secretada, e o soro obtido a partir desta proteína recombinante foi capaz de se ligar à superfície de leptospiras virulentas, indicando que LepA962_Phg pode representar um importante domínio de interação entre as leptospiras e seu hospedeiro. Finalmente, a proteína LepA388 pertencente a uma extensa família de proteínas modificadoras de virulência com função desconhecida (DUF_61), presente apenas nas leptospiras patogênicas mais virulentas, apresentou aumento na expressão de seu gene codificador em animais infectados por leptospiras virulentas de acordo com dados na literatura. Além disso, porções recombinantes da região Nterminal desta proteína apresentaram ligação a laminina, colágenos I e IV, vitronectina e fibronectinas plasmática e celular, principalmente considerando a sequência identificada por phage display. Estes dados reforçam as predições de modelos tridimensionais da proteína LepA388 e de outros membros da família DUF_61, as quais identificam domínios semelhantes a toxinas (como abrina e CARDS) responsáveis pela ligação e internalização celulares nos hospedeiros. Dados recentes sugerem um possível papel citotóxico desempenhado pelas proteínas desta família em leptospiras, as quais podem também ser consideradas potenciais candidatas vacinais e para diagnóstico da leptospirose, devido à sua distribuição restrita em espécies e cepas patogênicas de importância para saúde humana.

Leptospira spp. constitutes a group of gram-negative spirochete bacteria comprising saprophytic, intermediate and pathogenic species, the last being causative agents of leptospirosis, a zoonotic disease of worldwide extent and endemic in developing tropical regions. The growing number of identified leptospiral species further highlights their genetic diversity and unique virulence mechanisms, many of them with unknown function. Efforts to develop new vaccines with cross-protection and long-lasting effect have revealed possible vaccine candidates that need to be properly validated. Therefore, there is still an urgent need for a universal vaccine against leptospirosis capable of controlling and reducing the increasing outbreaks of the disease. Adhesins are important virulence factors in several pathogens, constituting promising antigens for the development of vaccines against leptospirosis, as well as for the development of faster and more accurate diagnostic methods. Previously, three conserved hypothetical proteins in L. interrogans were identified by phage display technique, arbitrarily named as LepA069, LepA962 and LepA388. Expression of the LepA069 encoding gene showed an increase of approximately 70 % in animals infected by virulent leptospires, representing the first functional evidence of this still unknown protein. Recombinant portions of the hypothetical lipoprotein LepA962 (LepA962_Nt and LepA962_Phg) were obtained, demonstrating the strong interaction of the LepA962_Phg protein, containing the sequence identified by phage display, with laminin, plasma fibronectin, collagen I and fibrinogen in a dose-dependent manner. Furthermore, LepA962_Phg showed binding to VERO cells and its secreted extracellular matrix, and the serum obtained from this recombinant protein was able to bind to the surface of virulent leptospires, indicating that LepA962_Phg may represent an important domain of interaction between leptospires and its host. Finally, LepA388 protein belonging to an extensive family of virulence modifying proteins with unknown function (DUF_61), present only in the most virulent pathogenic leptospires, showed an increase in the expression of its encoding gene in animals infected by virulent leptospires according to data in literature. Moreover, recombinant portions of the N-terminal region of this protein showed binding to laminin, collagens I and IV, vitronectin and plasma and cell fibronectins, especially considering the sequence identified by phage display. These data support the predictions of three-dimensional models of the LepA388 protein and other members of the DUF_61 family, which identify toxin-like domains (such as abrin and CARDS) responsible for cellular binding and internalization in hosts. Recent data suggest a possible cytotoxic role played by proteins of this family in leptospires, which can also be considered potential vaccine candidates and antigens for diagnosis, due to their restricted distribution in pathogenic species and strains of importance to human health

Diseases caused by pathogens in the urban water system in the metropolitan region of Belém, Pará, Brazil, and their relationship with the socio-economic context of the population

