Tesis sobre el tema "Leptospirosis disease"
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Yan, Ke-Ting. "Aspects of immunity to Leptospira borgpetersenii serovar hardjo". Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387931.
Texto completodel, Valle-Mendoza Juana, Carlos Palomares-Reyes, Hugo Carrillo-Ng, Yordi Tarazona-Castro, Sungmin Kym, Miguel Angel Aguilar-Luis, Valle Luis J. Del et al. "Leptospirosis in febrile patients with suspected diagnosis of dengue fever". BioMed Central Ltd, 2021. http://hdl.handle.net/10757/657332.
Texto completoObjective: This study was carried out to determine the prevalence of leptospirosis among febrile patients with a suspicious clinical diagnosis of dengue fever in northern Peru. Results: A total of 276 serum samples from patients with acute febrile illness (AFI) and suspected diagnosis for dengue virus (DENV) were analyzed. We identified an etiological agent in 121 (47.5%) patients, DENV was detected in 30.4% of the cases, leptospirosis in 11.2% and co-infection by both pathogens was observed in 5.9% of the patients. In this study the most common clinical symptoms reported by the patients were: headache 89.1%, myalgias 86.9% and arthralgias 82.9%. No differences in symptomatology was observed among the different study groups.
National Research Foundation of Korea
Revisión por pares
Soares, Luciane Marieta. "O uso da talidomida como terapia adjuvante na leptospirose experimental". reponame:Repositório Institucional da FIOCRUZ, 2013. https://www.arca.fiocruz.br/handle/icict/7524.
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Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil
A leptospirose é uma zoonose de importância global, causada por leptospiras patogênicas. Seu tratamento é limitado quando iniciado após quatro dias do surgimento de sintomas, portanto, novas terapias adjuvantes são necessárias. Objetivo. Testar a droga imunomoduladora talidomida como terapia adjuvante à ampicilina no modelo de tratamento tardio da leptospirose experimental em hamsters. Métodos. 60 hamsters foram infectados via intraperitoneal por Leptospirainterrogans cepa L1-130, e foram separados em grupos: nenhum tratamento (NONE), talidomida (TAL), ampicilina (AMP) e ambos (AMP-TAL). A talidomida foi administrada via sonda orogástrica na dosagem de 50 mg/Kg diluída em óleo de linhaça (2ml/Kg) por três dias. Já a ampicilina por via intramuscular: 100mg/Kg/bid por seis dias. Foram realizados dois desenhos experimentais. Experimento 1: o tratamento foi iniciado 48h após o início dos sinais clínicos da doença. Experimento 2: o tratamento foi iniciado imediatamente após a detecção do primeiro óbito entre os animais infectados. Resultados. Experimento1: todos os hamsters dos grupos AMP e AMP-TAL sobreviveram (n=8) enquanto todos os animais dos grupos NONE (n=6) e TAL (n=8) morreram. Os hamsters dos grupos AMP e AMP-TAL não mostraram lesões renais, pulmonares ou hepáticas. Baixa carga de leptospiras foi detectada nos órgãos alvo. Experimento 2: o desfecho letal foi observado em 6/6 hamsters no grupo NONE, 8/8 do grupo TAL, 6/8 do AMP e 6/8 do AMP-TAL. A talidomida usada como adjuvante não prolongou a sobrevida dos animais tratados com ampicilina. No entanto, o grupo TAL apresentou sobrevida mais longa que o grupo que não recebeu tratamento algum. Os animais tratados apresentaram maior frequência de destrabeculação de hepatócitos. Conclusão: Esse estudo abre novas perspectivas no desenvolvimento de um tratamento tardio na leptospirose, contudo observou-se que a talidomida utilizada como terapia adjuvante não teve impacto na sobrevida de hamsters como modelo de início tardio de terapia antimicrobiana.
Leptospirosis is a zoonosis of global importance, caused by pathogenic leptospira. His treatment is limited when started after four days of onset of symptoms, increasing the risk of morbidity and mortality, so new adjuvant therapies are needed.Objectives.To test the immunomodulatory drug, thalidomide, as an adjuvant therapy to antibiotics in experimental leptospirosis. Methods. Hamsters were infected by Leptospirainterrogans strain L1-130, and groups were assigned based on no treatment (NONE), thalidomide only (TAL), ampicillin only (AMP) or both (AMP-TAL). Thalidomide was administered via a gastric tube: 50 mg/kg in linseed oil and 2 ml/kg for three days. Ampicillin was administered intramuscularly at the rate of 100 mg/kg/bid for six days. Treatment was started two days after the onset of symptoms (experiment 1) and immediately after detection of the first death (experiment 2). Results. Experiment 1: all hamsters from the groups AMP and AMP-TAL survived (n=8), while all hamsters from groups NONE (n=6) and TAL (n=8) died. The AMP and the AMP-TAL groups showed no renal, lung or liver pathology and absent or very low leptospiral burden in target organs. Experiment 2: lethal outcome was observed in 6/6 hamsters in the NONE group, 8/8 in the TAL group, and 6/8 in the AMP group and the AMP-TAL group. Thalidomide showed no survival benefit when compared to hamsters treated with ampicillin alone. The TAL group, however, had a longer interval between infection and death when compared to the NONE group. Treated animals had a higher frequency of liver plate disarray. The TAL, AMP and AMP-TAL groups had very low tissue leptospiral counts. Conclusion: This study may open new perspectives to assist the development of a delayed treatment in leptospirosis, however it was observed that thalidomide used as adjuvant therapy had no impact on the survival of hamsters as late onset of antimicrobial therapy model.
Santos, Adriana Maria Amurete Roque dos. "Leptospirose canina : estudo retrospetivo sobre a relação entre as alterações hematológicas, achados ecográficos e desfecho clínico". Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2021. http://hdl.handle.net/10400.5/21233.
Texto completoO estudo retrospetivo desenvolvido teve como objetivo caraterizar uma amostra de canídeos infetados com Leptospira spp., comparando os resultados obtidos com os descritos pela bibliografia disponível e, ainda, verificar se existem associações entre as alterações he matológicas, os achados ecográficos e o desfecho clínico dos casos. A amostra do presente estudo é constituída por 17 cães diagnosticados com leptospi rose no Hospital Veterinário do Atlântico durante um período de quatro anos. As alterações analíticas mais frequentemente observadas na amostra incluem as con centrações elevadas de ureia (n=17), creatinina (n=17), FAS (n=14) e ALT (n=9), bem como a presença de leucocitose (n=11), neutrofilia (n=10) e trombocitopenia (n=10). Todos os animais apresentaram alterações ao exame ecográfico, sendo as mais fre quentes o aumento da ecogenecidade do córtex renal (n=10), renomegalia (n=8) e hepato megalia (n=8). Durante a hospitalização quase metade dos animais desenvolveram um quadro de infeção respiratória (n=8), verificando-se que a principal causa de morte dos animais deste estudo foi o desenvolvimento de hemorragia pulmonar (n=5). É possível concluir que os resultados obtidos neste estudo apresentam uma elevada concordância com os resultados descritos por outros autores, porém não se verificou a exis tência de correlações entre as alterações analíticas, achados ecográficos e o desfecho clínico dos casos.
ABSTRACT - Canine Leptospirosis: a retrospective study on the relation between haemato logical alterations, ultrasonography findings and clinical outcome - The aim of this study is to characterize, retrospectively, the data of dogs diagnosed with Leptospira spp. and compare the results with the current literature. Furthermore, to com pare the haematological alterations, ultrasonography findings and clinical outcomes of the dif ferent cases. The sample group consisted of 17 dogs diagnosed with leptospirosis at the Hospital Veterinário do Atlântico in the last four years. High concentrations of urea (n=17), creatinine (n=17), ALP (n=14) and ALT (n=9) were the most common laboratorial findings in the sample group, as well as leucocytosis (n=11), neutrophilia (n=10) and thrombocytopenia (n=10). Ultrasonography abnormalities were found in all the dogs, namely an increase in the echogenicity of the renal cortex (n=10), renomegaly (n=8) and hepatomegaly (n=8). During hospitalization, nearly half of the sample group developed respiratory symp toms/infection (n=8), which lead to the main cause of death, pulmonary haemorrhage (n=5). In conclusion, the results from this study are in concordance with results obtained from previous studies. On the other hand, no correlation was found between the haematological alterations, ultrasonography findings and clinical outcomes of the cases.
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Gallego-Beltran, Juan Fernando. "Leptospirosis in Columbian dairy cattle : microbiological, serological, molecular and epidemiological aspects of the disease". Thesis, Royal Veterinary College (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272308.
Texto completoМоскалюк, В. Д., М. О. Андрущак y І. В. Баланюк. "Клініко-епідеміологічна характеристика перебігу лептоспірозу у хворих на Буковині". Thesis, Сумський державний університет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/45570.
Texto completoГоляр, О. І. y Д. М. Шпарик. "Епідеміологічні особливості лептоспірозу в Україні". Thesis, Сумський державний університет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/45402.
Texto completoBiscornet, Leon. "Leptospirosis in the Seychelles : geographic, molecular and epidemiological investigations of a zoonotic disease in a tropical insular environment". Thesis, La Réunion, 2020. http://www.theses.fr/2020LARE0013.
