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[Pulmonary manifestations in severe ictero-hemorrhagic leptospirosis]
Abstract:
Eight cases of pulmonary involvement were observed in 17 severe cases of ictero-haemorrhagic leptospirosis. Haemoptysis (7 cases) occurred on the 4th day of the infectious syndrome and was associated with other haemorrhagic manifestations in 4 cases. Cough, pain and polypnoea were not constant. Chest X-ray showed diffuse, non-specific changes, such as nodular opacities or infiltrates. Septicaemia was confirmed in all cases with acute renal failure in 7 cases and meningitis in 6 cases. Severe thrombocytopenia was demonstrated in 2 cases. Six patients recovered quickly with regression of the lung changes within 12 days. Two patients died, one of a fulminant haemoptysis related to a disseminated intravascular coagulation syndrome, and the other of acute respiratory failure. All cases were confirmed serologically. Although lung changes in leptospirosis are usually benign and mild, haemoptysis and polypnoea with diffuse radiological changes are poor prognostic factors. The pathological changes were similar to those of haemorrhagic alveolitis. These changes may be either due to the liberation of toxins or to an immunological phenomenon.
Insights
Pulmonary involvement in severe leptospirosis can cause severe bleeding and respiratory issues. Early detection of lung changes like haemoptysis is crucial for prognosis in leptospirosis patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Pathology
Background:
- Leptospirosis is a zoonotic infection with diverse clinical manifestations.
- Pulmonary involvement in severe leptospirosis is not well-characterized.
- Hemorrhagic leptospirosis can present with severe systemic complications.
Purpose of the Study:
- To describe the clinical and radiological features of pulmonary involvement in severe leptospirosis.
- To identify prognostic factors for pulmonary complications in leptospirosis.
- To elucidate the pathological basis of lung changes in severe leptospirosis.
Main Methods:
- Retrospective case series of 17 severe leptospirosis patients.
- Clinical data collection including symptoms, laboratory results, and imaging.
- Serological confirmation of leptospirosis.
- Analysis of pathological findings in fatal cases.
Main Results:
- Eight patients (47%) had pulmonary involvement, predominantly haemoptysis (7 cases).
- Pulmonary changes included diffuse, non-specific radiological findings.
- Associated complications included acute renal failure (7 cases) and meningitis (6 cases).
- Poor prognostic factors identified: haemoptysis, polypnoea, and diffuse radiological changes.
- Two deaths occurred due to fulminant haemoptysis and respiratory failure.
Conclusions:
- Pulmonary involvement in severe leptospirosis can be severe, presenting with haemoptysis and diffuse radiological changes.
- Haemoptysis and respiratory distress are poor prognostic indicators.
- Pathological changes resemble hemorrhagic alveolitis, possibly due to toxins or immune responses.