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Anicteric leptospirosis-associated severe pulmonary hemorrhagic syndrome: a case series study
Stelios F Assimakopoulos1, Fotini Fligou, Markos Marangos
1Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
Abstract:
In leptospirosis, severe pulmonary hemorrhagic syndrome has replaced Weil's disease as the main cause of mortality, with rates of up to 75%. Four men, all farmers, were admitted to the intensive care unit between August 2009 and July 2010 with a diagnosis of acute respiratory distress syndrome. All patients presented with fever, hemoptysis, bilateral pulmonary infiltrates in chest radiographs, and thrombocytopenia and had compatible epidemiological history with leptospirosis; 3 patients had anemia, 3 had renal failure, 2 had increased creatine kinase, whereas bilirubin was slightly increased in only 1 patient. Leptospirosis was diagnosed serologically in all cases. Empirical therapy with ceftriaxone was administered immediately to all patients, while implementation of ARDSnet protective mechanical ventilation approach combined with an early goal-directed hemodynamic approach led to a relatively low mortality rate (25%). Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II and Sepsis-Related Organ Failure Assessment scoring systems were unable to predict the outcome of the patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome.
Insights
Severe pulmonary leptospirosis is a major cause of death. Early mechanical ventilation and hemodynamic support in farmers with acute respiratory distress syndrome reduced mortality, showing treatment effectiveness.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Leptospirosis is a zoonotic disease with severe pulmonary involvement, now a leading cause of mortality.
- Severe pulmonary hemorrhagic syndrome (SPHS) has become the primary cause of death in leptospirosis cases.
Observation:
- Four male farmers presented with acute respiratory distress syndrome (ARDS), fever, hemoptysis, pulmonary infiltrates, and thrombocytopenia.
- Clinical presentation included anemia, renal failure, and elevated creatine kinase; only one patient had slightly increased bilirubin.
- Serological diagnosis confirmed leptospirosis in all patients.
Findings:
- Empirical ceftriaxone therapy was initiated immediately.
- The ARDSNet protective mechanical ventilation strategy combined with early goal-directed hemodynamic management resulted in a 25% mortality rate.
- Standard scoring systems (APACHE II, SAPS II, SOFA) failed to predict outcomes in these SPHS patients.
Implications:
- This case series highlights the effectiveness of a combined therapeutic approach in managing severe pulmonary leptospirosis.
- Early intervention with mechanical ventilation and hemodynamic support can significantly improve survival rates.
- Current predictive scoring systems may not be adequate for assessing prognosis in leptospirosis-associated SPHS.