Texto completoLeptospirosis is an emerging neglected disease representing a heavy burden in the tropics, especially in tropical islands such as Seychelles, which record among the highest human incidence worldwide. This thesis aims at exploring the eco-epidemiology of leptospirosis in Seychelles by (i) using rats as markers of environmental exposure to Leptospira infection, (ii) describing the molecular epidemiology of the disease in humans and animals in a One Health framework, and (iii) identifying occupational and behavioural risk factors while comparing the current situation to that described 25 years ago. The combination of fine spatial distribution, molecular and clinical epidemiology complement each other in providing a comprehensive picture of the continuum involving reservoirs and human hosts within a shared environment.Habitat fragmentation and proximity to nutritional sources are found good predictors of Leptospira-laden Rattus spp. Geospatial analyses determined a selection of other important variable factors that are strongly correlated with Leptospira infection in Rattus spp., including altitude or distance to surface water (negative correlation), urbanization and heavy rainfall (positive correlation). Results of these analyses can guide policy makers and especially urban planners to best implement landscape structures for conservation or pest control goals leading to reduced exposure of humans to rat-borne diseases.Rattus norvegicus is found significantly more infected than Rattus rattus. Therefore, increased infection in urbanized/fragmented habitats may result at least in part from Rattus spp distribution, as R. norvegicus is mostly found in urban areas. Most importantly, genotyping of Leptospira in human acute cases and rats suggests that these rodents are involved in only a third of human acute infections, while most human cases originate from yet to be identified reservoir(s).An annual incidence of 54.6 (95% CI 40.7-71.8) per 100,000 confirms the major medical and public health importance of the disease in the country. The disease affects mainly men (96%) and displays a case fatality rate of 11.2%, mostly associated with severe forms (acute renal failure, hepatic failure and pulmonary haemorrhage). Farming and gardening related activities, proximity to cattle and cats, thrombocytopaenia, leukocytosis, elevated bilirubin and high values for renal function tests are predictors of leptospirosis. The geographical distribution of human cases poorly overlaps districts of high prevalence in rats in keeping with a restricted role of rats in human disease.The comparison of figures reported herein and in previous studies published 25 years ago reveals changes in behaviour and exposure, and shows that the development of health care has lowered the case fatality despite still high disease incidence in the country. A low level of knowledge on leptospirosis is reported, urging the need for implementing health education campaigns. Altogether, the data presented in this thesis strongly supports the implementation of a research program aiming at discovering alternative reservoir(s) to provide a full understanding of the epidemiological situation, which will allow fine tuning preventive measures for an efficient control of a disease that is still recognised as the infectious disease causing the highest mortality in the country
Araújo, Wildo Navegantes de. "Aspectos epidemiológicos da leptospirose no Brasil, 2000 a 2009 e a avaliação do conhecimento e das atitudes sobre a doença em uma favela na cidade de Salvador, Bahia". reponame:Repositório Institucional da FIOCRUZ, 2010. https://www.arca.fiocruz.br/handle/icict/4324.
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Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
A leptospirose é a principal doença infecciosa zoonótica em áreas urbanas nos países em desenvolvimento, porém subnotificada. O conhecimento e as atitudes sobre a leptospirose é desconhecida nas comunidades brasileiras onde a doença é prevalente. Objetivos: 1) Descrever os casos notificados de leptospirose, fatores de risco para óbito, influência das chuvas em cidades metropolitanas e parte da carga da leptospirose no Brasil, 2000-2009. 2) Descrever o conhecimento e as atitudes sobre leptospirose dos moradores de uma favela na cidade de Salvador. Métodos:1) Foram descritos os casos notificados de leptospirose no Sistema Nacional de Vigilância de 2000 a 2009. Foi analisada a influência das chuvas e a ocorrência de casos de leptospirose em cinco metrópoles brasileiras. Foram calculadas as taxas de incidência, hospitalização, mortalidade e letalidade por leptospirose e foram avaliados os fatores de risco para óbito a partir das variáveis demográficas entre os casos confirmados. 2) Foi conduzido um estudo transversal sobre o conhecimento e atitudes sobre leptospirose na comunidade de Pau da Lima, Salvador – Bahia. Resultados: 1) A doença acomete populações vulneráveis socialmente que vivem em áreas urbanas. As taxas de incidência, hospitalização, mortalidade e letalidade foram 1,48, 1.04, 0,12 por 100.000 habitantes e 9%, respectivamente. A partir de 15 anos de idade (OR=1,88; IC95% 1,39-2,55), baixo nível educacional (OR=1,35; IC95% 1,17-1,56), viver em área urbana (OR=2,19; IC95% 1,80-2,69) foram detectados como fatores de risco para óbito entre os casos confirmados. As chuvas tiveram forte relação com a ocorrência de surtos sazonais da doença em cinco cidades metropolitanas. 2) 72,7% das pessoas sabem que a leptospirose é uma doença transmitida por ratos, 56,4% reconhecem que pegam a doença com o contato com urina de ratos, 17,8% referiram limpar esgotos ao redor da sua casa, 35,5% referiram usar luvas e 33,3% botas para se proteger. Conclusão: No Brasil, a doença acomete homens adultos, com baixa nível educacional que vivem em áreas urbanas, tais achados estão associados a óbitos. Muitos surtos sazonais ocorreram sob influência das chuvas nas cidades metropolitanas estudadas. Na comunidade de Pau da Lima, uma favela de Salvador, as pessoas conhecem a leptospirose e as principais atitudes detectadas estão relacionadas as contínuas exposições a água de chuvas e esgotos na comunidade. As conclusões deste trabalho apontam para a necessidade de estruturar serviços de saúde que antecedam as chuvas, e para obras de saneamento básico em regiões metropolitanas com maior incidência da doença. Recomendamos que sejam realizados outros estudos sobre o conhecimento em relação a leptospirose para entender os déficits de informação da população, assim como instruí-los para organizadamente cobrarem soluções como obras de saneamento básico que minimizem o impacto da leptospirose na população.
The leptospirosis is major zoonotic infectious disease in urban areas in the developing countries. However, the leptospirosis is underreported in the world. The knowledge and attitudes about leptospirosis of the communities which suffer due the leptospirosis is unavailable. Objectives 1) To describe the leptospirosis cases reported, risk factors for death, influence of the rainfalls in metropolitan cities and, part of the burden caused by the leptospirosis in Brazil from 2000 through 2009. 2) To describe the knowledge and attitudes about leptospirosis in slum area in metropolitan city of the Brazil. Methods: 1) Were described the leptospirosis cases reported in the National Surveillance System from 2000 to 2009. Were analyzed the influence of the rainfalls in metropolitan cities, were analyzed frequency measures and, were identified risk factors for death. 2) Was conducted a cross-section study about the knowledge and attitudes about leptospirosis in the community of “Pau da Lima”, Salvador- Bahia. Results: 1) The disease attacks adult men in economically active age with low educational level living in urban areas. Incidence, hospitalization, mortality and lethality rates were 1.48, 1.04, 0.12 per 100.000 inhabitants, and 9% respectively. Being aged 15 or above (OR=1.88; IC 95% 1.39-2.55), having low educational level (OR=1.35; IC 95% 1.17-1.56), and living in urban areas (OR=2.19; IC 95% 1.80-2.69) have been detected as risk factors for death among the confirmed cases. Rains were strongly related to the occurrence to seasonal outbreaks of the disease in five metropolitan cities studied. 2) In an urban slum in Salvador, 72.7% of the individuals know that leptospirosis is a disease transmitted by rats, 56.4% recognized that the disease can be contracted by getting in contact with the urine of rats, 17.8% clean the sewers surrounding their houses, 35.5% wear gloves and 33.3% wear boots to protect them. Conclusion: In Brazil, the disease attacks adult men with low educational level living in urban areas, these covariates are associated to death. Many seasonal outbreaks occur in the studied metropolitan cities under the influence of rain. In a slum area in Salvador, people know leptospirosis and the main attitudes detected are related to continuous exposition of the community to rainfalls and sewers. Health policies geared to structuring health services prior to rains and the implementation of basic sanitation infrastructure to be requirements for minimizing the occurrence of leptospirosis in mega cities. We also recommend the conduction of studies on the knowledge and attitudes in order to understand population’s information deficit, as well as to instruct them to demand solutions such as the construction of basic sanitation infrastructure in an orderly manner.
JÃnior, Geraldo Bezerra da Silva. "ManifestaÃÃes clinicas,classificaÃÃo da lesÃo renal aguda e fatores de risco para Ãbito em pacientes com a forma grave de leptospirose". Universidade Federal do CearÃ, 2010. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=13163.
