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[Respiratory manifestations of leptospirosis. A retrospective study of 91 cases (1978-1984)]
J P Courtin1, M Di Francia, I Du Couëdic
1Service de Pneumologie et Maladies Infectieuses, Centre Hospitalier Sud Réunion, Saint-Pierre, La Réunion.
Abstract:
Leptospirosis, an ubiquitous zoonotic disease, is a systemic infection usually producing fever with hepatorenal involvement, meningoenephalitis, and hemorrhage. Respiratory manifestations are less well known but have been described in certain regions such as Southeast Asia or the Reunion Island. From January 1978 through December 1994, 154 cases of documented leptospirosis were admitted to the South Reunion Hospital Center. Pulmonary involvement was observed in 91 of these cases (59.1%) with hemoptysis (37.4%) and radiological evidence of bilateral reticulonodular infiltration (40%). Extra-pulmonary manifestations in most cases suggested leptospirosis at admission. Thirteen consecutive patients underwent endoscopy explorations with bronchoalveolar lavage: intra-alveolar hemorrhage was evidenced in all cases. This highly typical pattern of cytolysis would emphasize (20.8%) when the classical extra-pulmonary signs are too discrete to suggest the diagnosis. In this series, 10 patients required ventilatory assistance and 2 were given corticosteroid boluses for massive hemoptysis. Mortality due to leptospirosis is two-fold higher in cases with pulmonary involvement.
Insights
Pulmonary involvement in leptospirosis (a zoonotic disease) is common, often presenting with hemoptysis and lung infiltrates. This respiratory complication significantly increases mortality risk in affected patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Zoonotic Diseases
Background:
- Leptospirosis is a widespread zoonotic disease known for systemic symptoms like fever, hepatorenal issues, and hemorrhage.
- Respiratory manifestations of leptospirosis are less recognized but occur in specific regions.
Purpose of the Study:
- To investigate the prevalence and characteristics of pulmonary involvement in leptospirosis patients.
- To highlight the diagnostic significance of respiratory symptoms and bronchoalveolar lavage findings.
Main Methods:
- Retrospective analysis of 154 documented leptospirosis cases admitted between 1978 and 1994.
- Review of clinical data, radiological findings, and results from bronchoscopies with bronchoalveolar lavage in 13 patients.
Main Results:
- Pulmonary involvement was observed in 59.1% of cases, with hemoptysis in 37.4% and bilateral reticulonodular infiltrates in 40%.
- Bronchoalveolar lavage revealed intra-alveolar hemorrhage in all 13 patients who underwent endoscopy.
- Leptospirosis with pulmonary involvement showed a two-fold higher mortality rate.
Conclusions:
- Pulmonary leptospirosis is a significant clinical presentation, often characterized by hemoptysis and characteristic bronchoalveolar lavage findings.
- Early recognition of pulmonary signs is crucial, as they can be indicative of the disease even when classical extra-pulmonary signs are subtle.
- Pulmonary involvement is associated with increased mortality, emphasizing the need for prompt diagnosis and management.