The metropolitan region of Belém-PA suffers human fecal pollution in the local water supply system favoring the increase in cases of water circulating diseases in the population, especially the most socioeconomically vulnerable. Therefore, it is necessary to compile information on cases of these diseases over the years in this region, in order to better define public health policies. Thus, this work aims to contribute to the gathering of this information through a literature review selecting articles found in the SciELO, Pubmed and Google Academic databases with publications between 2005 and 2021 in Portuguese and English. The neighborhoods most affected by water circulation diseases proved were Guamá, Marco, Jurunas, Tapanã, Telegrafo and Terra Firme, located close to hydrographic basins, rivers and canals and are subject to flooding due to high tides and overflowing canals. In addition, the population in these neighborhoods is considered underprivileged. The most cited diseases and symptoms were leptospirosis, worms and diarrhea, which are easily prevented. Total and thermotolerant coliforms were also widely described, being the main indicators of fecal water contamination. The importance of sanitary measures is evidenced, as these reduce cases of water supply diseases in urban centers and improve population health. The quality of the water in the supply network is also important to mitigate the prevalence of these diseases.

Prevalencia y factores de riesgo de leptospirosis en la industria porcícola / Prevalence and risk factors of leptospirosis in the pig industry

La leptospirosis es una enfermedad clasificada como zoonótica, y también es una de las más olvidadas. Como enfermedad endémica zoonótica, permanece en los lugares menos favorecidos afectando la salud humana y tambien de los ciertos animales domésticos. Tal afectación ocasiona pérdidas sustanciales económicas y sanitarias en las poblaciones vulnerables. La incidencia, se estima que afecta a un millón de seres humanos ocasionando la muerte a casi 59.000 de ellas. La transmisión de la leptospirosis humana es debida a la exposición directa o indirecta de las fuentes de infección primaria como animales infectados (orina o tejidos), y también por el contacto con alimentos o aguas contaminadas. En este trabajo se estudió la prevalencia y los factores de riesgos de leptospirosos en la industria porcícola en diferentes regiones del Estado Peruano. Los resultados mostraron que los trabajadores, en su mayoría, masculinos, con edades comprendidas entre 20 y 50 años fueron los más vulnerables a estos serovares de Leptospira, lo cual se relaciona con el contacto directo con porcinos y sus derivados. Por otra parte, las condiciones de vida de los trabajadores influyen en la mayor prevalencia de este servar. Condiciones rurales, falta de higiene, el contacto con mascotas sin tratamiento son factores de riego para la propagación de la leptospirosis(AU)

Leptospirosis is a disease classified as zoonotic, and it is also one of the most neglected. As an endemic zoonotic disease, it remains in the least favored places, affecting human health and also that of certain domestic animals. Such damage causes substantial economic and health losses in vulnerable populations. The incidence is estimated to affect one million human beings, causing the death of almost 59,000 of them. Transmission of human leptospirosis is due to direct or indirect exposure to primary infection sources such as infected animals (urine or tissues), and also by contact with contaminated food or water. In this work, the prevalence and risk factors of leptospirosis in the pig industry in different regions of the Peruvian State were studied. The results showed that workers, mostly male, aged between 20 and 50 years were the most vulnerable to these Leptospira serovars, which is related to direct contact with pigs and their derivatives. On the other hand, the living conditions of the workers influence the higher prevalence of this servar. Rural conditions, lack of hygiene, contact with untreated pets are risk factors for the spread of leptospirosis(AU)

Efectividad de la reacción en cadena de la polimerasa en tiempo real (PCR-RT) e Inmunodot en el diagnóstico temprano de leptospirosis: análisis comparativo con la prueba de Microaglutinación (MAT) / Effectiveness of the real-time polymerase chain reaction (RT-PCR) and Immunodot in the early diagnosis of Leptospirosis: comparative analysis with the Microagglutination test (MAT)