Texto completoIntroduÃÃo. A leptospirose à uma doenÃa endÃmica no Nordeste, sendo caracterizada por complicaÃÃes potencialmente fatais como a lesÃo renal aguda (LRA). O objetivo deste estudo foi avaliar as manifestaÃÃes clÃnicas, a classificaÃÃo da LRA e os fatores de risco para Ãbito em pacientes com a forma grave de leptospirose. MÃtodos. Foi realizado estudo retrospectivo em pacientes com a forma grave de leptospirose internados em hospitais terciÃrios na cidade de Fortaleza, nordeste do Brasil. Foram avaliadas as manifestaÃÃes clÃnicas, os exames laboratoriais na admissÃo e durante a internaÃÃo e o tratamento instituÃdo. LRA foi definida de acordo com as classificaÃÃes RIFLE e AKIN, sendo comparados os pacientes nas diferentes classes. Foram comparados os pacientes que usaram com aqueles que nÃo usaram penicilina, assim como os pacientes que sobreviveram com os que foram a Ãbito. AnÃlises univariada e multivariada foram usadas para a investigaÃÃo dos fatores de risco para Ãbito. A anÃlise estatÃstica foi feita pelo programa SPSS versÃo 10.0. Resultados. Foram incluÃdos 287 pacientes, com mÃdia de idade de 36,8Â15,6 anos, sendo 80,8% do sexo masculino. Os principais sinais e sintomas apresentados foram febre (96,2%), mialgia (90,6%), icterÃcia (85,7%), cefaleia (74,2%), vÃmitos (70,7%), desidrataÃÃo (54%) e calafrios (53,7%). LRA foi observada em 237 pacientes (82%) pelo critÃrio RIFLE e 242 (84%) pelo AKIN. A mortalidade geral foi de 13%. A mortalidade foi semelhante nos pacientes que usaram e que nÃo usaram penicilina (11,6% vs. 13,7%, p=0,60). Aumento da mortalidade foi observado de acordo com as piores classificaÃÃes: RIFLE-R (2%), RIFLE-I (8%) e RIFLE-F (23%), assim como AKIN 1 (2%), AKIN 2 (8%) e AKIN 3 (23%), p < 0,0001. Os pacientes com oligÃria tiveram maior mortalidade (20%), em comparaÃÃo com os pacientes sem oligÃria (5%), p=0,02. Os fatores de risco independentes para Ãbito foram: RIFLE-F (OR=10,5, IC 95%=1,3-80,8, p<0,001), AKIN 3 (OR=7,5, IC 95%=2,2-25,2 p<0,001) e necessidade de diÃlise (OR=3,5, IC 95%=1,1-11,01, p=0,01). ConclusÃes. A LRA à uma complicaÃÃo frequente na leptospirose, com mortalidade significativa. Houve associaÃÃo entre as classificaÃÃes RIFLE e AKIN com a mortalidade na leptospirose. Os fatores de risco independentes para Ãbito sÃo classificaÃÃo RIFLE-F, AKIN 3 e necessidade de diÃlise.
Introduction. Leptospirosis is en endemic disease in Northeast of Brazil, which is characterized by potential fatal complications such as acute kidney injury (AKI). The aim of this study was to evaluate the clinical manifestations, the AKI classification and the risk factors for death in patients with the severe form of leptospirosis. Methods. A retrospective study was conducted in patients with severe form of leptospirosis admitted to tertiary hospitals in Fortaleza city, Northeast of Brazil. The clinical manifestations, laboratory tests at admission and during hospital stay, as well as treatment, were evaluated. AKI was defined according to the RIFLE and AKIN classifications, and the patients in each category were compared. Patients who used and who did not use penicillin, as well as survivors and non-survivors, were compared. Univariate and multivariate analysis were performed to investigate the risk factors for death. Statistical analysis was done with SPSS program version 10.0. Results. A total of 287 patients were included, with a mean age of 36.8Â15.6 years, and 80.8% were male. The main signs and symptoms at admission were fever (96.2%), myalgia (90.6%), jaundice (85.7%), headache (74.2%), vomiting (70.7%), dehydration (54%) and chills (53.7%). AKI was observed in 237 patients (82%) according to the RIFLE criteria and 242 (84%) according to AKIN. General mortality was 13%. Mortality was similar in patients who used and who did not use penicillin (11.6% vs. 13.7%, p=0.60). An increase in mortality was observed according to the worst classifications of RIFLE and AKIN: RIFLE-R (2%), RIFLE-I (8%) e RIFLE-F (23%), AKIN 1 (2%), AKIN 2 (8%) e AKIN 3 (23%), p<0.0001. Patients with oliguria had a higher mortality (20%), when compared to those without oliguria (5%), p=0.02. Independent risk factors for death were: RIFLE-F (OR=10.5, 95% CI=1.3-80.8, p<0.001), AKIN 3 (OR=7.5, 95% CI=2.2-25.2 p<0.001) and need of dialysis (OR=3.5, 95% CI=1.1-11.01, p=0.01). Conclusions. AKI is a frequent complication in leptospirosis, with significant mortality. There was association between RIFLE and AKIN classifications with mortality. Independent risk factors for death were RIFLE-F, AKIN 3 and need of dialysis.
Lima, Helena Cristina Alves Vieira. "Incidência de fatores de risco associados às diferentes formas clínicas da leptospirose: um estudo de vigilância de base populacional em uma comunidade urbana de Salvador-Bahia". reponame:Repositório Institucional da FIOCRUZ, 2011. https://www.arca.fiocruz.br/handle/icict/4218.
Texto completoMade available in DSpace on 2012-07-19T21:14:03Z (GMT). No. of bitstreams: 1 Helana Cristina Alves V Lima Incidencia e fatores de risco associados... 2011.pdf: 793768 bytes, checksum: a96bd31b1f3f1ee9dcf815c3bc18e379 (MD5) Previous issue date: 2011
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil
A leptospirose é um problema de saúde pública em comunidades carentes do Brasil. As formas leves são subdiagnosticadas por causa da inespecificidade da apresentação clínica. São necessários estudos para determinar a frequência da leptospirose em comunidades carentes e identificar características que permitam predizer o risco de leptospirose entre pacientes com síndrome febril aguda (SFA). Este trabalho tem como objetivos determinar a prevalência da leptospirose em pacientes atendidos por SFA, determinar a incidência das formas leves e graves e identificar fatores preditores para a doença. Para tanto, de 01 de abril de 2009 a 31 de março de 2010, foi estabelecida uma vigilância de base populacional para atendimentos por SFA na comunidade de Pau da Lima, em Salvador, Bahia. Uma amostragem dos casos de SFA identificados foi investigada para leptospirose com o uso de microaglutinação (MAT) em amostras de sangue pareadas. Formas graves foram identificadas por um sistema de vigilância hospitalar. Os casos de SFA positivos e negativos foram comparados quanto ao perfil sociodemográfico, clínico e epidemiológico para identificar características preditoras da doença. A vigilância identificou 5.712 atendimentos por SFA em moradores com idade≥5 anos, sendo 1.729 (30%) recrutados e 1.479 (85%) avaliados quanto ao diagnóstico. Os recrutados foram semelhantes aos não recrutados quanto às características demográficas e clínicas. Dos pacientes avaliados, 1% foi confirmado como caso de leptospirose, sendo 14 casos leves autolimitados e 1 caso grave. A incidência anual de leptospirose leve estimada para a comunidade foi de 84/100.000 habitantes. No mesmo período foram identificados nove casos de leptospirose grave em residentes da comunidade estudada. A incidência de leptospirose grave foi de 14/100.000 habitantes. As seguintes características sociodemográficas e exposições ambientais nos 30 dias que precederam a doença foram associadas ao diagnóstico de leptospirose nos pacientes com SFA: sexo masculino; receber Bolsa Família; ter contato peridomiciliar com lama, com lixo, com esgoto; residir até 10 metros de esgoto aberto; presença de ratos no peridomicílio; ter contato ocupacional com esgoto; e trabalhar como agente de limpeza. Concluiu-se que carga da leptospirose é maior do que a identificada apenas com base nos casos graves. Características demográficas, clínicas e epidemiológicas devem ser utilizadas para predizer o risco de leptospirose.
Leptospirosis is a public health problem in Brazil's poor communities. The mild forms are underdiagnosed because of nonspecific clinical presentation. Studies are required to determine the incidence of leptospirosis in poor communities and identify characteristics that allow to predict the risk of leptospirosis among patients with acute febrile syndrome (AFS). This work aims to determine the prevalence of leptospirosis in patients served by AFS, determine the incidence of serious and light shapes and identify factors predictors for the disease. To this end, of the March 31, 2010, April 1, 2009 was established a population-based surveillance for attendances by SFA in the community of Pau da Lima, Salvador, Bahia. A sampling of cases identified SFA was investigated for leptospirosis using micro-agglutination test (MAT) in paired blood samples. Severe forms have been identified by a hospital surveillance system. The AFS cases were positive and negative compared to socio-demographic profile, to identify clinical and epidemiological characteristics of predictives of the disease. The surveillance identified 5,712 attendances by AFS in residents aged ≥ 5 years, 1,729 (30) recruited and 1,479 (85) evaluated with diagnosis. The recruited were similar to those not recruited as clinical and demographic characteristics. Of patients evaluated, 1% was confirmed as cases of leptospirosis, of which 14 being mild and 1 severe. The annual incidence of leptospirosis estimated for a community was light of 84/100.000 inhabitants. There is no same period were identified nine serious cases of leptospirosis in residents of the community studied. A severe leptospirosis incidence was of 14/100.000 inhabitants. As the following socio-demographic characteristics and environmental exposures. The following socio-demographic characteristics and environmental exposures during the 30 days preceding the disease were associated with the diagnosis of leptospirosis in patients with AFS: male, receiving Bolsa Familia, peridomestic have contact with mud, garbage, sewage, living within 10 meters of open sewage, presence of rats in animal sheds have contact with sewage occupational and work as a cleaning agent. In conclusions, the burden of leptospirosis is higher than identified based only in severe cases. Demographic, clinical and epidemiological research should be used to predict the risk of leptospirosis
Jagadesh, Soushieta. "Biogeography of Emerging Infectious Diseases In search for the hotspots of Disease X: A biogeographic approach to mapping the predictive risk of WHO’s Blueprint Priority Diseases Emerging human infectious diseases of aquatic origin: a comparative biogeographic approach using Bayesian spatial modelling Global emergence of Buruli Ulcer Spatial variations between Leishmania species: A biogeographic approach to mapping the distribution of Leishmania species in French Guiana Mapping priority neighborhoods: A novel approach to cluster identification in HIV/AIDS population". Thesis, Guyane, 2020. http://www.theses.fr/2020YANE0007.
