14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 77.011
Session: Gram-positives & Miscellaneous Pathogens
Date: Friday, March 12, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Analysis and correlates of atypical lymphocytosis in leptospirosis in the cohort of patients at an
infectious diseases unit, University Hospital, from 1996 to 2009, in Rio de Janeiro, Brazil
A. Barbosa 1 , P. V. Damasco 2 , C. A. L. Ávila 2 , M. Ribeiro-Carvalho 3 , E. R. S. Lemos 4 , M. N.
Bóia 2 , M. M. Pereira 5
1 University Hospital Pedro Ernesto, Rio de Janeiro State University- UERJ, Brazil., Rio de
Janeiro, Rio de Janeiro, Brazil, 2 Infectious Diseases Unit at University Hospital Pedro Ernesto,
Faculty of Medical Sciences, State University of Rio de Janeiro /UERJ – RJ, Brazil, Rio de
Janeiro, Brazil, 3 Department of General Pathology and Laboratory, Faculty of Medical Sciences,
State University of Rio de Janeiro/UERJ- RJ, Brazil., Rio de Janeiro, Brazil, 4 National Reference
Laboratory for Hantavirosis, Instituto Oswaldo Cruz /FIOCRUZ, Rio de Janeiro, Brazil., Rio de
Janeiro, Brazil, 5 WHO/PAHO Collaborating Center and National Reference Laboratory for
Leptospirosis, Instituto Oswaldo Cruz /FIOCRUZ, Rio de Janeiro (RJ), Brazil., Rio de Janeiro,
Brazil
Background: Laboratory findings associated with dengue fever include a lymphocytosis often
marked by atypical lymphocytes while in leptospirosis, peripheral-blood smear will indicate
bacterial infection. There is no case report in medical literature associating leptospirosis and
atypical lymphocytes. The role of cell-mediated immunity in host defense to Leptospira spp.
remains poorly understood in both animal models and human disease. Whereas Leptospirosis
related to atypical lymphocytes should be cause for scientific investigation.
Methods: This study was developed at the Pedro Ernesto University Hospital, over a period of
13 years (1996-2009) with suspected leptospirosis. Leptospirosis was defined in accordance with
the World Health Organization criteria. We describe the demographic, epidemiological, clinical
and laboratory characteristics of 33 patients. A value of P < 0.05 was considered significant. For
proportional analysis X2 test was used.
Results: Mean age was 34 years, and there was no case of leptospirosis among adolescent
females in our cohort. 82% had epidemiological factor positive. The mean hospital stay was 11
days and only 78,7 % received antibiotic treatment. Fever was recorded in 100% of the cases,
myalgia in 96,9% and 90.9% had jaundice. Complications: 62.5% with bleeding, 60.6%
progressed to renal failure, 21.2% respiratory failure and 18.0% were admitted in the ICU. After
comparing the groups with atypical and without atypical lymphocytes, we found that the first
group had less renal failure (p < 0,04). There were two cases in the first group where we had the
opportunity to study the lymphocytes in the cytometry flow. We observed a predominance of gd
lymphocytes. There were no deaths in the group of atypical lymphocytes and the mortality in our
cohort in Rio de Janeiro was of 9.1%.
Conclusion: In Brazil, most cases of leptospirosis and dengue fever were reported in the tropical
rain season. We observed an expansion of T cells in peripheral blood in two patients with
Leptospirosis. We found lower morbidity in patients with atypical lymphocytosis in our cohort.
Leptospirosis is an emerging infectious disease where atypical lymphocytes may be observed.
Therefore, the infectious diseases physician must be aware of this new data.