Introducción: la leptospirosis es una enfermedad infecciosa producida por espiroquetas del género Leptospira. Se disemina a través de la orina de animales domésticos, con mayor frecuencia por roedores. En República Dominicana se necesitan pruebas confiables para el diagnóstico en etapas tempranas de la enfermedad. En el presente trabajo se aborda la validez diagnóstica del PCR en Tiempo Real y del IGM (INMUNODOT) en comparación con la prueba de Microaglutinación (MAT). Materiales y métodos: se realizó un estudio observacional, descriptivo, de corte transversal con 69 pacientes admitidos en el Hospital Regional "José María Cabral y Báez" con diagnóstico presuntivo de leptospirosis desde el 2010 hasta el 2012. Resultados: del total de los casos (69), la mayoría fueron del sexo masculino (94.2 %), menores de 49 años (79.4 %) y provenían de la provincia de Santiago (58 %). La mortalidad fue de 52.1 % de los cuales 52.3 % fueron reportados positivos para Leptospira y 47.6 % resultaron negativos según el MAT. Al comparar los resultados de PCR en relación al MAT se obtuvo una sensibilidad de 27.3 % y una especificidad de 80 %. Los resultados del PCR y del Immunodot fueron equivalentes. Conclusión: en el presente trabajo la realización del PCR en sangre, después del 5to día de inicio de la enfermedad, no demostró ser mejor que la Inmunodot para la detección temprana de la enfermedad, al contrastarlos con el resultado del MAT. En República Dominicana, los casos hospitalizados con diagnóstico presuntivo de leptospirosis permanecen con muy alta mortalidad. Por tanto, es prioritario optimizar el diagnóstico y el tratamiento de estos casos. En este estudio, los casos confirmados con Leptospirosis que fallecieron indican que debe actualizarse el protocolo de tratamiento y asegurarse que pueda implementarse. Por otra parte, los casos no confirmados fallecidos exigen investigar otras causas de enfermedad como la Infección por Hanta Virus.

Introduction: Leptospirosis is an infectious disease caused by spirochaetes of the genus Leptospira. It spread through the urine of domestic animals most frequently in rodents. Need reliable tests to diagnose in early stages of the disease and it has been proposed the use of the PCR in real-time as an option. The present work deals with the diagnostic real-time PCR and IGM (INMUNODOT) in comparison with the Microagglutination (MAT) test. Materials and methods: An observational, descriptive, cross-sectional study with 69 patients admitted as possible Leptospirosis in the Hospital "Jose Maria Cabral y Báez" of Santiago from 2010 to 2012. Results: Of the total cases (69), most were male (94.2%), under 49 years of age (79.4%) coming from the province of Santiago (58%). Mortality was 52.1% of which 52.3% were reported positive for leptospirosis and 47.6% were negative according to the MAT. To compare the results of PCR in relation to the MAT was obtained a sensitivity of 27.3% and a specificity of 80%. The results of the PCR and immunodot were equivalent. Conclusion: In this study, the realization of the PCR in blood after the 5th day of the disease not proved to be better than the Inmunodot for the early detection of the disease. Is necessary to evaluate cases less than 5th day. In the Dominican Republic, hospitalized with a presumptive diagnosis of Leptospirosis cases remain with very high mortality. Therefore, it is important to optimize the diagnosis and treatment of these cases. In this study, confirmed cases with Leptospirosis who died, indicate that you must upgrade the treatment protocol and ensure that it can be implemented. On the other hand, the deceased not confirmed cases require to investigate other causes of disease as the Hanta Virus infection.

Terapia de reemplazo renal continua. Presentación de un caso / Continuous renal replacement therapy. Case report

RESUMEN La insuficiencia renal aguda es definida como la pérdida de función del riñón ocasionada por diversas causas, entre ellas infección e ingesta de fármacos. Esta entidad tiene alta morbilidad y mortalidad en las unidades de cuidados críticos. El tratamiento de la misma va desde la propia protección renal hasta la sustitución artificial de las funciones del riñón lesionado. En la actualidad la terapia de reemplazo renal continua se ha utilizado como soporte renal, y ofrece mayor estabilidad clínica a los pacientes más inestables. En esta revisión se comentan conceptos, indicaciones y los más recientes estudios que validan el uso de esta terapéutica, así como el método de programación que se utilizó en un paciente con diagnóstico de una leptospirosis icterohemorrágica (síndrome de Weil), que estuvo en shock séptico con disfunción multiorgánica, donde se empleó esta terapia con resultados satisfactorios (AU).