Texto completoThe COVID-19 pandemic highlights that the spread of infectious diseases goes beyond geographical boundaries. Simultaneous changes in local biodiversity and land use, the increasing international connectivity through human transport and trade and the imminent threat of climate change have increased the risk of the emergence and reemergence of infectious diseases. The current public health response to emerging infectious diseases (EID) by passive surveillance has proven largely ineffective in preventing and controlling disease outbreaks. The way toward is to “get ahead of the curve” by identifying potential hotspots of disease emergence and detecting the environmental triggers such as land transformation, biodiversity loss and climate change. I used a biogeographic approach to study and analyze disease emergence across different taxonomic pathogen groups such as bacterial, viral, protozoal and fungal, globally and in French Guiana, a French Overseas territory located in South America. I found that regions at risk of floods, recent conversion of forest to agricultural lands and increasing minimum temperature (i.e. temperature at night) caused by cli mate change were drivers for disease emergence locally and globally across the different pathogen groups. The main findings of the PhD thesis are the following:1. Biogeographic approach to mapping the distribution of EIDs with using existing human cases data, remote sensing imagery and unconventional statistical models is effective to “get ahead of the curve” in the detection of regions at risk and the management of EIDs.2. EIDs are not unprecedented but predictable by identifying and managing the triggers of disease emergence, which have a direct link with the anthropization of the environment
Paula, Luiza Gabriella Ferreira de. "Soroprevalência de anticorpos contra patógenos zoonóticos e percepção sobre biossegurança na comunidade interna do Hospital Veterinário da Escola de Veterinária e Zootecnia da Universidade Federal de Goiás". Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/7058.
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Veterinarians, teachers, students and employees of the Veterinary Hospital of the Veterinary and Zootechnical School of the Federal University of Goiás are exposed to daily occupational hazards, including zoonotic pathogens. This study is aimed at analyzing the occurrence of anti-Leptospira spp., Anti-Toxoplasma gondii antibodies and after pre-exposure rabies vaccination in the internal members of the Veterinary Hospital through the microscopic sero-agglutination technique (SAM), the simplified fluorescence inhibition microtest (SFIMT) and the indirect hemagglutination test. Response to the serovars Automnalis, Copenhageni, Grippotyphosa, Butembo, Icterohaemorrahagiae, Australis and Canícola were detected in 6,15% (8/130). Among the 130 analyzed, 96.15% (125/130) presented serum-neutralization titers for anti-rabies antibodies post-pre-exposure prophylactic vaccination for individual immunological protection and 3.85% (5/130) did not. In relation to the anti-Toxoplasma gondii antibodies, 70% (91/130) were positive. The main activities reported by the participants included clinical care, animal restraint activities, sample collection and analysis, imaging diagnosis, pharmaceutical activities, practical classes, emergency procedures, surgical activities, necropsies and environment clean-up. The reported risk factors were contact with pathogens, accidents with sharp objects, bites, pecks, scratches, recoil, direct contact with secretions and excretions, ionizing radiation, patients of unknown origin, contact with high flow of people and animals, incorrect or incomplete information provided by animal tutors, absence of auxiliaries in some procedures and biological waste. Important biosafety measures pointed out by the participants were: obtain the patient's complete history, use protective equipment correctly, be more careful when carrying out routine procedures, adequate containment of all animals, pre-exposure vaccination of team members, awareness, and proper training and disposal of waste. By demonstrating a sense of the risks and dangers to which they are exposed and by the appropriate biosafety measures, practitioners and students are closer to an adequate level of biosecurity.
Médicos veterinários, professores, estudantes e funcionários que atuam em instituições de saúde como o Hospital Veterinário da Escola de Veterinária e Zootecnia da Universidade Federal de Goiás estão expostos a riscos ocupacionais diariamente, incluindo patógenos zoonóticos. Este estudo objetivou analisar a ocorrência de anticorpos anti-Leptospira spp., anti-Toxoplasma gondii e após vacinação antirrábica pré-exposição nos membros internos do Hospital Veterinário por meio das técnicas de soroaglutinação microscópica (SAM), do microteste simplificado de inibição de fluorescência (SFIMT), e da realização da prova de hemaglutinação indireta. Resposta aos sorovares Automnalis, Copenhageni, Grippotyphosa, Butembo, Icterohaemorra-hagiae, Australis e Canícola foram detectadas em 6,15% (8/130). Dentre as 130 analisadas, 96,15% (125/130) apresentaram títulos de soro-neutralização para anticorpos anti-rábicos pós-vacinação pré-exposição para proteção imunológica individual e 3,85% (5/130) não. Em relação aos anticorpos anti-Toxoplasma gondii, 70% (91/130) apresentaram-se positivas. As principais atividades relatadas pelos participantes incluíram atendimentos clínicos, atividades de contenção, colheita e análises de amostras, diagnóstico por imagem, atividades na farmácia, aulas práticas, atendimentos emergenciais, atividades cirúrgicas, necropsias e limpeza do ambiente. Os fatores de risco relatados foram o contato com agentes patogênicos, acidentes com perfurocortantes, mordidas, bicadas, arranhões, coices, contato direto com secreções e excreções, radiações ionizantes, pacientes de origem desconhecida, contato com elevado fluxo de pessoas e animais, informações incorretas ou incompletas fornecidas pelos tutores dos animais, ausência de auxiliares em alguns procedimentos e resíduos biológicos. Já as medidas de biossegurança apontadas pelos participantes foram a obtenção do histórico completo do paciente, uso correto de equipamentos de proteção, maiores cuidados ao realizarem os procedimentos de rotina, contenção adequada de todos os animais, vacinação pré-exposição dos membros da equipe, conscientização e treinamento e descarte adequado dos materiais e resíduos. Ao demonstrarem noção dos riscos e perigos aos quais estão expostos e das medidas adequadas de biossegurança que podem colocar em prática, os profissionais e estudantes se encontram mais próximos de um nível de biosseguridade adequado.
Suwannin, Patcharapan. "Smart polymeric nanoparticles-based immunodiagnostic platform and biosensor for leptospira detection". Electronic Thesis or Diss., Lyon 1, 2024. http://www.theses.fr/2024LYO10180.
Texto completoThe objective of this thesis was to develop a detection tool for leptospiral bacteria capable of detecting them in various samples, such as human urine and blood, as well as water and soil from the environment. The development of a rapid leptospirosis detection method, based on the principle of latex particle agglutination, involved the preparation of polystyrene latex sensitized by adsorption of anti-leptospira antibodies. This method, based on visual observation, demonstrated good sensitivity and specificity for the detection of leptospira in environmental water samples. Additionally, to increase sensitivity, an electrochemical sensor based on the use of a specific oligonucleotide sequence was employed to detect leptospiral DNA in artificial urine samples. The developed sensor showed very good sensitivity, indicating a detection limit below the attomole (aM) level and no cross-reactions with other bacteria contaminating the urine. This thesis proposes detection methods ranging from simple macroscopic detection to the use of an electrochemical sensor for sensitive and specific detection
Fornazari, Felipe [UNESP]. "Comparação de técnicas no diagnóstico da infecção leptospírica em ovinos e implicações na saúde pública". Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/98317.
Texto completoFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
A leptospirose é uma enfermidade infecto-contagiosa, de caráter zoonótico, que possui grande importância mundial. É causada por diversas espécies de bactérias patogênicas do gênero Leptospira, ocorrendo com maior frequência em regiões tropicais com condições sanitárias precárias. A infecção ocorre pelo contato direto ou indireto com a urina de animais infectados, e pode variar de assintomática até quadros clínicos graves que causam a morte. A leptospirose em ovinos é responsável por queda na produção animal, e por riscos para a saúde pública. O desenvolvimento de técnicas de diagnóstico permite identificar animais doentes, auxiliando no tratamento precoce, controle de reservatórios, e na prevenção da enfermidade. O presente estudo teve como objetivo principal comparar diferentes técnicas de diagnóstico na leptospirose em ovinos. Amostras de rim, fígado e sangue foram coletadas de 465 animais provenientes de um abatedouro. O soro foi submetido à Soroaglutinação Microscópica (SAM), e as amostras de rim e fígado dos animais soropositivos foram individualmente analisadas por quatro técnicas: cultivo bacteriano, técnica de Warthin Starry (WS), PCR convencional (PCR) e PCR quantitativa (qPCR). Amostras teciduais de 15 ovinos soronegativos, escolhidos aleatoriamente, foram utilizadas como controles negativos. No exame sorológico 21 animais foram positivos (4,5%) para os sorovares Hardjo (n=12), Hebdomadis (n=5), Sentot (n=2), Wolfii (n=1) e Shermani (n=1). Os títulos apresentados foram 100 (n=10), 200 (n=2), 400 (n=6) e 1600 (n=3). No cultivo bacteriano nenhum animal apresentou resultado positivo; na técnica de WS quatro animais foram positivos em amostras de rim, e nenhum de fígado; na PCR seis animais foram positivos em amostras de rim, e nenhum de fígado; e na qPCR 11 animais foram positivos, 8 em amostras...
