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      Pulmonary manifestations of leptospirosis

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          Abstract

          Leptospirosis has a spectrum of presentation which ranges from mild disease to a severe form comprising of jaundice and renal failure. Involvement of the lung can vary from subtle clinical features to deadly pulmonary hemorrhage and acute respiratory distress syndrome. Of late, it has been identified that leptospirosis can present atypically with predominant pulmonary manifestations. This can delay diagnosis making and hence optimum treatment. The purpose of this review is to bring together all the reported pulmonary manifestations of leptospirosis and the recent trends in the management.

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          Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden.

          Felipe S Torres, Mark A Swancutt, Elizabeth Cespedes … (2005)
          Pulmonary involvement in leptospirosis remains poorly recognized in regions where it is endemic, despite reports of recent outbreaks and epidemic disease. A prospective, population-based study was carried out to identify febrile patients exposed to Leptospira in urban and rural contexts in Iquitos, Peru. Evidence of exposure to Leptospira was obtained by serologic testing, and diagnosis of leptospirosis was confirmed in pulmonary cases by culture or quantitative real-time PCR assay. Of 633 consecutively enrolled febrile patients, 321 (50.7%) had antileptospiral IgM antibodies or high titers of antileptospiral antibodies. Seven patients with histories of only urban exposure to leptospires had severe pulmonary manifestations; of these, 5 patients died; 4 of the deaths were caused by pulmonary hemorrhage, and 1 was caused by acute respiratory distress syndrome and multiorgan failure. Real-time, quantitative PCR assay showed high levels of leptospiremia (>or=10(4) leptospires/mL) in most fatal cases; 1 patient, from whom tissue specimens were obtained at autopsy, had >or=10(5) leptospires/g of lung, kidney, and muscle tissue. DISCUSSION. This study demonstrates the underdiagnosis of leptospirosis in a region of high endemicity and the underrecognition of grave pulmonary complications. Pulmonary involvement in leptospirosis was present in urban but not rural areas. Presumptive treatment for leptospirosis should be initiated immediately in the appropriate epidemiological and clinical context.
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            Predictors of lethality in severe leptospirosis in urban Brazil.

            Marcia Buzzar, Antonio Seguro, Anne S Spichler … (2008)
            To ascertain prognostic factors associated with fatal outcomes in severe leptospirosis, a retrospective case-control study was done using population-based surveillance data. Centralized death certificate reporting of leptospirosis mortality was combined with details of patients' hospitalizations, which were obtained from hospitals representing all sectors of São Paulo city. Among identified leptospirosis cases, 89 lethal cases and 281 survivor cases were analyzed. Predictors of death included age>40 years, development of oliguria, platelet count 3 mg/dL, and pulmonary involvement. The latter was the strongest risk factor with an estimated odds ratio of 6.0 (95% confidence interval: 3.0-12.0). Serologic findings with highest titer against Leptospira interrogans serovar Copenhageni did not show significant differences between survivors and non-survivors. Lung involvement was an important predictor of death in leptospirosis in São Paulo, of relevance in leptospirosis-endemic regions where this complication is common.
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              Extracorporeal membrane oxygenation for adult respiratory failure.

              Giles J Peek, Hilliary M. Moore, Nick Moore … (1997)
              To review the first 50 patients to receive extracorporeal membrane oxygenation (ECMO) for respiratory failure at Glenfield Hospital, and to compare them with published series of patients receiving positive pressure ventilation. Retrospective chart review. Extracorporeal Life Support Organization/European Extracorporeal Life Support Organization recognized ECMO center. Fifty consecutive patients referred for ECMO with respiratory failure refractory to conventional management between 1989 and 1995. None. Primary end point was survival to hospital discharge, 66%. Other data (mean and SD): Murray Lung Injury Score, 3.4 (0.5); ratio of PaO2 to fraction of inspired oxygen, 65 (36.9) mm Hg; duration of ventilation pre-ECMO, 76.5 (83.7 h); peak airway pressure, 39.6 (7.4) cm H2O; end-expiratory pressure, 10 (3.3) cm H2O; minute ventilation, 12.6 (3.32) L/min; age, 30.1 (10.8) years; duration of ECMO, 207.4 (177.8) h; and units of blood transfused, 19 (17.3). Survival was significantly better than two previously reported series of patients receiving positive pressure ventilation (55.6% and 42% survival), p=0.036 and p=0.0006. Odds ratio for improved survival was 0.46 (95% confidence interval, 0.22 to 0.97, p=0.036). Survival with ECMO is 66% for adults with severe respiratory failure. ECMO should be considered in patients who remain hypoxic despite maximal positive pressure ventilation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Lung India
                Journal ID (iso-abbrev): Lung India
                Journal ID (publisher-id): LI
                Title: Lung India : Official Organ of Indian Chest Society
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0970-2113
                ISSN (Electronic): 0974-598X
                Publication date (Print): Oct-Dec 2012
                Volume: 29
                Issue: 4
                Pages: 347-353
                Affiliations
                [1] Department of Internal Medicine, St Stephen's Hospital, Tis Hazari, Delhi, India
                [1 ] Department of Pediatrics, Lady Hardinge Medical College, Delhi, India
                Author notes
                Address for correspondence: Dr. Sameer Gulati, Department of Internal Medicine, St Stephen's Hospital, Tis Hazari, Delhi, India. E-mail: drsameergulati@ 123456gmail.com
                Article
                Publisher ID: LI-29-347
                DOI: 10.4103/0970-2113.102822
                PMC ID: 3519021
                PubMed ID: 23243349
                SO-VID: 2e55327b-9313-4878-8216-df625a0b211b
                Copyright © Copyright: © Lung India
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Respiratory medicine
                Keywords: pulmonary manifestations,pulmonary hemorrhage,diffuse alveolar hemorrhage,ards,leptospirosis
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: pulmonary manifestations, pulmonary hemorrhage, diffuse alveolar hemorrhage, ards, leptospirosis

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