ABSTRACT Acute kidney failure is defined as the loss of kidney function caused by various causes, including infection and drug intake. This entity has high morbidity and mortality in critical care units. Treatment ranges from renal protection to artificial replacement of the functions of the injured kidney. Currently, continuous renal replacement therapy has been used as renal support, and offers greater clinical stability to the most unstable patients. In this review, authors discuss concepts, indications and the most recent studies that validate the use of this therapeutic, as well as the programming method that was used in a patient with diagnosis of icteric-hemorrhagic leptospirosis (Weil syndrome), who was in septic shock with multiorgan dysfunction, where this therapy was used with satisfactory results (AU).

Estudo retrospectivo da leptospirose canina em hospital veterinário escola no município de Londrina, Pr / Retrospective study of canine leptospirosis in a veterinary school hospital in the municipality of Londrina, Pr / Estudio retrospectivo de leptospirosis canina en un hospital veterinario escolar del municipio de Londrina, Pr

O objetivo do trabalho foi relatar a ocorrência de casos de cães com Leptospira spp. no Hospital Veterinário de Londrina. Foram avaliados 5.454 prontuários, durante os meses de janeiro a dezembro de 2016, e selecionados os que apresentaram solicitação de exame para Lepstopira por meio da técnica de campo escuro (CE). Nos positivos pela técnica CE dados sobre o sexo, sinais clínicos, endereço, data do atendimento e resultado na SAM foram coletados. A análise dos dados foi realizada pelo programa EpiInfo (7.2.3.1), dos 5.454 prontuários nos quais foi solicitado exame CE em 7,06% (385/5.454), e nesses, 13,76% (53/385) foi identificada a presença da espiroqueta. Dos animais positivos na técnica CE, 20,75% (11/53) foram reagentes na SAM. O sorovar Canicola foi o mais frequente em 90,91% (10/11) dos animais, apresentando títulos variados de 100 a 12.800. Para o sorovar Pomona 9,09% (1/11) dos animais apresentaram títulação de 100. Os sinais clínicos mais observados foram apatia em 58,49% (31/53), azotemia em 49,06% (26/53) e êmese em 49,06% (26/53) dos casos. Quanto ao sexo, os machos constituíram 71,70% dos casos e as fêmeas 28,30% (p=0,0015). Os resultados demonstraram a presença de Leptospira spp. entre os animais atendidos no hospital veterinário de Universidade Estadual de Londrina e reforçam a importância do sorovar Canicola entre os cães, visto que esse foi o mais frequente entre os sorovares e que apresentou os maiores títulos.(AU)

The purpose of this work is to report the occurrence of cases of dogs with Leptospira spp. at the Veterinary Hospital of Londrina. A total of 5,454 medical records were evaluated from January to December 2016, and data obtained from the examination for Lepstopira using the dark field technique (DF) were selected. In cases which were positive by the DF technique, data on gender, clinical signs, address, care data, and SAM results were collected. Data analysis was performed using the EpiInfo program (7.2.3.1). From the total 5,454 medical records in which DF examination was requested, in 7.06% (385/5.454), and from those, 13.76% (53/385) were positive for Leptospira. From the animals positive in the DF technique, 20.75% (11/53) were reactive in SAM. The Canicola serovar was the most prevalent, being present in 90.91% (10/11) of the animals, with titers ranging from 100 to 12,800. For the Pomona serovar, 9.09% (1/11) of the animals presented a title of 100. The most frequent clinical signs observed were apathy, in 58.49% (31/53); azotemia in 49.06% (26/53); and emesis in 49.06% (26/53) of the cases. As for gender, male animals constituted 71.70% of the cases and female 28.30% (p = 0.0015). The results demonstrated the presence of Leptospira spp. among animals treated at the Veterinary Hospital of the State University of Londrina which reinforces the importance of the Canicola serovar among dogs, since it was the serovar with the highest prevalence and highest titer found.(AU)

