Abstract
The authors relate the findings in the cerebrospinal fluid in 20 cases of Weil's disease observed in the wards of the "Hospital das Clínicas da Faculdade de Medicina de São Paulo", calling attention to the frequency of the repercussions of Weil's disease in the nervous system and the value of the cerebrospinal fluid examination to demonstrate them. Twenty seven tests were made in the cerebrospinal fluid, always by sub-occipital punction, the punction being performed between the 4th. and the 37th. day of illness. All patients were male, aged 15 to 45 years with: jaundice (20), fever and muscular pains (17), headache (18), bleedings (14), vomits(13), oliguria (11), anuria (4). None of them showed clinical signs of meningitis, only one showed convulsions (of the comitial type). In all cases evidence of leptospirosis was obtained by means of serological agglutination, 19 positive with Leptospira ictero-hemorragisae and 1 with Leptospira canicola. The tests performed in the cerebrospinal fluid were: pressure mensuration; physical properties; icterus index; qualitative and quantitative cell counts; amount of proteins, chlorides, glycose, urea and bilirrubin; benjoin and Takata-Ara colloidal reactions; bile's pigments; Wassermann, Steinfeld, Winberg, Eagle and Meinicke reactions; bacterioscopic examination; guinea-pig inoculation and agglutination test. The authors did not find one single case of increased tention of cerebrospinal fluid. In all cases, the cerebrospinal fluid was xanthochromic whose intensity did not agree with the blood icterus index. To a spinal fluid with icterus index 0,5 the corresponding blood index was 104, while another fluid with icterus index 2, the corresponding blood index was 42. The intensity and precocity of xanthochromic colour in the spinal fluid is a signal of utmost importance in the diagnosis of Weil's disease. Xanthochromia of the spinal fluid in jaundices of other etiologies is found only after a long time of illness and with very intense jaundice. The spinal fluid's in Weil's disease aproached to yellow canarian with tendency to greenish, while the colour of hemorragic spinal fluids has slightly reddish tonality. At the spectrophotometer, in these cases, luminous absorption has been observed in the ray of the hemoglobin and substances proveninents of its direct desintegration, while, in Weil's disease, the luminous absorption takes place in the ray of the bilirrubin. The foreign authors pointed that in all cases of Weil's disease about 40% are anicteric, without xanthochromia of the spinal fluid. These cases dont have been described among us. The cell counting of the spinal fluid showed a normal number in 11 patients and increased number in the other 9, which decreases in proportion to the evolution of the disease, while the percentage of segmented neutrophils increases in direct proportion to the total number of cells. The dosage of chlorides and glycose did not show any alteration; we cannot, therefore, confirm the fact, related by other authors, of the constant increased amount of glycose in this disease. The amount of urea is in direct proportion with the blood amount. The colloidal reactions showed, in 3 cases, results of the meningitis type; in 6 cases, results of the parenchymatous type, in one of the mixed type; in two, inespecific curve in the middle tubes. The colloidal reactions of the parenchymatous type call the attention to the possibility of encephalics damages in Weil's disease, which has to be confirmed by histopathologic studies. No bile's pigments were found in the spinal fluids which had been tested; the characteristic reactions of lues and cysticercosis were always negative, as well as the bacterioscopic test. The guinea-pigs inoculation gave always a negative result and the titles of agglutinines were always very low, lower than those found in the blood.
The authors conclude:
1 - There is no agreement between the clinical meningeal symptoms always missing and the spinal fluid alterations present in 100% of cases; 2 - The frequency of the spinal fluids alterations and its intensity showed the utmost importance of its examination in the diagnosis of the nervous system's alterations in Weil's disease; 3 - There is a direct connection between the occurrence of segmented neutrophils - his number and percentage - with the total number of cells and no connection with the date of the punction; 4 - The alterations of spinal fluid in Weil's disease hint the existence of meningeal and encephalic damages wich need to be proved by histopathologic studies; 5 - In diagnosis of icteric form of Weil's disease it is of utmost importance the spinal fluid examination including physical properties (tonality and intensity of the xanthochromia), icterus index, pressure mensuration, qualitative and quantitative citological counts, dosage of chlorides, glycose, urea, bilirrubin, reactions of Nonne, benjoin and Takata-Ara, research of bile's pigments and of leptospira, guinea-pig inoculation and agglutinine's titration.