Leptospirosis is an infectious disease, of zoonotic character, which has great importance worldwide. It is caused by several species of pathogenic bacteria of Leptospira genera, occurring more frequently in tropical regions with poor sanitary conditions. The infection occurs by direct or indirect contact with urine of infected animals, and can vary from asymptomatic to severe clinical pictures that lead to death. Leptospirosis in sheep is responsible for decrease in animal production, and for risks in public health. The development of diagnostic techniques allows to identifying sick animals, assisting in early treatment, reservoirs control, and disease prevention. The present study had as main objective to compare different techniques of leptospirosis diagnostic in sheep. Samples of kidney, liver and blood were collected from 465 animals originated from a slaughterhouse. The sera were submitted to Microscopic Agglutination Test (MAT), and kidney and liver samples of seropositive animals were individually analyzed by four techniques: bacteriological culture, Warthin Starry (WS) technique, conventional PCR (PCR), and quantitative PCR (qPCR). Tissue samples from 15 seronegative sheep, chosen randomly, were used as negative controls. In serologic exam 21 animals were positive (4.5%) to serovars Hardjo (n=12), Hebdomadis (n=5), Sentot (n=2), Wolfii (n=1) and Shermani (n=1). The titers presented were 100 (n=10), 200 (n=2), 400 (n=6) and 1600 (n=3). In bacteriologic culture no animal presented positive result; in WS technique four animals were positive in kidney samples, and none in liver; in PCR six animals were positive in kidney samples, and none in liver; and in qPCR 11 animals were positive, 8 in kidney samples and three in liver samples. The bacterial quantification resulting from qPCR revealed median of 4.32 bacteria/μL in liver... (Complete abstract click electronic access below)
Fornazari, Felipe. "Comparação de técnicas no diagnóstico da infecção leptospírica em ovinos e implicações na saúde pública /". Botucatu : [s.n.], 2012. http://hdl.handle.net/11449/98317.
Texto completoBanca: Jane Megid
Banca: Márcia Marinho
Resumo: A leptospirose é uma enfermidade infecto-contagiosa, de caráter zoonótico, que possui grande importância mundial. É causada por diversas espécies de bactérias patogênicas do gênero Leptospira, ocorrendo com maior frequência em regiões tropicais com condições sanitárias precárias. A infecção ocorre pelo contato direto ou indireto com a urina de animais infectados, e pode variar de assintomática até quadros clínicos graves que causam a morte. A leptospirose em ovinos é responsável por queda na produção animal, e por riscos para a saúde pública. O desenvolvimento de técnicas de diagnóstico permite identificar animais doentes, auxiliando no tratamento precoce, controle de reservatórios, e na prevenção da enfermidade. O presente estudo teve como objetivo principal comparar diferentes técnicas de diagnóstico na leptospirose em ovinos. Amostras de rim, fígado e sangue foram coletadas de 465 animais provenientes de um abatedouro. O soro foi submetido à Soroaglutinação Microscópica (SAM), e as amostras de rim e fígado dos animais soropositivos foram individualmente analisadas por quatro técnicas: cultivo bacteriano, técnica de Warthin Starry (WS), PCR convencional (PCR) e PCR quantitativa (qPCR). Amostras teciduais de 15 ovinos soronegativos, escolhidos aleatoriamente, foram utilizadas como controles negativos. No exame sorológico 21 animais foram positivos (4,5%) para os sorovares Hardjo (n=12), Hebdomadis (n=5), Sentot (n=2), Wolfii (n=1) e Shermani (n=1). Os títulos apresentados foram 100 (n=10), 200 (n=2), 400 (n=6) e 1600 (n=3). No cultivo bacteriano nenhum animal apresentou resultado positivo; na técnica de WS quatro animais foram positivos em amostras de rim, e nenhum de fígado; na PCR seis animais foram positivos em amostras de rim, e nenhum de fígado; e na qPCR 11 animais foram positivos, 8 em amostras... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Leptospirosis is an infectious disease, of zoonotic character, which has great importance worldwide. It is caused by several species of pathogenic bacteria of Leptospira genera, occurring more frequently in tropical regions with poor sanitary conditions. The infection occurs by direct or indirect contact with urine of infected animals, and can vary from asymptomatic to severe clinical pictures that lead to death. Leptospirosis in sheep is responsible for decrease in animal production, and for risks in public health. The development of diagnostic techniques allows to identifying sick animals, assisting in early treatment, reservoirs control, and disease prevention. The present study had as main objective to compare different techniques of leptospirosis diagnostic in sheep. Samples of kidney, liver and blood were collected from 465 animals originated from a slaughterhouse. The sera were submitted to Microscopic Agglutination Test (MAT), and kidney and liver samples of seropositive animals were individually analyzed by four techniques: bacteriological culture, Warthin Starry (WS) technique, conventional PCR (PCR), and quantitative PCR (qPCR). Tissue samples from 15 seronegative sheep, chosen randomly, were used as negative controls. In serologic exam 21 animals were positive (4.5%) to serovars Hardjo (n=12), Hebdomadis (n=5), Sentot (n=2), Wolfii (n=1) and Shermani (n=1). The titers presented were 100 (n=10), 200 (n=2), 400 (n=6) and 1600 (n=3). In bacteriologic culture no animal presented positive result; in WS technique four animals were positive in kidney samples, and none in liver; in PCR six animals were positive in kidney samples, and none in liver; and in qPCR 11 animals were positive, 8 in kidney samples and three in liver samples. The bacterial quantification resulting from qPCR revealed median of 4.32 bacteria/μL in liver... (Complete abstract click electronic access below)
Mestre
Weddell, Chad Allen. "Evaluation of Soil as a Risk Indicator for Human Leptospirosis in Coastal, Rural Ecuador". Scholar Commons, 2015. http://scholarcommons.usf.edu/etd/5795.
Texto completoTochetto, Camila. "Aspectos anatomopatológicos da leptospirose em cães". Universidade Federal de Santa Maria, 2012. http://repositorio.ufsm.br/handle/1/10125.
Texto completoLeptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira and it is one of the most important diseases with worldwide distribution. Although leptospirosis is recognized as one of the most commonly reported infectious diseases in dogs, there are no morphological criteria to achieve a definitive diagnosis based only on necropsy lesions. The objective of this study is to establish criteria for the pathological diagnosis of leptospirosis. The necropsy files of the Laboratório de Patologia Veterinária (LPV) of the Universidade Federal de Santa Maria (UFSM) were acessed and all cases diagnosed as leptospirosis between the years of 1965 and 2011 (n=135) were reviewed. Immunohistochemistry for confirmation of definitive diagnosis was performed only in those cases where the kidney tissue was considered viable in quantity and quality (n=79). The positive cases were identified and correspond to the results shown here (n=53). Main necropsy lesions included icterus (79.2%) and hemorrhage (75.5%), mainly in the lungs (56.6%). Gross hepatic (56.6%) and renal (50.9%) changes were frequently found and were characterized mainly by discoloration (respectively 30.2% and 32.1%), accentuation of hepatic lobular pattern (26.4%) and white streaks in the cut surface of kidneys (22.6%). Extrarenal lesions secondary to uremia occurred in half of the cases (50.9%). Enlarged livers (11.3%), and kidneys (9.4%), and rough renal capsular surfaces (3.8%) were less common findings. In the histopathology of the kidneys (n=53), the encountered lesions (98.1%) were almost exclusively acute or subacute (96.2%) and were characterized by varying degrees of tubular nephrosis (86.8%) and non-suppurative interstitial nephritis (60.4%), with evident degenerativeinflammatory dissociation. In the histopathology of the liver (n=42), the encountered lesions (97.6%) consisted mainly of hepatocellular dissociation (78.6%), intracanalicular cholestasis (33.3%) and hepatocellular necrosis (31%). Reactive lesions, such as Kupffer cell hypertrophy, sinusoidal leucocytostasis and inflammatory mononuclear infiltrate within portal triads were observed in several cases (42.8%). In the histopathology of the lung (n=28), alveolar hemorrhage (85.7%) and edema (57.1%) were rather frequent lesions. Neutrophils and macrophages in the alveolar spaces (35.7%) and neutrophils within small pulmonary vessels (17.9%) were also frequent findings. The findings stemming from the current study should serve as an alert for Brazilian veterinary pathologists, since the pathological presentations of canine leptospirosis in this region (Central Region of the State of Rio Grande do Sul, Brazil) did not change in the last 50 years, and is still similar to that described worldwide up to the decade of 1980 s, but rather different from that currently recognized in the United States, Canada and part of West Europe. We recommend that the histopathological criteria for the diagnosis of canine leptospirosis should include the concomitant occurrence of acute or subacute tubulointerstitial nephritis, non specific reactive hepatitis and diffuse alveolar damage, including diffuse alveolar hemorrhage with capillaritis, in dogs which at necropsy had presented icterus, hemorrhage and extrarenal lesions of uremia without splenomegaly.
