Leptospirosis severa en el puerperio: informe de un caso / Severe leptospirosis in puerperium: a case report

Resumen ANTECEDENTES: La leptospirosis es una infección bacteriana que puede aparecer durante el embarazo o puerperio; su manifestación más grave es el síndrome de Weil, que puede provocar la muerte por choque séptico, insuficiencia multiorgánica y complicaciones hemorrágicas severas. CASO CLÍNICO: Paciente de 26 años, procedente de la provincia de Supe (Lima, Perú), en etapa puerperal, a quien se practicó cesárea cuatro días antes en una institución ajena al hospital. Acudió al hospital debido a la aparición de ictericia generalizada, fiebre de 39 °C, hepatoesplenomegalia, anasarca y síndrome de disfunción multiorgánica. Mediante la prueba de ELISA e IgM (subtipos Hursbridge 1/200 e Icterohaemorrhagiae 1/400) se estableció el diagnosticó de leptospirosis. En el noveno día se inició tratamiento con ceftriaxona. Cuatro semanas después tuvo mejoría clínica y fue dada de alta del hospital en condición estable. CONCLUSIONES: El diagnóstico de leptospirosis es incierto durante el embarazo, incluso un 10% de las pacientes afectadas podrían agravar su situación. Es importante vigilar el bienestar del feto y decidir la finalización del embarazo por la mejor vía, según las condiciones de la madre y el feto.

Abstract BACKGROUND: Leptospirosis is a rare infectious complication that could manifest during pregnancy or puerperium. The most severe form, the Weil syndrome, has elevated mortality due to septic shock, multiple organ failure and severe bleeding complications. CLINICAL CASE: A 26-year-old female underwent cesarean section due to high risk of loss of fetal well-being at an outside hospital. On the 4th day postpartum, she was referred to our center febrile (38-39 ° C), with generalized jaundice, anasarca and hepatosplenomegaly, with further deterioration into multiorgan dysfunction syndrome. Elisa IgM was positive for Leptospirosis, specifically for the subtypes Hursbridge 1/200 and Icterohaemorrhagiae 1/400. On the ninth day after admission, ceftriaxone was started. Four weeks later, she had clinical improvement and was discharged in stable condition. CONCLUSIONS: The diagnosis of leptospirosis infection is uncertain during pregnancy and up to 10% of affected patients could have complications. It is important to monitoring the fetal well being and determine the proper time of pregnancy termination by the best route of delivery if there are maternal or fetal indications.

IgM ELISA for leptospirosis diagnosis: a systematic review and meta-analysis / ELISA IgM para diagnóstico de leptospirose: revisão sistemática e meta-análise

Abstract A systematic review with meta-analysis was performed to estimate the accuracy of IgM ELISA for Leptospirosis diagnosis. A search of Medline, Lilacs, Embase, Cochrane Central Register of Controlled Trials and Grey literature (Google Scholar and British Library) was conducted. The medical subject headings (MeSHs) and the words "leptospirosis", "human leptospirosis" and "IgM ELISA" were used. Fifty-two studies were analyzed, which included 10,775 samples. The pooled sensitivity of all the studies was 86% (CI 95%, 85%-87%) and specificity was 90% (CI 95%, 89%-91%). In studies of the acute phase, the sensitivity and specificity were 84% (CI 95%, 82%-85%) and 91% (CI 95%, 90%-91%), respectively. In conclusion, IgM ELISA is sensitive for use as an initial screen for leptospiral infections.

Resumo O objetivo desta revisão sistemática e meta-análise foi avaliar a acurácia do ELISA IgM para o diagnóstico precoce da leptospirose em humanos. A busca foi realizada nas seguintes bases de dados: Medline, PubMed, LILACS, Embase e Cochrane Central Register of Controlled Trials e Grey literature (Google Scholar and British Library). As palavras-chaves usadas foram: "leptospirosis", "human leptospirosis" e "IgM ELI-SA". Foram analisados 52 estudos, que incluíram 10.775 amostras. A sensibilidade e especificidade combinada de todos os estudos foram 86% (CI 95%, 85%-87%) e 90% (CI 95%, 89%-91%), respectivamente. Nos estudos de fase aguda, a sensibilidade e especificidade foram, respectivamente, 84% (CI 95%, 82%-85%) e 91% (CI 95%, 90%-91%). Conclui-se que o ELISA IgM é um teste sensível para rastreamento inicial da leptospirose.

