RESUMO
Pulmonary involvement is a fairly common complication of leptospirosis. A high dose of steroids is often used in the treatment of pulmonary leptospirosis. Here we report two cases who developed severe invasive fungal infections following the use of steroids for pulmonary leptospirosis. Routine use of steroids for pulmonary leptospirosis may do more harm than good as the evidence for this practice is sparse.
Assuntos
Leptospirose/diagnóstico , Pneumopatias/diagnóstico , Feminino , Humanos , Imunoglobulina M , Leptospira , Leptospirose/tratamento farmacológico , Leptospirose/mortalidade , Pneumopatias/tratamento farmacológico , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Esteroides/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: Cytomegalovirus (CMV) disease is responsible for significant morbidity and mortality following renal transplantation. Currently serology is the only method widely available in our country. Newer methods like early CMV pp65 antigenemia assay and CMV DNA amplification can diagnose CMV disease in its very early period. AIM: The aim of our study was to compare serologic method with antigenemia assay and CMV DNA amplification to diagnose CMV. METHODS: Seventy-three renal transplant recipients (from 7 centres) with clinical suspicion of CMV disease were studied prospectively. The diagnosis of CMV infection was suspected on the basis of fever and leucopenia. RESULT AND DISCUSSION: Three tests were done in all 73 patients and in 22 healthy subjects (control group). The sensitivity and specificity of serological test (CMV IgM) was 72.97 and 62.06%; of antigenemia assay was 89.18 and 100% and of PCR was 100 and 72.41%. CONCLUSION: Antigenemia assay is a sensitive and specific test for early and rapid diagnosis of CMV infection. Qualitative PCR is a sensitive marker but has low specificity.
Assuntos
Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/diagnóstico , Transplante de Rim/efeitos adversos , Reação em Cadeia da Polimerase , Testes Sorológicos , Adolescente , Adulto , Antígenos Virais/sangue , Estudos de Casos e Controles , Citomegalovirus/genética , Infecções por Citomegalovirus/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Sensibilidade e EspecificidadeRESUMO
Acute renal failure has rarely been reported in association with acute hepatitis A infection. The commonest form of renal injury in such patients has been found to be acute tubular necrosis. We report two cases of hepatitis A infection in which acute renal failure occurred very early in the course of the illness and had a clinical presentation and recovery pattern suggestive of acute tubular necrosis. In both patients, the clinical course of renal dysfunction was almost parallel to the course of hepatic dysfunction. Patient 1 needed dialysis, whereas patient 2 did not need dialysis and had a very rapid recovery from renal function in spite of having more severe azotaemia. Patient 2 was administered acetylcysteine in high doses for suspected fulminant hepatic failure. A potential benefit of a high dose of acetylcysteine in recovery of renal function from acute tubular necrosis is postulated.