Leptospirose é uma zoonose causada por espiroquetas do gênero Leptospira e constitui uma das mais importantes doenças de distribuição mundial. Embora leptospirose seja reconhecidamente uma das doenças infecciosas mais frequentemente descritas em cães, não existem critérios morfológicos para a realização do diagnóstico definitivo com base apenas na necropsia. Assim, o objetivo principal deste trabalho é estabelecer critérios anatomopatológicos para o diagnóstico da leptospirose. Os arquivos de necropsia do Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM) foram acessados e todos os casos diagnosticados como leptospirose entre os anos de 1965 e 2011 foram revisados (n=135). Foi realizada imuno-histoquímica para confirmação do diagnóstico definitivo apenas nos casos em que o tecido renal foi considerado viável em quantidade e qualidade (n=79). Os casos positivos foram identificados e correspondem aos resultados aqui demonstrados (n=53). Na necropsia, as principais lesões observadas incluíram icterícia (79,2%) e hemorragia (75,5%), principalmente no pulmão (56,6%). Alterações macroscópicas hepáticas (56,6%) e renais (50,9%) foram frequentes e caracterizavam-se principalmente por descolorações (30,2% e 32,1% respectivamente), acentuação do padrão lobular hepático (26,4%) e estriações brancas na superfície de corte dos rins (22,6%). Lesões extrarrenais de uremia ocorreram na metade dos casos (50,9%). Hepatomegalia (11,3%), nefromegalia (9,4%) e irregularidade da superfície capsular dos rins (3,8%) foram menos comuns. Na histologia dos rins (n=53), as lesões encontradas (98,1%) foram quase que exclusivamente agudas ou subagudas (96,2%) e caracterizavam-se por graus variados nefrose tubular (86,8%) e nefrite intersticial não supurativa (60,4%), com evidente dissociação degenerativo-inflamatória. Na histologia do fígado (n= 42), as lesões encontradas (97,6%) eram constituídas principalmente por dissociação dos cordões de hepatócitos (78,6%), colestase intracanalicular (33,3%) e necrose hepática (31%). Lesões reativas, como hipertrofia das células de Kupffer, leucocitostase sinusoidal e infiltrado inflamatório mononuclear nos espaços porta, foram vistas em muitos casos (42,8%). Na histologia do pulmão (n=28), hemorragia (85,7%) e edema (57,1%) alveolares foram muito prevalentes. Neutrófilos e macrófagos nos espaços alveolares (35,7%) e neutrófilos no interior de pequenos vasos pulmonares (17,9%) também foram achados frequentes. Os resultados aqui demonstrados devem servir de alerta aos patologistas veterinários brasileiros, pois a apresentação anatomopatológica da leptospirose canina em nossa região (Região Central do Rio Grande do Sul, Brasil) não se modificou nos últimos 50 anos, mantendo-se semelhante àquela descrita internacionalmente até a década de 1980, mas muito diferente do que é atualmente reconhecido para os Estados Unidos, o Canadá e parte da Europa Ocidental. Recomendamos que os critérios histopatológicos para o diagnóstico da leptospirose canina devem incluir a presença concomitante de nefrite tubulointersticial aguda ou subaguda, hepatite reativa não específica e lesão alveolar difusa, incluindo hemorragia alveolar difusa com capilarite, em cães que durante a necropsia demonstrem icterícia, hemorragias e lesões extrarrenais de uremia na ausência de esplenomegalia.
Rodrigues, Cláudio Manuel. "O círculo vicioso da Leptospirose: ampliando o conceito de negligência em saúde no Brasil". Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, 2016. http://www.arca.fiocruz.br/handle/icict/14865.
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Fiocruz. Centro de Desenvolvimento Tecnológico em Saúde
A leptospirose é a zoonose de maior incidência mundial, apesar de não haver uma confiável estimativa de sua carga global. Calcula-se que anualmente ocorram mais de um milhão de casos no mundo, o que possivelmente leve a 58.900 óbitos em todo planeta. No Brasil, o Ministério da Saúde vem empregando esforços para qualificar o diagnóstico e o tratamento da doença, mas que não necessariamente repercute na elevação do número de notificações de suspeitos. Sendo assim, foi proposta a Matriz do Círculo Vicioso da Negligência da Leptospirose no Brasil avaliando diversos aspectos inerentes a falta de um diagnóstico mais precoce e preciso para evitar a subnotificação de casos e a falta de uma real incidência e de carga global da doença, o que impactaria diretamente no planejamento da gestão em saúde, corroborada por pesquisa de opinião com especialistas defendendo a visão da negligência para com a informação em saúde no Brasil. A coleta de dados foi realizada por um questionário eletrônico, do tipo opinião, e disponibilizada através de e-mail a profissionais e pesquisadores selecionados previamente através de parâmetros curriculares na Plataforma Lattes. Como uma síntese do resultado podemos afirmar que, no geral, tanto os pesquisadores quanto os profissionais em saúde humana e animal foram coesos quanto à adesão às premissas enunciadas. Das 22 questões apenas três foram fortemente refutadas, o que confere certo grau de adesão às premissas apresentadas, agregando valor simbólico à matriz proposta.
Leptospirosis is the worldwide most incident zoonosis in the world, although there is no estimate global load that can be trustable. The annual appraisal cases suggested more than a million cases in a globally analysis, what may lead to a death rate near 58.900 people. Therefore, to leptospirosis ongoing circle matrix was proposed in Brazil to evaluate inherent features of the disease, as the lack of a real incidence rate, by means of underreporting and the absence of a precise global charge disease information. These two factors has an impact that could inevitably lead to a lack of awareness to implement forthright health planning emplacement in the future, by Brazilian government, coupled to the fact that the country public health specialist standpoints agreed with the lack of this reliability about Brazilian health data. The process of data gathering was performed by statement opinion electronic quiz, sent by email to previously selected researchers trough curriculum background criteria at Plataforma Lattes. As a synthesis of the results, we could assure allege that as well as researchers and professionals, even at human or animal health agreed with the prior placed assumptions. Only three of 22 questions at the quiz were contested, which besides conferring some adhesion to the previously presented assumptions, also adds emblematic value to the proposed matrix.
Schoonman, Luuk. "Epidemiology of leptospirosis and other zoonotic diseases in cattle in Tanzania and their relative risk to public health". Thesis, University of Reading, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.493992.
Texto completoMartins, Mário Henrique da Mata. "As definições da leptospirose humana como problema de saúde pública no Brasil". Pontifícia Universidade Católica de São Paulo, 2018. https://tede2.pucsp.br/handle/handle/20958.
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Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
The purpose of this thesis was to explore the ways in which causes to a public health problem, people responsible for its existence and specific places and periods for intervention are assigned, engendering certain government strategies to the detriment of others. Our goal was to make visible the effects of these definitions on the actions of a public policy and to problematize the bases that sustain their production. The phenomenon of our study was human leptospirosis, a potentially lethal disease which has been doubly neglected by public policy because of the invisibility of its population profile and its mimetic clinical picture. We adopted discursive practices as our theoretical and methodological framework and focused on the attribution processes presented in the definition of this public health problem and on the versions produced. An analytical tool was developed in order to enable the analysis of these elements in documents of public domain (scientific articles, models of notification and investigation forms, campaign materials) and speeches (interviews with managers, technicians and users of public health services). In our analysis of the Brazilian scientific literature on the subject, we have identified a recurrent attribution of cause to the bacteria, which could lead one to believe that the investment in vaccines and antibiotics would eliminate the problem. However, the plurality of types of bacteria and the controversy over the use of antibiotics in cases of leptospirosis show the limitation of this reasoning. The analysis of the leptospirosis models of notification and investigation forms made it possible to identify that a biomedical version of the disease was produced with the justification that only clinical-laboratory factors, in detriment of environmental and epidemiological data would be under direct responsibility of the health sector. On the other hand, when analysing posters, folders and leaflets used in the campaigns for the prevention of leptospirosis in a Brazilian municipality, we have identified that they present a preventive version of the disease. In these materials, the communicational model is unidirectional and authoritarian, and the responsibility for infection and prevention actions is attributed to the population, sometimes acknowledging and sometimes neglecting their living conditions. Finally, we have also analysed the attributions of cause and responsibility for the disease in the speeches of managers, technicians and users of health services. Through the analysis, it was possible to identify five common causes and responsibilities addressed by the participants: social conditions, basic sanitation, the rat, the preparation of the health sector and the population. However, the resolution uttered by the majority of managers and technicians was the need to inform, educate and/or punish the population, an attribution that is not presented in the users' speech and points to a lack of dialogue between these groups. Given the multiplicity of attributions and the potential effects they generate for the management of Brazilian health policy, we could defend the thesis that the definition of a health problem is a psychosocial practice in which the attributions and associations between repertoires constitute a central element of dispute, produced in the use of language
