Features to be considered in the pathogenesis of human leptospirosis
Keywords:
Leptospirosis/etiology.Abstract
Introduction: a review of the pathogenesis of human leptospirosis was conducted, given the importance of the disease in Cuba due to its morbidity and mortality rates, endemism, with seasonal raising and occasional outbreaks, and the growth of deaths.Objective: to update the pathophysiology for a better understanding of the clinical manifestations, contributing to timely therapeutic and early diagnosis of the disease.
Development: its pathogenesis is complex, with recently elucidated features. Harmful substances produced by the microorganism, initially hypothetical as the cytotoxic factor which damages the vascular endothelium causing vasculitis and hemolytic enzymes that damage the red cell membrane, which have been recently isolated. The importance of vascular endothelium in its pathogenesis, given by the capillary vasculitis, and the deposit in these circulating immune complexes, complemented by the amount of tissular damage, and the pathological activation of clotting mechanism due to the enhancement of the injured vascular endothelium. Microangiopathic hemolytic anemia was also reported in a patient with confirmed leptospirosis. The lack of vasculitis in patients, who died due to pulmonary hemorrhage, hypothesizes about the endothelial dysfunction as the cause of organ failure; reviewing the nonspecific inflammatory factors and neurological mechanisms in the pathogenesis of the disease.
Conclusions: the most important aspects reviewed are highlighted, contributing to the early diagnosis of the disease and its complications together with appropriate and timely therapeutic practices.
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References
1. García Portela R. Leptospirosis humana. La Habana: Editorial Científico Técnica; 2009.
2. Bharti AR, Nally JE, Ricaldi JN, Natthias NA. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis. 2003;3 (12): p.757-71.
3.-Kumar P, Clarrk M.eds. Clinical Medicine. 7th ed. London: SAUDERS Elsevier; 2009.
4. Corrales Bravo T. Leptospirosis humana. Historia natural, diagnóstico y tratamiento. Rev Mex Patol. 2005; 52 (4):p.246-56.
5. Lemaroig Valenzuela D, Carrillo Vera M. Leptospiras y disfunción orgánica múltiple. Caso clínico y revisión de la literatura. Rev Asoc Mex Med Crit Ter Int. 2003;17(5):p.176-83.
6. García Portela R, Delgado Rodríguez A, Ruz Hernández M, García Otero M. Leptospirosis. Estudio de los fallecidos en el trienio 1994-1996 en el "Hospital "Abel Santamaría". Rev Electrónica. [Internet]. 1998 [citado 8 Abr. 2013]; 2 (1): aprox. 8 p.
7. Flisser A, Velazco V, Martínez Campos C, González Domínguez F. Infectious diseases in Mexico. A Survey from 1995-2000. Arch Med Res. 2002; 33:p. 343-50.
8. Garrido R, Castillo L, Hernández G, Abarca J. Systemic leptosporisis as a cause of multiple organ failure. Report of a case. Rev Med Chil. 1996;124(/3):p. 359-82.
9.- DE Koning J, Van Hoeven JG, Meindere AE. Respiratore failure in leptospirosis Weils disease. Neth J Med. 1995;47 (5):p. 224-29.
10. Zunino E, Pizarro R. Leptospirosis. Puesta al día. Rev Chil Infectol [Internet] 2007, jun. [citado 23 feb 2009]; 24 (3): (aprox. 4 p.). Disponible en: http://www.s.cl/scielo.php?script= sci_arttsx&pid==S071610182007000300008&&Ing=es
11. Goris M, Kikken V, Straetemans M, Alba S, Goeijenbier M, Van Gorp EC, et. Towards the Burden of human leptospirosis: Duration of acute ILLness and occurrence of post-leptospirosis symptoms of patients in the Netherlands. PLoS One [Internet] 2013 [citado 18 ago 2015];8 (10): [aprox. 13 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789694
12. Haake DA, Levett PN. Leptospirosis in humans. Curr Trop Microbiol Immunol [Internet] 2015 [citado 11 ago 2015]; 387: [aprox. 21 p.] Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 4442676
13. Duany Badell LE, Achón García M, Varen Alvarez A, Badell Taquechel E, Morales Pérez NF, Bolaños Valladares T. Aspectos clínicos y epidemiológicos de pacientes con leptospirosis en Cienfuegos. 2001-2010. Medisur [Internet] 2014 [citado 6 ago 2015];12 (4): [aprox. 9 p.]. Disponible en: http://medisus.sld.cu/index.php/medisur/article/view/2731/1495
14. Bertherat E, Mueller MJ, Shako JC, Picardeau M. Discovery of a leptospirosis cluster amidst a pneumonic plague outbreak in a miners camp in the Democratic Republic of the Congo. Int J Environ Res Public Health [Internet]. 2014 Feb [citado 18 ago 2015]; 11 (2): [aprox. 8 p.]. Disponible en: http://www.ncbi.nlm.nhi.gov/pmc/articles/PMC3945570/
15. Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser AS, Lescalkzo J. Harrison`s Principles of Internal Medicine. 18 th ed. E.U.A.: Mc Graw- Hill Companies; 2012.