Avaliação do teste de aglutinação microscópica utilizando-se como antígeno leptospiras saprófitas para o diagnóstico da leptospirose humana / Evaluation of microscopic agglutination test using saprophytic leptospires for diagnosis of human leptospirosis

O objetivo deste trabalho foi avaliar a capacidade de efetuar o diagnóstico precoce do teste de aglutinação microscópica (MAT) utilizando-se como antígeno leptospiras saprófitas sorovar Patoc (MAT-Patoc). Neste contexto, os resultados obtidos em amostras de soro de casos confirmados de leptospirose foram comparados com aqueles obtidos no teste ELISA IgM. Cento e cinquenta e oito amostras colhidas na fase aguda da doença foram analisadas pelo MAT-Patoc. Os soros com títulos ≥ 50 foram considerados reagentes. A sensibilidade do MAT-Patoc e do ELISA-IgM foi de 13,29% e 28,48%, respectivamente. Nos sete primeiros dias da doença, o MAT-Patoc foi capaz de detectar 12,29% dos casos, enquanto o ELISA-IgM detectou 24,59%. O MAT-Patoc foi reagente em amostras de casos cujos prováveis sorogrupos infectantes foram Icterohaemorrhagiae, Cynopteri e Ballum. Em conclusão, a utilização do teste MAT-Patoc apresentou menor sensibilidade no diagnóstico quando comparado ao ELISA-IgM, embora tenha sido reagente em algumas amostras com resultado não reagente. O MAT-Patoc deve ser utilizado em combinação com ELISA-IgM para melhorar a sensibilidade do diagnóstico de leptospirose na primeira fase da doença, com subsequente confirmação pelo MAT de referência.

The aim of this study was to evaluate the early detection of antibodies by the microscopic agglutination test (MAT) using saprophytic leptospira serovar Patoc (MAT-Patoc), in serum samples from patients with confirmed leptospirosis. The obtained results were compared with those found in ELISA-IgM. A hundred fifty-eight serum samples collected from patients in acute phase of illness were analysed by MAT-Patoc. Samples with titers ≥ 50 were considered positive. The sensitivity of MAT-Patoc and IgM-ELISA was 13.29 % and 28.48 %, respectively. In the first seven days of the disease, MAT-Patoc was positive in 12.29 % of the cases, while the IgM-ELISA was positive in 24.59 %. The MAT-Patoc was positive in sera from confirmed cases, and the infecting serogroups were Icterohaemorrhagiae, Cynopteri and Ballum. In conclusion, the use of MAT-Patoc test showed lower sensitivity for diagnosing leptospirosis when compared with ELISA-IgM, although positive reactivity was found in some samples with negative results. The MAT-Patoc should be used in combination with ELISA-IgM to improve the sensitivity of the diagnosis of leptospirosis in the first phase of the disease, with subsequent confirmation by standard MAT.

Avaliação de testes diagnósticos para a identificação da infecção pelo vírus da dengue em pacientes com síndrome febril aguda / Diagnostic assessment tests to identify the infection by the dengue virus in patients with acute febrile syndrome

A dengue é atualmente um dos principais problemas de saúde pública do mundo e segundo a Organização Mundial de Saúde (OMS) é a doença que mais acomete o homem na atualidade. Sua incidência vem aumentando e estima-se que 50-100 milhões de pessoas desenvolvam a doença a cada ano no mundo. O diagnóstico laboratorial da dengue é realizado por diferentes tipos de testes, entre eles estão o isolamento viral, o RT-PCR, e a detecção por ELISA ou por meio de testes rápidos do antígeno viral NS1 e de anticorpos IgM específicos contra o vírus. A fim de contribuir para um melhor entendimento sobre a validade destes testes em diferentes circunstâncias, o objetivo principal deste trabalho foi avaliar a validade dos diferentes métodos laboratoriais no diagnóstico da dengue. A sensibilidade dos testes diagnósticos, ELISA IgM, ELISA NS1 e RT-PCR, foi avaliada de forma individual e de forma combinada utilizando amostras de soro de 623 pacientes incluídos em um estudo prospectivo de vigilância de base populacional entre fevereiro e julho de 2010...

Dengue is currently one of the main problems of public health and the world according to the World Health Organization (WHO) is the disease that affects more men today. Its incidence is increasing and it is estimated 50-100 million people develop the disease each year worldwide. Laboratory diagnosis of dengue is done by testing different types, which include viral isolation, RT-PCR, and detection by ELISA or by rapid viral tests NS1 antigen and specific IgM antibodies against the virus. In order to contribute to a better understanding of the validity of these tests in different circumstances, the aim of this study was to evaluate the validity of different laboratory methods for diagnosis of dengue. The sensitivity of diagnostic tests, IgM ELISA, ELISA NS1 and RT-PCR was evaluated individually and in combination form using serum samples from 623 patients enrolled in a prospective population-based study of surveillance between February and July 2010...

