Kidney biomarkers in tropical infections: an update.

Neglected tropical diseases affect over 1 billion people, and cause 170,000 deaths each year. They result in disability, stigma and disfigurement, and also push families into poverty. Tropical infections can involve the kidney, presenting as a wide variety of ways, varying from transient urinary abnormalities to severe acute kidney injury (AKI). It is important to assess renal function in patients with tropical infections for earlier detection of AKI, appropriate treatment and prevention of Chronic Kidney Disease (CKD) outcome in some of them. There was an exponential increase in research on new kidney biomarkers that were earlier and specific for renal damage but few in the scope of tropical infections. In this review, we focus on kidney biomarkers that are being studied in some of the most prevalent tropical infections such as visceral leishmaniasis, leptospirosis, malaria, schistosomiasis and leprosy. Further studies are needed to evaluate the usefulness of renal biomarkers in the early diagnosis of renal diseases associated with tropical infections.

Early identification of leptospirosis-associated pulmonary hemorrhage syndrome by use of a validated prediction model.

OBJECTIVE: To identify prediction factors for the development of leptospirosis-associated pulmonary hemorrhage syndrome (LPHS). METHODS: We conducted a prospective cohort study. The study comprised of 203 patients, aged > or =14 years, admitted with complications of the severe form of leptospirosis at the Emílio Ribas Institute of Infectology (Sao Paulo, Brazil) between 1998 and 2004. Laboratory and demographic data were obtained and the severity of illness score and involvement of the lungs and others organs were determined. Logistic regression was performed to identify independent predictors of LPHS. A prospective validation cohort of 97 subjects with severe form of leptospirosis admitted at the same hospital between 2004 and 2006 was used to independently evaluate the predictive value of the model. RESULTS: The overall mortality rate was 7.9%. Multivariate logistic regression revealed that five factors were independently associated with the development of LPHS: serum potassium (mmol/L) (OR = 2.6; 95% CI = 1.1-5.9); serum creatinine (micromol/L) (OR = 1.2; 95% CI = 1.1-1.4); respiratory rate (breaths/min) (OR = 1.1; 95% CI = 1.1-1.2); presenting shock (OR = 69.9; 95% CI = 20.1-236.4), and Glasgow Coma Scale Score (GCS) < 15 (OR = 7.7; 95% CI = 1.3-23.0). We used these findings to calculate the risk of LPHS by the use of a spreadsheet. In the validation cohort, the equation classified correctly 92% of patients (Kappa statistic = 0.80). CONCLUSIONS: We developed and validated a multivariate model for predicting LPHS. This tool should prove useful in identifying LPHS patients, allowing earlier management and thereby reducing mortality.

Complement fixation and haemagglutination reaction with methanol extracts of icterohaemorrhagiae, canicola and patoc leptospires serovars

Nas reaçöes de fixaçäo de complemento (RFC) os antígenos homólogos apresentaram títulos mais elevados que os heterólogos com soros de coelhos anti-leptospiras. Soros de doadores de banco de sangue, de indivíduos de doença de Chagas, sífilis, hepatite e lepra mostraram se näo reatores na RFC com antígenos metílicos. A análise química dos antígenos revelou a presença de polissacáride e de proteínas. Na reaçäo de hemaglutinaçäo os soros de coelhos antileptospiras, apresentaram reaçäo cruzada com os antígenos heterólogos. Os soros normais e de pacientes com doença de Chagas, sífilis, lepra e hepatite mostraram-se inespecíficos na faixa de diluiçäo de 1:10 a 1:160