Pancreatic involvement in fatal human leptospirosis: clinical and histopathological features

Daher, Elizabeth De Francesco; Brunetta, Denise Menezes; Júnior, Geraldo Bezerra da Silva; Puster, Rainardo Antônio; Patrocínio, Régia Maria do Socorro Vidal

doi:10.1590/s0036-46652003000600002

Cited by 35 publications

(49 citation statements)

References 29 publications

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“…This property of albumin is reported to be hindered by the high glucose concentration (Bourdon et al 1999). Glucose concentration is reported to increase in human leptospirosis with pancreatitis involvement (Daher et al 2003) this may have also been the case in this study but we have no data to confirm the involvement of pancreatitis. However, increased glucose in this study might have aggravated oxidative stress by inhibiting albumin's antioxidant activity (Bourdon et al 1999).…”

Section: Discussionmentioning

confidence: 51%

Serum sialic acid and oxidative stress parameters changes in cattle with leptospirosis

et al. 2008

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This study was designed to disclose some indicators of oxidative stress and inflammation in natural cases of bovine leptospirosis. For this purpose, 12 bulls exhibiting clinical signs of leptospirosis and 10 healthy bulls were used. Animals were subjected to thorough clinical examination and the clinical signs were recorded. All animals were blood sampled in order to determine serum total sialic acid (TSA), lipid bound sialic acid (LBSA), malondialdehyde (MDA), reduced glutathione (GSH), nitric oxide (NO), uric acid (UA), total protein (TP), albumin and glucose. Urine samples were collected from each animal and examined under dark-field microscope to observe spirochetes. Diseased animals exhibited clinical signs suggesting leptospirosis and the diagnosis was supported by positive dark-field microscope examination. Mean TSA (mmol/L), LBSA (mmol/L), TP (g/dl), albumin (g/dl), glucose (mg/dl), MDA (micromol/L), GSH (mg/dl), NO (nmol/ml), and UA (mg/L) levels were 1.63 +/- 0.02, 0.40 +/- 0.10, 7.18 +/- 0.24, 3.23 +/- 0.5, 64.96 +/- 1.88, 5.71 +/- 0.11, 78.68 +/- 0.72, 7.94 +/- 0.34, and 8.75 +/- 0.41 in healthy bulls, and 2.50 +/- 0.05, 0.70 +/- 0.2, 9.27 +/- 0.17, 2.55 +/- 0.62, 107.93 +/- 2.52, 8.82 +/- 0.14, 47.85 +/- 1.85, 14.57 +/- 0.63 and 15.85 +/- 0.80 in leptospirosis cases, respectively. The differences between the two groups were statistically significant (P < 0.001). Increased TSA, LBSA, MDA, NO, UA, TP, glucose and decreased GSH and albumin concentrations were suggestive of inflammation and oxidative stress in diseased bulls. The results obtained may suggest that oxidative damage along with other mechanisms might have taken part in the pathogenesis of bovine leptospirosis and further detailed studies are needed to fully understand the mechanism(s) of the disease.

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Section: Discussionmentioning

confidence: 51%

Serum sialic acid and oxidative stress parameters changes in cattle with leptospirosis

et al. 2008

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“…2 Pancreatitis is described as an uncommon complication of leptospirosis, but there are a considerable number of reports in literature. [37][38][39][40] In the present study, the complications found were pulmonary bleeding (14%), tract intestinal bleeding (13%), atrial fibrillation (11.4%), pulmonary infection (6.0%), meningitis (1.0%) and pancreatitis (0.5%).…”

Section: Discussionmentioning

confidence: 68%

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Daher¹,

Lima²,

Júnior³

et al. 2010

Braz J Infect Dis

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INTRODUCTION: leptospirosis is a zoonosis of worldwide importance. The disease is endemic in Brazil. This study was conducted to describe the clinical and laboratory presentation of leptospirosis in a metropolitan city of Brazil. METHODS: this is a retrospective study including 201 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil, between 1985 and 2006. All patients had clinical and epidemiological data suggestive of leptospirosis, and positive laboratorial test for leptospirosis (microscopic agglutination test, MAT, higher than 1:800). RESULTS: a total of 201 patients were included, with mean age of 38.9 ± 15.7 years; 79.1% were male. The mean length from onset of symptoms to admission was 7 ± 3 days. The main clinical signs and symptoms at admission were fever (96.5%), jaundice (94.5%), myalgia (92.5%), headache (74.6%), vomiting (71.6%) and dehydration (63.5%). Hemorrhagic manifestations were present in 35.8%. Acute kidney injury was found in 87% of the patients. Platelet count was less than 100,000/mm³ in 74.3%. Hematuria was found in 42.9%. Death occurred in 31 cases (15.4%). CONCLUSIONS: leptospirosis is a globally relevant disease with potential fatal outcome. Signs and symptoms suggestive of leptospirosis must be known by any physician in order to institute early adequate treatment to improve outcome. Early indication and daily hemodialysis seems to be beneficial in this group of patients