Detección de anticuerpos IgM contra leptospiras por un sistema comercial ELISA-IgM / Detection of IgM antibodies to leptospires by using a commercial ELISA-IgM system

Introducción: la leptospirosis humana es una zoonosis sistémica y transmisible producida por bacterias invasivas del complejo Leptospira interrogans sensu lato. Numerosos métodos se utilizan para el serodiagnóstico de esta entidad clínica, dentro de los cuales se encuentra ELISA. Objetivos: aplicar un nuevo sistema serológico comercial de ELISA, para la pesquisa de anticuerpos IgM contra leptospiras e identificar los serogrupos de leptospiras presentes en los sueros positivos por este sistema. Métodos: de pacientes sospechosos de leptospirosis se estudiaron 27 y 61 sueros con anticuerpos contra leptospiras y sin estos, respectivamente. La técnica de microaglutinación con antígenos vivos (MAT) se utilizó como método de referencia. Los sistemas comerciales de SD Leptospira ELISA-IgM, SD flujo lateral Leptospira IgM y la hemoaglutinación indirecta (HAT) fueron comparativamente empleados. Resultados: 27 sueros con anticuerpos contra leptospiras resultaron positivos por SD Leptospira ELISA-IgM, 20 por SD flujo lateral Leptospira IgM y 9 por hemoaglutinación indirecta. De 61 sueros sin anticuerpos contra leptospiras, 9 y 8 resultaron positivos, respectivamente, por SD Leptospira ELISA-IgM y por SD flujo lateral Leptospira IgM. Los serogrupos Ballum y Canicola predominaron en los sueros positivos por el sistema comercial. La coincidencia entre SD Leptospira ELISA-IgM y la técnica de microaglutinación con antígenos vivos fue de 89,77 porciento. Conclusiones: SD Leptospira ELISA-IgM muestra una mayor positividad en los sueros estudiados, lo que avalaría su posible introducción en Cuba. Se confirma la amplia reactividad del antígeno usado en SD Leptospira ELISA-IgM, lo cual sugiere mantener una activa vigilancia de laboratorio sobre los serogrupos de leptospiras, a nivel nacional

Introduction: human leptospirosis is a communicable systemic zoonosis caused by the invasive bacteria Leptospira interrogans sensu lato complex. Numerous methods are used for serodiagnosis of this disease, including the ELISA tests. Objectives: to implement a new commercial serological ELISA test (SD Leptospira ELISA-IgM, SD Bioline, Korea) for screening of IgM antibodies and for identification of Leptospira serogroups in positive sera. Methods: twenty seven and sixty one sera, with/without IgM antibodies to leptospires, respectively, were studied. They had been taken from patients suspected of having leptospirosis. The microscopic agglutination test with live antigens (MAT) was the reference method. In addition, other commercial systems such as SD Leptospira IgM Lateral Flow and indirect hemagglutination (HAT) tests were comparatively used. Results: all the 27 sera with antibodies against Leptospira were positive according to SD Leptospira ELISA-IgM, 20 sera were found positive by SD Lateral Flow Igm test and 9 sera by the indirect HAT test. Of the 61 sera without antibodies to leptospires, 9 and 8 were positive by SD Leptospira ELISA-IgM and SD Leptospira IgM Lateral Flow test, respectively. Serogroups Canicola and Ballum were predominant in positive sera tested by the commercial system under evaluation. The agreement coefficient between SD Leptospira ELISA-IgM and MAT was 89.77 percent. Conclusions: SD Leptospira ELISA-IgM showed higher positivity rate than the other systems in the studied sera; this aspect would support its possible introduction in Cuba. The great reactivity of the antigen used in the system was confirmed, which indicates that active laboratory surveillance of leptospiral serogroups should be kept nationwide

Enfermedad de Lyme: historia, microbiología, epizootiología y epidemiología / Lyme disease: history, microbiology, epizootiology and epidemiology

Objetivo: teniendo en cuenta el riesgo potencial que para Cuba constituye la presencia del agente trasmisor, los autores consideran importante la revisión del tema con vistas a una actualización de los especialistas y demás entidades del sistema de salud que puedan intervenir en la vigilancia y control epidemiológico de esta enfermedad. Desarrollo: se comenta la historia de la enfermedad, la microbiología, la epizootiología y la epidemiología, así como las manifestaciones clínicas en los principales animales domésticos. Conclusiones: la borreliosis de Lyme es una nueva enfermedad infecciosa; comparte como otras borrelias y espiroquetas su afinidad por el sistema nervioso central y el sistema nervioso periférico, y se convierte en un diagnóstico de exclusión optimista en Neurología. Conocer sus vectores, su distribución geográfica y algunas de las características biológicas específicas de esta nueva especie de borrelia es de suma importancia para el médico práctico de este nuevo siglo, donde la inmunología y la biología molecular iluminan el oscuro camino de viejas y nuevas interrogantes

Objective: bearing in mind the risk posed by the presence of the vector of Lyme disease in Cuba, the authors have considered it necessary to carry out a review of the disease with the purpose of contributing updated information to specialists and health institutions involved in its surveillance and epidemiological control. Content: a discussion is presented of the history, microbiology, epizootiology and epidemiology of Lyme disease, as well as its clinical manifestations in the main domestic animal hosts. Conclusions: Lyme borreliosis is a new infectious disease. Like other borrelias and spirochetes, it has an affinity for the central nervous system and the peripheral nervous system, thus becoming a diagnosis of optimistic exclusion in neurology. Knowledge about the vectors, geographic distribution and some specific biological characteristics of this new borrelia species is crucial for practitioners of the 21st century, a time when immunology and molecular biology shed new light on old and new questions alike