O objetivo desta tese foi explorar os modos pelos quais se atribuem causas a um problema de saúde pública, pessoas responsáveis por sua existência e lugares e períodos específicos para intervir sobre ele, engendrando determinadas estratégias de governo em detrimentos de outras. Nossa meta foi tornar visíveis os efeitos dessas definições nas ações de uma política pública e problematizar os fundamentos que sustentam sua produção. Nosso fenômeno de estudo foi a leptospirose humana, uma doença potencialmente letal que tem sido duplamente negligenciada pela política pública em virtude da invisibilidade de seu perfil populacional e seu quadro clínico mimético. O referencial teórico-metodológico adotado foi o das práticas discursivas com foco nos processos de atribuição, presentes na definição do problema e nas versões produzidas sobre o fenômeno. Uma ferramenta analítica foi desenvolvida para possibilitar a análise desses elementos em documentos de domínio público (artigos científicos, modelos de fichas de investigação e materiais de campanha) e falas (entrevistas com gestores, técnicos e usuários dos serviços de saúde). Em nossa análise da literatura científica brasileira sobre o assunto, identificamos uma recorrência à atribuição de causa à bactéria, o que poderia levar a crer que o investimento em vacinas e antibióticos eliminaria o problema. Todavia, a pluralidade de tipos da bactéria e a controvérsia sobre o uso ou não de antibióticos para casos de leptospirose evidenciam a limitação desse raciocínio. A análise que realizamos dos modelos das fichas de notificação e investigação da leptospirose, possibilitou identificar que, conforme os modelos eram alterados, uma versão biomédica da doença era produzida, com a justificativa de que apenas fatores de ordem clínico-laboratorial, em detrimento de dados ambientais e epidemiológicos, seriam de responsabilidade direta do setor saúde. Por outro lado, analisamos os cartazes, folders e panfletos utilizados nas campanhas de prevenção à leptospirose em um município brasileiro e identificamos que eles apresentam uma versão preventiva da doença. Nesses materiais, o modelo comunicacional é unidirecional e autoritário e a responsabilidade pela infecção e pelas ações de prevenção é atribuída à população, ora reconhecendo, ora negligenciando suas condições de vida. Por fim, analisamos também as atribuições de causa e responsabilidade pela doença nas falas de gestores, técnicos e usuários dos serviços de saúde. Por meio da análise, foi possível identificar cinco causas e responsáveis comuns abordados pelos participantes: as condições sociais, o saneamento básico, o rato, a preparação do setor saúde e a população. Todavia, a resolução proferida pela maioria dos gestores e técnicos foi a necessidade de informar, educar e/ou punir a população, atribuição que não se apresenta na fala dos usuários e aponta para uma falta de diálogo entre esses grupos. Tendo em vista a multiplicidade de atribuições e os efeitos potenciais que geram para o gerenciamento da política de saúde brasileira, pudemos defender a tese de que a definição de um problema de saúde é uma prática psicossocial na qual as atribuições e as associações entre repertórios que as constituem figuram um elemento central de disputa, produzidos na linguagem em uso
Чемич, Микола Дмитрович, Николай Дмитриевич Чемич, Mykola Dmytrovych Chemych, Оксана Миколаївна Чемич, Оксана Николаевна Чемич, Oksana Mykolaivna Chemych, Володимир Юрійович Нікітенко et al. "Сучасні особливості перебігу лептоспірозу на Сумщин". Thesis, Вид-во СумДУ, 2010. http://essuir.sumdu.edu.ua/handle/123456789/3818.
Texto completoПришляк, О. Я., В. Ф. Пюрик, Б. М. Дикий, Т. З. Кобрин y О. П. Бойчук. "Клініко-епідеміологічна характеристика лептоспірозу в Івано-Франківській області". Thesis, Сумський державний університет, 2015. http://essuir.sumdu.edu.ua/handle/123456789/43132.
Texto completoEymann, Jutta. "Management of urban common brushtail possums (Trichosurus vulpecula)". Doctoral thesis, Australia : Macquarie University, 2007. http://hdl.handle.net/1959.14/6.
Texto completoThesis (PhD)--Macquarie University, Division of Environmental and Life Sciences, Department of Biological Sciences.
Includes bibliographical references.
Preface -- Management issues of urban common brushtail possums (Trichosurus vulpecula): a loved or hated neighbour -- Effects of deslorelin implants on reproduction in the common brushtail possum (Trichosurus vulpecula) -- Brushtail possums (Trichosurus vulpecula) in metropolotan Sydney: population biology and response to contraceptive implants -- Strategic survey for Toxoplasma gondii and Neospora caninum in the common brushtail possum (Trichosurus vulpecula) from urban Sydney, Australia -- Leptospirosis serology in the common brushtail possum (Trichosurus vulpecula) from urban Sydney, Australia -- Conclusions.
The common brushtail possum (Trichosurus vulpecula) is indeed a common inhabitant of many Australian citites, and one of the few marsupials that has adapted well to the urban environment. Their close proximity to people provides a great opportunity to experience native wildlife in the backyard, however, their utilization of house roofs, bold behaviour and appetite for garden plants often leads to conflict with householders. Population numbers are sufficiently high to require ongoing management to minimise negative impacts for humans and brushtail possums alike in a socially acceptable manner. The aim of this thesis was to identify current management issues and address the need for improved and novel management strategies. The potential of slow-release implants, containing the GnRH agonist deslorelin, as a contraceptive agent for brushtail possums was tested on a captive population. Males appeared resistant to treatment, but deslorelin was found to inhibit reproduction in female brushtail possums for at least one breeding season, making it a promising tool to control fertility in some wild populations. A further aim was to trial deslorelin implants on a wild urban population, to collect more information about the urban biology of this species and to point out issues which have previously not been addressed. Close proximity and interaction of urban brushtail possums with humans and their domestic animals can increase the risk of disease exposure and transmission and influence the health of wild populations. Serosurveys showed that animals were readily exposed to Leptospira spp. and Toxoplasma gondii. This thesis also provides the first data on brushtail possum dispersal in urban areas, knowledge which is highly relevant to the development of management strategies such as fertility control. The findings from this research broaden our knowledge about urban brushtail possums and should assist wildlife authorities in developing alternative or improved management procedures.
Mode of access: World Wide Web.
xxv, 287 p. ill., maps
Boqvist, Sofia. "Leptospira infection among pigs in southern Vietnam : aspects on epidemiology, clinical affection and bacteriology /". Uppsala : Dept. of Obstetrics and Gynaecology, Swedish Univ. of Agricultural Sciences ([Institutionen för obstetrik och gynekologi], Sveriges lantbruksuniv.), 2002. http://epsilon.slu.se/avh/2002/91-576-6374-2.pdf.
Texto completoЛюбчак, Владислав Вiкторович, Владислав Викторович Любчак, Vladyslav Viktorovych Liubchak, Вікторія Валеріївна Ільїна, Виктория Валерьевна Ильина, Viktoriia Valeriivna Ilina, Михайло Петрович Ковалішин et al. "STRUCTURAL DISTRIBUTION OF PLASMAPHERESIS SESSIONS’ AMOUNT IN THE COURSE OF TREATMENT INFECTIOUS NOSOLOGIES ON THE BASIS OF SUMY REGIONAL CLINICAL HOSPITAL OF INFECTIOUS DISEASES AFTER Z.Y. KRASOVYTSKYI". Thesis, Sumy State University, 2019. https://essuir.sumdu.edu.ua/handle/123456789/84484.
Texto completoВ настоящее время лечебный плазмаферез занимает видное место как эфферентная терапия в комплексном лечении пациентов для продления ремиссии в некоторые инфекционные нозологии (хронический гепатит, острый гепатит, сепсис, токсический гепатит, герпес, лептоспироз, хронический арахноэнцефалит). По данным патофизиологического аспектов, использование афереза способствует нормализации обмена белков, параллельно с гормональным состоянием, в виде подавления дезаминирования аминокислот, что важен в спектре плазмафереза.
Nowadays curative plasmapheresis has a prominent place as an efferent therapy in the complex treatment of patients for the prolongation of remission in certain infectious nosologies (chronic hepatitis, acute hepatitis, sepsis, toxic hepatitis, herpes, leptospirosis, chronic arachnoencephalitis). According to the pathophysiological aspects, the use of apheresis promotes the normalization of protein metabolism in parallel with the hormonal state, in the form of suppression of amino acids deamination, which is important in the spectrum of plasmapheresis.
Hesterberg, Uta Walburga. "A serological prevalence study of important infectious diseases of cattle in rural areas of Kwa Zulu Natal, South Africa". Diss., Access to E-Thesis, 2007. http://upetd.up.ac.za/thesis/available/etd-05062008-081645.
Texto completoVALENÇA, Rômulo Menna Barreto. "Aspectos epidemiológicos das infecções por Leptospira spp., Toxoplasma gondii e Chlamydophila abortus em suínos de granjas tecnificadas no estado de Alagoas". Universidade Federal Rural de Pernambuco, 2009. http://www.tede2.ufrpe.br:8080/tede2/handle/tede2/5836.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The objective of this study was to determine the prevalence and identify the risk factors associated with infection by Leptospira spp. in commercial pig farms in the state of Alagoas, Brazil. To compose the study, were used 342 pigs (312 sows and 30 boars) from at seven swine herds distributed in five districts of the state of Alagoas. The serological diagnosis of infection was done by Microscopic Agglutination Test (SAM). The risk factors analysis was performed by the application of research questionnaires, consisting of objective questions relating to the designer, the general characteristics of the property, the production management, and reproductive health. Detected a prevalence of 16.10% (55/352) of pigs positive. The risk factors associated were: The not perform quarantine (p = 0.003, OR = 5.43, CI = 1.79 -16.41) and artificial insemination utilization (p = 0.023, OR = 3.38, CI = 1.18 - 9, 66). Was foundsignificant association of sows infection with the increased number of stillborn and mummified, and with the increase frequency of estrus recurrence and increased the numbers of days from weaning to service of seropositive sows. It is concluded that infection with Leptospira spp. is disseminated in commercial pig farms in the state of Alagoas, favoring the reproductive failures and decrease of zootechnical performance. The risk factors identified in this study are facilitators in the dissemination of infection and should be adjusted to control the disease in the herds studied.