16. Nally JE, Chantranuwat X, Wu X, Fishbein MC. Alveolar septal seposition of inmunoglobulin and complement parallels pulmonary hemorrhage in a guinea pig model of severe pulmonary leptospirosis. Am J Pathol. 2004;164(3):p.1115-27.
17. Medeiros FD. Leptospirosis-associates disturbances of blood vesels, lungs and hermostasis. Acta Trop. 2010; p.115:155.
18. Jibaja E, Almeida G, Mena M, Acosta M, Acosta J, Pazmuño L. Leptospirosis: Reporte de un caso: Rev Ecuatoriana Med Crit. 2000; (1): p.94-98.
19. García Portela R, Ruz Hernández M, García Otero M, Marín Hernández D. Leptospirosis con anemia hemolítica microangiopática. Presentación de un caso. Hospital "Abel Santamaría". Revista de Ciencias Médicas [Internet]. 2011 ene-mar. [citado 8 abr. 2013];15(1) :(aprox. 8p.). Disponible en: http://publicaciones. pri.sld.cu/index.thp/publicaciones/article/view/751 /1404
20. Carvajal Gutiérrez V, Murillo O, Campo N, Barrantes Boza M. Anemia hemolítica autoinmune con prueba de Coombs negativa. RMSS (Internet). (actualizado 20 feb 2010; citado 16 mar 2010). Disponible en: htpp://www.Binasss.sa.cr/revistas/rmcc/552/art8.htm
21. Araujo ER. Acute kidney injure in human leptospirois: an immunohistochemical pathophysiological correlation. Virchow Arch. 2010; p. 456:367.
22. Martinelli RM, Luna A, Rocha H. Is rhabdonyolisis an additional factor in the patogénesis of acute renal failure in leptospirosis? Rev Inst Med Trop Sao Paulo. 1994;36 (2):p.111-14.
23. Hanvanich M, Moollaor P, Suwangool P, Sitprija V. Hemolytic uremic syndrome in leptospirosis bataviae. 1985; 40 (2):p. 230-31.
24. Farreras-Rozman. Medicina Interna. 13 th. ed. La Habana: Editorial Ciencias Médicas; 2011.
25. Seijo A, Coto H, San Juan J, Videla J. Letal leptospiral pulmonary hemorrhage: an emerging disease in Buenos Aires, Argentina. Emerg Infect Dis. 2002:8.
26. Ríos Goncalves A, Carvalho JE, Silva J, Rozembaum R. Hemoptises e sindrome se angustia respiratoria do adulto como cause de morte na leptospirose. Mudancas dos padroes clinicote anatomopatologicos: relato de aso. Arq Bras Med. 1993; 67 (3):p. 161-63.
27. Jain AP, Narang P, Dey S, Mendiratta DK. Leptospirosis. A case report. Indian J Pathol Microbiol.2003;46(3):p.432-33.
28. Clinical spectrum of pulmonary involvement in leptospirosis in an endemic region with cuantification of leptospiral burden. Clin Infect Dis. 2005; 40:343.
29. Gouveia EL. Leptospiropsis-associated severe pulmonary hemorrhagic syndrome. Emerg Infect. 2008; p. 14:505.
30. Trevejo RT, Rigan PérezJG, Ashfird DA, NcClureEM. Epidemic leptospirosis associated with pulmonary hemorrhage in Nicaragua 1995. J Infect Dis. 1998; 178 (5): p. 1547-63.
31. Machado ES, Feres JG, Feijo LA: Is CK- MB isoenzine useful for diagnosis of cardiac involment in icteric leptospirosis.? Rev Inst Med Trop Sao Paulo. 1995; 37 (5):p. 461-65.
32. Ram P, Chandra MS. Unusual electrocardiographic abnormality in leptospirosis. Case report. Angiology 1985; 36 (7):p. 477-82.
33. O`brien MM, Vincent JM, Person OA. Leptospirosis and pancreatitis: A report of ten cases. Pediatr Infect Dis J. 1998; 17 (5):p. 436-38.
34. Daher EF, Brunetta DM, De Silva Junior GB, Puster RA. Pancreatic involvement in fatal human leptospirosis: clinical and histophatological features. Rev Inst Med Trop Sao Paulo. 2003;45(6):p. 307-13.
35. Edwaed CN, Everard CR. Hyperamilasemia and pancreatitis in leptospirosis. Am J Gastroenterology. 1991; 86:p. 1665-68.
36. Malne J, Pryor J, Lusangulira K. Leptospirosis in Ponpei (1986-1995). A case series in the use of dopamine/steroir for Weil`s syndrome. Pacif Health Dialog. 1996; 3:p. 153-61.
37. Morgan AG, Cawish F. Ascending polyneurophatic in leptospirosis. A case study. Ann Trop Parasit. 1980; 4 (5):p. 567-68.
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