Patient with headache, myalgia, and a history of travel, initially presents a framework of aseptic

Last Review: 08/16/2013
35 year old man with history of travel to the interior for 10 days (ecotourism), presents a chart of headache and myalgia important 1 day ago. Searched the PS, where he held collection of tests showed a normal blood count and serum CPK levels increased 3 times and cerebrospinal fluid (CSF) with mild pleocytosis with 60 cells and a predominance of lymphomononuclear cells.
Patient with headache, myalgia, and a history of travel, initially presents a framework of aseptic meningitis that could be a common viral meningitis, but draws attention associated myalgia. Other hypotheses that should be raised are dengue and leptospirosis.
In evolution, the patient showed worsening of symptoms after improvement for 2 days. Had worsening of renal function with creatinine 3.5 mg / dL and urea 80 mg / dL. The CPK increased and the patient presented with jaundice predominance szőnyegtisztítás of direct bilirubin and hemorrhagic appearance of conjunctival suffusion.
Leptospirosis is a zoonosis of worldwide distribution and importance. Before primarily associated with floods, has been increasingly associated with adventure tourism, especially water sports. His pattern of findings has also displayed some changes over the years, being possible szőnyegtisztítás increasingly hemorrhagic pulmonary manifestations.
Leptospires belong to the group of spirochetes, and its manifestations pathogenic to humans occur with infection by Leptospira interrogans, particularly with serotype icterohaemorragia leptospira. From the genetic point of view, consists of two circular chromosomes, whose complete genetic sequence was recently decoded. They have the characteristic of being highly mobile, with features of both aerobic and gram-negative bacteria and gram-positive spirochetes. His direct visualization is possible only with the dark-field microscopy.
Infection in humans occurs by continuity solutions on the skin or connective tissue, which serve as a gateway to the pathogen after environmental exposure as well as exposure to contaminated water. The indirect transmission of contaminated water through the rat urine is by far the leading cause of infection. Its distribution is worldwide, but has larger implications in tropical regions. Can subclinical or nonspecific cases occur mainly in epidemic regions. One study showed that in epidemic region of Peru, 20-30% of patients with nonspecific fever had serologic evidence of leptospirosis. The leptospira can stay in the renal tubules of transmitters animals and is excreted in the urine of them, when can then infect szőnyegtisztítás humans, which explains its transmission.
Understanding the pathophysiological mechanism of the manifestations caused by leptospirosis is limited. It is known, for example, outbreaks of infections are mild or a more severe as the pathogenicity of the strain or by genetic characteristics of the infected human. Its wide spectrum of manifestations, from asymptomatic infection to a great number of different manifestations, szőnyegtisztítás suggest that several events may occur influencing the onset of these manifestations.
The pathogenic mechanisms are divided between those related to direct effects of leptospira and related effects caused by the human immune response. The motility of Leptospira is a first important factor in the pathogenesis because it allows its rapid dissemination in different tissues, including lung, liver, kidneys, and other organs. There are still lipopolysaccharide membrane of leptospira that interact with toll-like receptors and may initiate the cascade of sepsis. Among these, one may include hemolysin and sphingomyelinase. The protein fibronectin, in turn, is involved in initial adhesion and invasion of different sites, as well as other mechanisms are related to the induction of apoptosis and interfering channels in Na-K-dependent ATPase in isolated segments of the nephron.
In different organs, the direct or indirect actions of leptospira cause damage. In the liver, for example, cause hepatocellular dysfunction with decreased synthesis of coagulation factors, albumin and decrease cholesterol esterification factors. In the kidney, tubular leptospira cause damage through the formation of immune complexes, hypoxemia, low flow and even by direct toxic effect of Leptospira box interstitial nephritis and tubular necrosis with renal failure. In muscles, the changes include formation of cytoplasmic vacuoles and myositis. Patients szőnyegtisztítás may develop vasculitis with endothelial destruction and inflammatory szőnyegtisztítás infiltrates. This process of vasculitis is responsible for major disease outbreaks. In the lungs, the low amount of leptospires in tissue suggests that the demonstrations are