Avaliação das alterações da hemostasia e anticorpo anticardiolipina em pacientes com a forma grave da leptospirose

A prospective study was designed to evaluate disorders of hemostasis and levels of anticardiolipin antibodies (ACL) in 30 patients with severe leptospirosis and acute renal failure (ARF) (ARF was defined as serum creatinine >; or = 1.5 mg/dL). The patients had been admitted to the Walter Cantídio University Hospital, São José Infectious Diseases Hospital and General Hospital of Fortaleza, Ceará, from August 1999 to July 2001. They all were male, with a mean age of 32 ± 14 years and with clinical and laboratory diagnoses of ARF leptospirosis. The time elapsed between onset of symptoms and the first hemorrhagic manifestation was 9 ± 4 days. Bleeding was observed in 86% of the patients. Laboratory tests showed significantly high levels of urea (181 ±95 mg/dl), fibrinogen, (515 ± 220 mg/dl), prothrombin time (13.3 ± 0.9 seconds) and low platelet counts (69 ± 65x10³/mm³) on admission. There was no elevation in activated partial thromboplastin time or thrombin time. Levels of IgM and IgG ACL concentrations were significantly increased (p ; ou = 1,5 mg/dl). Os pacientes foram internados no Hospital Universitário Walter Cantídio, Hospital São José de Doenças Infecciosas e Hospital Geral de Fortaleza, Ceará, de agosto/1999 a julho/2001. Todos eram do sexo masculino com idade de 32 ± 14 anos e apresentavam manifestações clínicas com diagnóstico laboratorial de leptospirose associada à IRA. O tempo do início dos sintomas ao aparecimento das manifestações hemorrágicas foi de 9 ± 4 dias. As manifestações hemorrágicas foram observadas em 86% dos pacientes. Dados laboratoriais mostraram níveis significativamente elevados de uréia, 181 ±95 mg/dl; fibrinogênio, 515 ± 220 mg/dl; tempo ativado de protrombina, 13,3 ± 0,9 seg e diminuição das plaquetas, 69 ± 65x10³/mm³ na admissão. Não houve alteração no tempo de trombina e de tromboplastina parcial ativado. Os níveis de ACL IgG e IgM estavam significativamente elevados (p < 0,05) na forma grave da leptospirose quando comparados ao grupo controle (28,5 ± 32,4 vs. 11,5 ± 7,9MPL U/ml e 36,7 ± 36,1 vs. 6,5 ± 2,5 GPL U/ml), respectivamente. A vasculite, trombocitopenia e uremia devem ser consideradas como fatores importantes na patogênese dos distúrbios hemorrágicos observados na forma grave da leptospirose que constituem a principal causa de óbito na doença

Evaluation of hemostasis disorders and anticardiolipin antibody in patients with severe leptospirosis

A prospective study was designed to evaluate disorders of hemostasis and levels of anticardiolipin antibodies (ACL) in 30 patients with severe leptospirosis and acute renal failure (ARF) (ARF was defined as serum creatinine > or = 1.5 mg/dL). The patients had been admitted to the Walter Cantídio University Hospital, São José Infectious Diseases Hospital and General Hospital of Fortaleza, Ceará, from August 1999 to July 2001. They all were male, with a mean age of 32 ± 14 years and with clinical and laboratory diagnoses of ARF leptospirosis. The time elapsed between onset of symptoms and the first hemorrhagic manifestation was 9 ± 4 days. Bleeding was observed in 86% of the patients. Laboratory tests showed significantly high levels of urea (181 ±95 mg/dl), fibrinogen, (515 ± 220 mg/dl), prothrombin time (13.3 ± 0.9 seconds) and low platelet counts (69 ± 65x10³/mm³) on admission. There was no elevation in activated partial thromboplastin time or thrombin time. Levels of IgM and IgG ACL concentrations were significantly increased (p < 0.05) in leptospirosis patients when compared to control patients (28.5 ± 32.4 vs. 11.5 ± 7.9MPL U/ml and 36.7 ± 36.1 vs. 6.5 ± 2.5 GPL U/ml), respectively. Vasculitis, thrombocytopenia and uremia should be considered important factors for the pathogenesis of hemorrhagic disturbances and the main cause of death in severe leptospirosis