El objetivo de este trabajo fue reportar la ocurrencia de casos de perros con Leptospira spp. en el Hospital Veterinario de Londrina. Se evaluaron un total de 5.454 historias clínicas de enero a diciembre de 2016, y se seleccionó los que presentaron solicitud de examen de Lepstopira mediante la técnica de campo oscuro (CE). En los positivos por la técnica de CE se recogieron datos de sexo, signos clínicos, domicilio, fecha de atención y resultado en la SAM. El análisis de los datos se realizó mediante el programa EpiInfo (7.2.3.1), de las 5.454 historias clínicas en las que se solicitó examen CE en el 7,06% (385/5.454), y en estas, el 13,76% (53/385) se identificaron la de espiroqueta. De los animales positivos en la técnica CE, el 20,75% (11/53) fueron reactivos en la SAM. El serovar Canicola fue el más frecuente en el 90,91% (10/11) de los animales, con títulos que oscilaron entre 100 y 12.800. Para el serovar Pomona, el 9.09% (1/11) de los animales tuvo un título de 100. Los signos clínicos más observados fueron apatía en 58.49% (31/53), azotemia en 49.06% (26/53) y emesis en 49.06% (26/53) de los casos. Cuanto al sexo, los machos constituyeron el 71,70% de los casos y las hembras el 28,30% (p = 0,0015). Los resultados demostraron la presencia de Leptospira spp. entre los animales tratados en el Hospital Veterinario de la Universidad Estatal de Londrina y refuerzan la importancia del serovar Canicola entre los perros, ya que este fue el más frecuente entre los serovares y tuvo los títulos más altos.(AU)

Hemorragia alveolar pulmonar como presentación poco frecuente de infección por Leptospira spp: una enfermedad ocupacional del personal militar en zonas tropicales / Pulmonary alveolar hemorrhage as an unusual presentation of Leptospira spp: an occupational-disease of military personnel in tropical zones

Resumen La leptospirosis es una de las zoonosis endémicas más importantes en el mundo con un aumento de la incidencia en los últimos años. En el personal militar podría ser catalogada como una enfermedad ocupacional dado sus actividades específicas en áreas rurales. Su presentación clínica es variable siendo en la mayoría de los casos una enfermedad febril autolimitada. De acuerdo con diversos factores dependientes del patógeno y del hospedero pueden presentarse manifestaciones severas de la enfermedad dentro de la cual destaca el compromiso pulmonar con una alta tasa de mortalidad. Existe evidencia del uso de esteroide sistémico como parte del tratamiento de esta complicación. Presentamos el caso de un paciente joven, militar, que debuta con síndrome de hemorragia alveolar difusa secundario a leptospirosis y presenta una excelente respuesta al tratamiento con altas dosis de metilprednisolona, con una discusión del proceso diagnóstico y aspectos fisiopatológicos de esta condición.

Leptospirosis is one of the most important endemic zoonoses in the world with an increase in incidence in recent years. In military personnel it could be classified as an occupational disease given their specific activities in rural areas. Its clinical presentation is variable being in most cases a self-limited febrile disease. According to various factors dependent on the pathogen and the host, severe manifestations of the disease may occur within which the pulmonary involvement with a high mortality rate stands out. There is evidence of systemic steroid use as part of the treatment of this complication. We present a case of a young, military patient who debuts with diffuse alveolar hemorrhage syndrome secondary to leptospirosis and presents an excellent response to treatment with high doses of methylprednisolone, with a discussion of the diagnostic process and pathophysiological aspects of this condition.

Leptospirose: Características da enfermidade em humanos e principais técnicas de diagnóstico laboratorial / Leptospirosis: Characteristics of the human disease and main laboratory diagnostic techniques

A leptospirose é a zoonose de maior distribuição geográfica, com estimativa de cerca de 60.000 mortes por ano. A doença é causada por bactérias do gênero Leptospira, que possui mais de 300 diferentes sorovares e 64 espécies já identificadas, sendo o ambiente a principal fonte de contaminação. A doença em humanos apresenta manifestações clínicas variadas e caráter bifásico, devendo ser confirmada por meio do diagnóstico laboratorial. O objetivo deste trabalho foi reunir conceitos atualizados sobre a leptospirose humana e as principais técnicas de diagnóstico laboratorial empregadas. A MAT é considerada o padrão-ouro para o diagnóstico da leptospirose, mas devido à baixa sensibilidade na fase inicial da doença é necessário o emprego de técnicas mais sensíveis neste período. Baseado em diversos estudos, as metodologias de PCR, ELISA-IgM e teste rápido apresentaram sensibilidade satisfatória nos primeiros dias após o início dos sintomas. Na segunda semana, a MAT apresentou 100% de sensibilidade, mantendo sua alta especificidade em ambas as fases. No geral, os testes sorológicos de ELISA-IgM e teste rápido apresentaram resultados satisfatórios como métodos de diagnóstico precoce, principalmente tratando-se de locais com pouca infraestrutura, diferente dos laboratórios de referência onde é possível empregar as técnicas de PCR e MAT.