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“…In the same time nonspecific inflammatory factors are involved. Hypovolemia, systemic vasculitis, leading to blood hyperviscosity, low-graded intravascular coagulation compromise the microcirculation, resulting in stasis and tissue hypoxia [2,4,5,6,9,14,16]. Perhaps immunological mechanisms play important role in the tissue injury [1,3,7,15,16].…”

Section: Doi: 105272/jimab200511113 Discussionmentioning

confidence: 99%

“…Hence functional pancreatic disorders prevalence in leptospirosis. They appears in immune phase of the disease [4].…”

Section: Doi: 105272/jimab200511113 Discussionmentioning

confidence: 99%

Pancreatic Involvement in Leptospirosis

Atanasova¹,

Gancheva²

2012

JofIMAB

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ABSTRACT:The research includes 84 patients with leptospirosis treated in Clinic at Infectious Diseases -Pleven. Mild course in 52,38%, moderate in 19,05%, and severe in 28,57% are established. Serum amylase level has been investigated in 37 cases. Increased rates are measured in 41,67% of mild cases (av. 279 U/L), in 25% of moderate cases (av. 290 U/L), and in 88,24% of severe cases(av. 937 U/L). Significant difference between serum amylase levels of mild and severe cases is established (p < 0,02). Presumably immunological mechanisms of damage by participation of interleukins (IL1, IL6, IL8) and tumor necrosis factor (TNF-a) are in the base of increased serum amylase level in leptospirosis. The functional changes of pancreas in leptospirosis are not fully clear and further research is needed.Key words: leptospirosis, pancreas, serum amylase, interleukins.Leptospirosis is an acute infectious disease caused by Leptospira interrogans -complex. The course of disease is in two phases -spirochaetemic and immune, with broad clinical spectrum. The clinical manifestations are well studied. More unclear is immunopathogenesis and the mechanism of damage in the pancreas.AIM of this research is analysis of clinical and laboratory parameters, characterizing the pancreatic functions in leptospirosis. MATERIAL AND METHODS:Retrospective (in part of the cases prospective) study in 84 patients with leptospirosis (1982 to 2004) is performed. RESULTS:Mild course (serum creatinine level below 200 µmol/ L) in 52,38% of cases, moderate (serum creatinine level between 200 and 600 µmol/L) in 19,05%, and severe course (serum creatinine level above 600 µmol/L) in 28,57% have been established.Abdominal pain localized in epigastria and left hypochondria and simulating acute surgery abdomen is presented in 7,31%; pain in epigastria and right hypochondria -in 8,54%, diffuse abdominal pain -in 4,89% of the patients. In 2,44% the pain is with irradiation to the scapulas and vertebral column. Persisting vomiting in 12,20% is observed. Pain at palpation of the abdomen presents in 8,54%, and peritoneal irritation -in 2,44%. The peristalsis is flaccid in 7,31%.Routine laboratory parameters: leucocytosis in 73,81%, granulocytosis with extreme left shift -in 97,62%, increased erythrocytes , sedimentation rate (ESR) -in 86,90%, thrombocytopenia -in 42,86%, increased fibrinogen above 4,6 g/L -in 73,81%; increased nitrogen parameters -blood urea nitrogen (BUN) above 8,3 mmol/L in 80,95% (av. 26,1 mmol/L), serum creatinine level above 135 µmol/L -in 72,62% (av. 303,2 µmol/L). Serum bilirubin is elevated in 70,24% (av. 167,9 µmol/L) with prevalence of conjugated fraction. Aminotransferase activity is moderately elevated (range from 12 to 382 U/L). Hyperglycemia in 64,63% (av. 7,3 mmol/L) and glycosuria in 26,84% are established. Serum amylase level is elevated in 59,45% (av. 556U/L; range from 58 to 3960 U/L).A table 1. includes average rates of laboratory parameters characteristic for pancreatic and renal functions. Significant difference in serum amylase...

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Pancreatic involvement in fatal human leptospirosis: clinical and histopathological features

Cited by 35 publications

References 29 publications

Serum sialic acid and oxidative stress parameters changes in cattle with leptospirosis

Serum sialic acid and oxidative stress parameters changes in cattle with leptospirosis

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Pancreatic Involvement in Leptospirosis

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