RESUMO
The case of a 56-year-old female tourist who survived cerebral Plasmodium falciparum malaria with disseminated intravascular coagulation and symmetrical peripheral gangrene, ultimately requiring amputation of her left-sided fingertips and toes, is reported. While symmetrical peripheral gangrene has been described rarely in Asian, African, and American patients with Plasmodium falciparum malaria and disseminated intravascular coagulation, no such case has been reported in travelers returning from endemic areas.
Assuntos
Coagulação Intravascular Disseminada/complicações , Coagulação Intravascular Disseminada/diagnóstico , Malária Cerebral/complicações , Malária Cerebral/diagnóstico , Plasmodium falciparum/isolamento & purificação , Animais , Coagulação Intravascular Disseminada/tratamento farmacológico , Doxiciclina/administração & dosagem , Quimioterapia Combinada , Feminino , Seguimentos , Pé , Gangrena/complicações , Gangrena/diagnóstico , Gangrena/tratamento farmacológico , Escala de Coma de Glasgow , Humanos , Infusões Intravenosas , Malária Cerebral/tratamento farmacológico , Pessoa de Meia-Idade , Quinina/administração & dosagem , Respiração Artificial , Medição de Risco , Índice de Gravidade de Doença , Viagem , Resultado do TratamentoRESUMO
Axotomy of vertebrate neurons leads to the transient upregulation of GAP-43 and alpha-tubulin. In adult zebrafish retina, mRNA levels of both genes were increased in retinal ganglion cells after optic nerve lesion following a similar time course. At 5 days after crush, the mRNA level of GAP-43 was increased nearly 20 times, whereas a 6-fold increase was observed for alpha-tubulin. Subsequently, upon target reinnervation, mRNA levels of both genes were downregulated and were 2-fold higher than normal at 25 days after crush. Stretching the optic nerve that results in diffuse axonal lesions led to the expression of both genes in identical subsets of retinal ganglion cells. When regeneration was prevented by removing a piece of the optic nerve, mRNA levels remained elevated. Disruption of axonal transport by colchicine and vinblastine led to the induction of both genes in normal retina. Blocking electrical activity with tetrodotoxin had no effect. This indicates that retrogradely transported signals induced by target contact regulate GAP-43 and alpha-tubulin transcription. Furthermore, the joint regulation of GAP-43 and alpha-tubulin mRNA levels after different kinds of lesion suggests that a common pathway underlies the regulation of neuronal GAP-43 and alpha-tubulin gene expression. In contrast, distinct mechanisms may control the extent and maintenance of increased mRNA levels of these genes.