Leptospirosis is the most widespread zoonosis, which has a balance of almost 60,000 deaths per year. Bacteria of Leptospira genus, which has more than 300 different serovars and 64 species already identified, cause the disease, being the environment the main source of contamination. The human disease presents a large set of clinical manifestations, showing biphasic presentation, the reason why leptospirosis must be confirmed by laboratory diagnosis. This study aimed to group recent concepts concerning human leptospirosis and the main diagnosis techniques employed at the laboratory. MAT is considered the gold standard for leptospirosis diagnosis, but has low sensitivity on the onset of disease, leading to the use of techniques with higher sensitivity on this period. Based on several studies, PCR, ELISA-IgM and rapid test presented satisfactory sensitivity on the onset of symptoms. In the second week, MAT showed 100% of sensitivity, maintaining its high specificity in both phases. In general, the ELISA-IgM and rapid serological tests showed satisfactory results as methods for early diagnosis, especially in the case of places with poor infrastructure, different from the reference laboratories where it is possible to use the PCR and MAT techniques.

Seroprevalencia de Leptospira spp. en equinos de tiro de comunidades indígenas mapuche de la Región de la Araucanía Chile / Seroprevalence of Leptospira spp. in draft horses from indigenous communities in the Araucanía Region, Chile

Resumen En la Región de la Araucanía no existen estudios sobre seroprevalencia de leptospirosis en equinos. Se analizaron muestras serológicas provenientes de 100 equinos de tiro de comunidades mapuche de cuatro comunas de la región mediante la técnica de microMAT. La seroprevalencia fue de 35% para al menos un serovar de Leptospira spp., siendo los serovares más frecuentes canicola (22%), grippotyphosa (21%), hardjo (13%) y pomona (10%). Se evidenció que las poblaciones equinas estudiadas están expuestas a la infección por Leptospira spp. y revelan un riesgo potencial de transmisión a sus propietarios.

Abstract In the Araucanía Region there are no studies on the seroprevalence of leptospirosis in horses. Serological samples from 100 draft horses from Mapuche communities of four communes in the region were analyzed using the microMAT technique. The seroprevalence was 35% for at least one serovar of Leptospira spp. being the most frequent serovars canicola (22%), grippotyphosa (21%), hardjo (13%) and pomona (10%). It was evident that the equine populations studied are exposed to infection by Leptospira spp. and reveal a potential risk of transmission to their owners.

Prediction model to discriminate leptospirosis from hantavirus

SUMMARY OBJECTIVE: The aim of this study was to build a prediction model to discriminate precociously hantavirus infection from leptospirosis, identifying the conditions and risk factors associated with these diseases. METHODS: A logistic regression model in which the response variable was the presence of hantavirus or leptospirosis was adjusted. RESULTS: As a result, the method selected the following variables that influenced the prediction formula: sociodemographic variables, clinical manifestations, and exposure to environmental risks. All variables considered in the model presented statistical significance with a p<0.05 value. The accuracy of the model to differentiate hantavirus from leptospirosis was 88.7%. CONCLUSIONS: Concluding that the development of statistical tools with high potential to predict the disease, and thus differentiate them precociously, can reduce hospital costs, speed up the patient's care, reduce morbidity and mortality, and assist health professionals and public managers in decision-making.

Hematúria macroscópica em equinos associada à infecção por Leptospira interrogans / Macroscopic haematuria in horses associated with Leptospira interrogans infection

Hematúria é uma grave manifestação clínica de doença do sistema urinário, ocorrendo sob as formas micro ou macroscópica. Neste artigo relatam-se dois casos de hematúria macroscópica associada à infecção por Leptospira interrogans sorogrupo Canicola. O exame clínico inicial revelou hematúria macroscópica, taquicardia, taquipneia, febre, elevação do tempo de perfusão capilar, hipomotilidade intestinal, além de icterícia da mucosa oral. Leucocitose, proteinúria, glicosúria, piúria e azotemia foram achados comuns aos dois casos. Teste de Soroaglutinação Microscópica foi realizado para titulação de anticorpos contra Leptospira interrogans. Tratamento incluiu medidas terapêuticas de suporte (fluidoterapia), controle da hematúria e antibioticoterapia. Sete dias após manifestação dos sinais clínicos iniciais, ambos animais receberam alta hospitalar após remissão dos sinais clínicos.