Objetivou-se com este estudo calcular a prevalência e identificar os fatores de risco associados à infecção por Leptospira spp. em suínos criados em granjas tecnificadas no Estado de Alagoas, Brasil. Para compor a amostra do estudo de prevalência foram utilizados 342 suínos, sendo 312 matrizes e 30 varrões, oriundos de sete granjas de ciclo completo e distribuídas em cinco municípios do Estado de Alagoas. O diagnóstico sorológico da infecção foi realizado pela técnica de Soroaglutinação Microscópica (SAM). A análise dos fatores de risco foi realizada por meio da aplicação de questionários constituídos por perguntas objetivas referentes ao criador, às características gerais da propriedade, ao manejo produtivo, reprodutivo e sanitário. Obteve-se uma prevalência de 16,10% (55/342) de suínos soropositivos. Os fatores associados foram: não realização de quarentena (p = 0,003; OR = 5,43; IC = 1,79 – 16,41) e a utilização da inseminação artificial (p = 0,023; OR = 3,38; IC = 1,18 – 9,66). Detectou-se associação entre a infecção dasmatrizes e o aumento do número de natimortos e mumificados, assim como com a maior freqüência de repetição de cio e aumento do intervalo desmama/estro nas matrizes soropositivas. Conclui-se que a infecção por Leptospira spp. encontra-se disseminada nas granjas suinícolas tecnificadas no Estado de Alagoas e contribui com a ocorrência de falhas reprodutivas e queda nos índices zootécnicos nessas propriedades. Os fatores de risco identificados nesse estudo são facilitadores na disseminação do agente e devem ser corrigidos para controlar a doença nos rebanhos estudados.
Houemenou, Honoré. "Qualité des eaux souterraines et de surface dans la métropole de Cotonou au sud du Bénin : Implications pour la leptospirose Degradation of groundwater quality in expanding cities in West Africa. A case study of the unregulated shallow aquifer in Cotonou". Thesis, Avignon, 2020. http://www.theses.fr/2020AVIG0058.
Texto completoGroundwater from large diameter wells in the Cotonou metropolis (southern Benin) is drawnfrom the Quaternary aquifer, which belongs to the Coastal Sedimentary Basin. This coastal aquifer is particularly vulnerable not only by its shallow nature and therefore risks from anthropogenic activities,but also by its proximity connectivity with a saline lake and contaminated pond waters. Inhabitants of underprivileged areas accounting for approximately 60% of the city's inhabitants are the most exposed to the daily use of this water resource for domestic purposes. Spatio-temporal sampling surveys andphysico-chemical, isotopic and bacteriological analyses helped to describe the current state of the shallow aquifer waters, to identify the main factors and periods at risk of contamination by waterborne diseases,in particular leptospirosis, an emerging zoonosis that is unknown in Cotonou. The aquifer appears to be mainly recharged by local rainfall. But the combined use of environmental tracers (major ions, Cl/Br ratio and stable isotopes), showed that this shallow aquifer is contaminated by salt water from Nokoué Lake during the dry season, by the leaching of solid waste, by wastewater from septic tanks and latrine leaks during rainfall recharge and via the recharge of temporary and permanent ponds. Although the interaction between groundwater and rock minerals contributes to mineralization, some anthropogenic pollutants such as nitrogen and trace elements (Mo, V, Zn and Al) can leach to groundwater or be retained by adsorption to sandy clay sediments in the unsaturated zone. Others, such as Fe and Mn, depend heavily on the redox conditions and the degradation of organic matter. The contaminated waters of Cotonou are a compatible environment for the survival of leptospirosis, especially in the pond waters that are formed at the start of the rainy season. Frequent contact with pond waters during the rainy season exposes the population of Cotonou to the risk of leptospirosis infections. Preventive measures against the risk of contamination of water-borne diseases undoubtedly deserve greater attention from the health authorities in the rapidly expanding populations in the coastal region of West Africa
Robertson, Colin John. "Space-time surveillance of emerging infectious disease". Thesis, 2010. http://hdl.handle.net/1828/3629.
Texto completoGraduate
Rodriguez, Forero Jhoanna. "La leptospirose féline : sondage sérologique et de PCR urinaire chez des chats sains et des chats atteints de maladie rénale". Thèse, 2013. http://hdl.handle.net/1866/10581.
Texto completoLeptospirosis is a globally widespread zoonosis, with prevalence in cats varying from 8.8% to 35% depending on geographical localization. Although serologic evidence of feline exposure exists, clinical disease is rarely reported. This study aimed to compare seropositivity and urinary PCR status for Leptospira spp. between healthy cats (H) and cats with kidney disease (KD: acute kidney injury (AKI) and chronic KD stages IIb, III and IV). The analytical sensitivity and specificity of the PCR performed by the Laboratoire de Diagnostic Moléculaire of the FMV were evaluated. In vitro validation showed that the PCR technique is effective for determining the presence of pathogenic leptospires in the urine of cats. A total of 251 cats were recruited, from which 240 cats were enrolled. Cats were enrolled from January 2010 to March 2012 and divided into two groups, H (n=125) and KD (n=115), based on complete blood count, serum biochemistry profile and urinalysis. Leptospira spp. serology by microscopic agglutination test (titers ≥ 1:100 considered positive) and urinary PCR were performed in all cats. Predicted seropositivity for Leptospira spp. was statistically different between groups; being 5% and 13,7% in the H and KD groups respectively (p=0.02). Serovars involved were Pomona (n=16), Bratislava (n=8) and Grippotyphosa (n=1), with titers being significantly higher for Pomona (p=0.04). The excretory status was confirmed by a positive urine PCR in eight cats. Of the 26 seropositive cats, four (H=2, KD=2) were also PCR positive. The prevalence of PCR positive cats was higher in the KD group (5.3%; 6/113) compared with the H group (1.6%; 2/125), but the difference between groups did not reach statistical significance (0.9% in H, 5.5% in KD; p=0.09). Age, sex and rural versus urban environment did not influence serologic or PCR status for Leptospira spp. Predicted seropositivity was greater between June and August (p =0.02) and in known hunters (p<0.01). The presence of another cat at home also increased significantly the predicted seropositivity (p<0.01), although the presence of a dog did not. When evaluating the PCR status of cats in the GEE model for individually tested variables, only the variables “contact with raccoons” and “contact with skunks” were statistically significant (P ≤ .03). Although the precise role of Leptospira spp. as an etiologic agent of feline KD remains unclear, the significant difference in the serologic status found between H and KD cats suggests that it may be an under-diagnosed cause of KD in cats. Several asymptomatic carriers were identified, suggesting that cats could be underestimated players in the transmission of the bacteria to humans.
Carragosela, Ricardo Alexandre Davide. "Weil’s disease in an urban setting : a case report". Master's thesis, 2015. http://hdl.handle.net/10451/26044.
Texto completoLeptospirosis is a worldwide zoonotic infectious disease with a broad and nonspecific clinical presentation. The milder form usually expresses as subclinical and self-limited anicteric febrile illness and full recovery is the rule. However, a much less common but life-threating form - known as Weil’s disease – typically presents as fever, jaundice and renal failure and was first described by Weil in 1886. In 1915, the causative agent of Weil’s disease was finally internationally announced as being Leptospira icterohaemorrhagiae. A century after its discovery, much more is known about Weil's disease agent, pathogenesis and treatment. Even so, leptospirosis still comes to international attention as a globally important re-emerging infectious disease. I report a case of Weil’s disease in an urban area presenting as fever, jaundice and progressive leg weakness, complicating with acute pancreatitis and impaired kidney function. Renal replacement therapy and transfusion support were eventually required.
A leptospirose é uma zoonose com expressão clínica variada e inespecífica. A sua forma mais ligeira é habitualmente subclínica e autolimitada, podendo apresentar-se como um quadro de febre sem icterícia com evolução clínica favorável. Embora menos comum, a leptospirose pode também manifestar-se como um quadro grave de febre, icterícia e insuficiência renal descrito pela primeira vez por Weil em 1886 e conhecido desde então como doença de Weil. Em 1915, o agente etiológico da doença de Weil foi finalmente anunciado à comunidade científica internacional, tendo sido designado de Leptospira icterohaemorrhagiae. Passados cem anos desde a sua descoberta, muito mais se sabe acerca da fisiopatologia e tratamento da doença de Weil. Ainda assim, a leptospirose continua a ser palco de grande preocupação a nível internacional, sendo vista como uma doença infeciosa em potencial crescimento. Apresenta-se um caso de doença de Weil numa área urbana manifestando-se como um quadro de febre, icterícia, diminuição da força muscular nos membros inferiores, pancreatite aguda e insuficiência renal com necessidade de terapia de substituição renal e suporte transfusional.
Ya-TingChang y 張雅婷. "Applying Spatial Analysis to Post-disaster Infectious Diseases - An Analysis of Risk Factors for Cluster of Leptospirosis at Wandan Township after Typhoon Morakot". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/26424816238700544689.
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