References
1. BEESON,P. R, D. D. HANKEYe C. F. COOPER- 1951 - Leptospiral iridocyclitis: evidence of human infection with leptospira pomond in U. S. A. J. A. M. A. 145 (4): 229-230.
2. BEESON,P. R. e D. D. HANKEY- 1952 - Leptospiral meningitis. A. M. A. Arch. lnt. Med. 89: 575-583.
3. BUZZARD,E. M. e J. A. H. WYLIE - 1947 - Meningitis leptospirosa. Lancei 252 : 417-420.
4. GARGILL,W. H., Jr. e P. B. BEESON- 1947 - Value of spinal fluid examination as diagnostic procedure in Weil's disease. Ann. Int. Med. 27: 396-400.
5. CLAPPER,M. e G. B. MYERS- 1943 - Clinical manifestations of Weil's disease with particular reference to meningitis. Arch. Int. Med. 72: 16-30.
6. CORRÊA,M. O. A. e J. A. MElRA - 1949 - Sôbre um caso de febre eanícola no homem. Rev. Med. Cir. S. Paulo 4: 47-64.
7. COSTA,S. e J. TROISIER - 1916 - Un cas de spirochétose íctérohémorragique s-ai. Mem. Soc. Méd. Hop. Paris 40: 1635-1639.
8. COSTA,S. e J. TROISIER- 1917 - Réactions cytoIogiques et chimiques du liquide céphaIo-rachidien dans Ia spiroohétose ictérohémorragique. Compt. Renâ. Soc. Biol. 80 : 29-31.
9. COSTA,S. e J. TROISIER- 1918 - Vi-ulence comparée du liquide céphalo-rachidien et du sang dans Ia spirochétose ictérohémorragique, Comp, Rend. Soc. Biol. 81: 1267-1268.
10. COSTA,S. e J.. TROISIER- 1918a - Les réactions cytologiques du liquide eéphalorachidien dans leurs rapports avec sa virulence au cours de Ia spirochétose ietérohémorragique. Compt. Rend. Soc. Biol. 81: 1269-1270.
11. COWDEN,F. E., F. D. OWNBYe R. L. ISHAM- 1952 - Weil's disease; raport of four cases emphasizing two adjuncts to earIy diagnosis. Amer. Practitioner 3(5) : 353-364.
12. DRAGERT,E. -1934 - Beitrag zur Pathologischen Anatomie der Weilschen Erkrankung. Virchows Arch. Path. Anat. 292: 452-464.
13. GUILLAIN,G. e C. RICHET- 1910 - Etude sur une rnaladie infectueuse caracterisée par de l'ietéce et un syndrome méningé. Buli. Mem. Soc. Méd. Hop. Paris 30: 289-299.
14. HAUNZ,E. A. e J. D.-CARDY - 1952 - CanicoIa fever: roport of nine cases of one family, with abstract of the world literature. A. M. A. Arach. Int. Med. 89 (6): 978-993.
15. XANEKO,R. e K. OKUDA- 1917 - The distribution in the human body of spirochaeta icterohaemorrhagiae. J. Exp. Med. 26: 325-339.
16. LAUBRY,C. e M. PARVU- 1910 - Syndrome méningé avec lymphocytose rachidienne d'origine indeterminée. Bull. Mém. Soc. Med. Hop. Paris 30: 236-244.
17. MOLLARET,P. e B. ERBER- 1935 - Contribuition á l'étude physiopathologique de Ia spirochétose méningée pure. Bull. Mem. Soc. Méd. Hop. Paris 51: 1638-1643.
18. MURGATROYD, F. - 1937 ~ Chronic meningitis in Weil's disease. Brit. Med. J. 1 : 7-11.
19. THIEL, P. H. van - The Ieptospiroses. Universitaire pers Leiden, Leiden, 1948.
20. TROISIER,S. e Y. BOQUIEN- La spirochétose méningée. Masson, Paris, 1933.
21. WALCH-SORGDRAGER,B. - 1939 - Leptospiroses. Bull. Heolih. Organ. League Nations 8: 143-386.
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