Haematuria is a serious clinical manifestation of urinary system disease, occurring in micro or macroscopic forms. In this article two cases of macroscopic haematuria associated with Leptospira interrogans serogroup Canicolainfection are related. The initial clinical examination revealed macroscopic haematuria, tachycardia, tachypnea, fever, increased capillary perfusion time, intestinal hypomotility, in addition to jaundice of the oral mucosa. Leukocytosis, proteinuria, glycosuria, pyuria and azotemia were common findings in both cases. Microscopic serum agglutination test was performed for titration of antibodies against Leptospira interrogans. Treatment included supportive therapeutic measures (fluid therapy), hematuria control and antibiotic therapy. Seven days after the manifestation of the initial clinical signs, both animals were discharged from the hospital without complications.

Epidemiología de la Leptospirosis en el departamento del Huila, Colombia. 2011- 2017 / Epidemiology of leptospirosis in the department of Huila. 2011 to 2017

Resumen Objetivo: Describir la epidemiología de la Leptospirosis en el departamento del Huila durante el período 2011 -2017. Materiales y métodos: Estudio descriptivo de corte transversal, retrospectivo. La población analizada fueron pacientes de los diferentes municipios del departamento del Huila que se reportaron como casos probables o confirmados de leptospirosis. Se estructuraron registros por cada año en bases de datos recopiladas por el área de epidemiología de la Secretaría de Salud del Huila, basadas en las fichas de notificación de vigilancia en salud pública para leptospirosis y generadas por cada Unidad Primaria Generadora de Datos (UPGD) ante la presencia del evento. Los datos fueron discriminados de acuerdo a las variables de interés para el estudio en una nueva base de datos en Excel; tabuladas con el programa estadístico R - Studio 3.3.3 y Epidat 4.2, para luego ser procesados con estadísticos descriptivos y finalmente ser expresados en porcentajes y en tasas de incidencia. Resultados: Se reportaron 268 casos, de los cuales 61 (23%) fueron confirmados por laboratorio y 207 (77%) sospechosos o probables. El 69% de los pacientes presentaron fiebre, mialgias y cefalea como síntomas representativos. El grupo etario más afectado tenía entre 27 y 59 años de edad (44%). La población se caracterizó por ser del área urbana (65%), con mayor frecuencia en hombres (72%). En relación a la ocupación laboral, se encontró mayor frecuencia en agricultores (20%) y en el personal de aseo (17%). Los factores de riesgo evidenciados fueron la presencia de animales domésticos en un 67% de los casos, así como la presencia de ratas en el hogar (51%) y el posible mal manejo del agua. Conclusiones: El incremento en el número de casos de Leptospirosis probablemente está asociado a la mala manipulación del agua y a la presencia de animales en el domicilio.

Abstract Objective: Describe the epidemiology of Leptospirosis in the department of Huila during the years 2011 to 2017. Materials and methods: This article is a descriptive, cross-sectional, retrospective study. The population analyzed were patients from the different municipalities of the department of Huila who were reported as probable or confirmed cases for leptospirosis, structuring records for each year in databases compiled by the epidemiology area of ​​the department's health secretary, based on the public health surveillance notification sheets for leptospirosis, and generated by each Primary Data Generating Unit (UPGD) in the presence of the event; The data were discriminated according to the variables of interest for the study in a new database in Excel; tabulated with the statistical program R - Studio 3.3.3 and Epidat 4.2, to later be processed with descriptive statistics and finally expressed in percentages and incidence rates. Results: 268 cases were reported, which 61 (23%) were confirmed by laboratory and 207 (77%) suspicious or probable. 69% of the patients presented fever, myalgia and headache as representative symptoms. The most affected group range in ages from 27 and 59 (44%). The population was characterized for being part of the urban area (65%), and the cases were more frequent in men (72%). Regarding to employment, it was found that farmers (20%) and the cleaning staff (17%) were the most common cases. The risk factors identified were the presence of domestic animals in 67% of the cases, as well as the presence of rats at home (51%) and the possible poor water management. Conclusions: The increase in the number of cases of Leptospirosis is probably associated with the poor water management and the presence of animals at home.

Leptospirosis y rickettsiosis, reto diagnóstico para el síndrome febril en zonas endémicas / Leptospirosis and rickettsiosis, a diagnostic challenge for febrile syndrome in endemic areas

Resumen. Se presenta el caso de un hombre de 50 años de edad proveniente de la región de Urabá, Colombia, con una infección mixta por Rickettsia rickettsii y Leptospira interrogans serovar Copenhageni ST78, y pruebas negativas para malaria y dengue. El paciente presentó un síndrome febril que no mejoró con el tratamiento antibiótico sistémico y, finalmente, falleció en la unidad de cuidados intensivos. El diagnóstico post mortem se hizo mediante tipificación molecular de los dos agentes etiológicos. En la inspección del domicilio del paciente, se encontró un ejemplar de Rattus rattus infectado con L. interrogans del mismo serovar detectado en él. No se encontraron garrapatas en los animales domésticos que habitaban con el paciente. Se reporta una infección mixta con síntomas clínicos progresivos y fatales en un paciente con antecedentes laborales de riesgo en una zona endémica para enfermedades tropicales, lo que obliga a tener presente la posibilidad de infecciones simultáneas en personas procedentes de áreas endémicas que consulten reiteradamente por síndrome febril sin resolución y tengan riesgo laboral relacionado con actividades agrícolas.

Abstract. This is the case of a 50-year-old male from the region of Urabá, Colombia, with a mixed infection by Rickettsia rickettsii and Leptospira interrogans serovar Copenhageni ST78 and negative test for malaria and dengue fever. The patient presented with febrile syndrome and was unresponsive to systemic antibiotic treatment, who finally died in the intensive care unit. We established the postmortem diagnosis through molecular typification of the two etiological agents. In the inspection at the patient's home, we found a Rattus rattus specimen infected with L. interrogans of the same serovar found in him. We found no ticks parasitizing the domestic animals cohabitating with the patient. This case of a mixed infection with progressive and fatal symptoms in a patient with occupational risk in a tropical disease endemic zone highlights the importance of considering the potential presentation of simultaneous etiologies in patients with multiple medical visits for unresolved febrile syndromes associated with risky exposure during agricultural activities.

A molecular survey reveals high occurrence of co-infections in intensive pork production farms with increased rates of mummified swine fetuses in Southern Brazil / [Pesquisa molecular revela alta ocorrência de coinfecções em granjas de produção intensiva de suínos com altas taxas de mumificação fetal no sul do Brasil]

Neste estudo, 308 amostras de fetos mumificados foram testadas para parvovírus suíno (PPV), circovírus suíno tipos 2 e 3 (PCV2 e PCV3) e leptospiras patogênicas. A idade gestacional no momento da perda gestacional e a frequência da mumificação fetal de acordo com a ordem de parto também foram investigadas. As amostras foram coletadas em granjas comerciais de criação de suínos da região sul do Brasil que apresentassem taxas de mumificação fetal igual ou maiores a 2,5%. Fragmentos de pulmão, rim, fígado e coração de fetos suínos mumificados foram coletados para análise molecular. Resultados da PCR foram classificados de acordo com a região de origem das amostras, tendo Santa Catarina, Paraná e Rio Grande do Sul contabilizado 87 (28,25%), 89 (28,90%) e 132 (42,86%) do total de amostras de fetos suínos mumificados, respectivamente. Coinfecções foram observadas na maioria dos casos e PCV3 foi o agente mais prevalente detectado, encontrado em 298 amostras (96,75%). A maioria das perdas gestacionais foi observada entre 50 e 70 dias de gestação (168; 54,5%) e a mumificação fetal não foi associada à ordem de parto das matrizes. Os achados sugerem que as altas taxas de fetos suínos mumificados na região Sul do Brasil podem ser explicadas pela infecção com esses agentes virais.(AU)