Clinicopathological and immunohistochemical featuresof the severe pulmonary form of leptospirosis

Abstract

Four cases of severe pulmonary form of leptospirosis (SPFL) are described. In all four of these blood culture proven cases, there was severe pulmonary injury characterized by alveolar hemorrhage and acute respiratory failure. Three patients died in less than 48 hours after onset of the first respiratory signs. Leptospiral antigen detection in lung tissues was positive by immunoperoxidase in all three of these cases, suggesting that the microorganism exerts a local direct destructive action. Patients with SPFL should be carefully monitored, as the abrupt onset of severe alveolar hemorrhage can lead to respiratory insufficiency and death. The authors emphasize the importance of radiological findings and blood gas analysis for prompt clinical diagnosis, and suggest that corticosteroids, associated with antibiotics, early respiratory support, and platelet transfusions are useful as an attempt to prevent further development of SPFL.

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

“…Autopsy showed extensive areas of pleuropulmonary hemorrhage, with a microscopic picture of hemorrhagic infiltrates involving alveoli and septa. The three patients also presented thrombocytopenia, a common finding in patients with severe leptospirosis [23][24][25].…”

“…Mortality rates can be as high as 30 to 60%. Profuse lung hemorrhage dominates the clinical presentation [23]. In four patients with SPFL described in Brazil, three died in less than 48 hours after onset of the first respiratory signs.…”

Alveolar Septal Deposition of Immunoglobulin and Complement Parallels Pulmonary Hemorrhage in a Guinea Pig Model of Severe Pulmonary Leptospirosis

“…1,2 The purpose of this study was to address the etiology and pathogenesis of the hemorrhagic diathesis seen in leptospirosis, and in particular, in the severe pulmonary form of the disease. [3][4][5][6][7] The hemorrhagic potential of leptospirosis has been noted since the first description of the features of severe human infection by Weil in 1886. 8 When the causative spirochete was first cultivated in 1916 by Inada, he accordingly named it "spirocheta icterohaemorrhagiae."…”

“…Recent reviews of human leptospirosis have highlighted the significance of pulmonary involvement. 1,2 It is clear that the severe pulmonary form of leptospirosis (SPFL) 6 may occur as distinct outbreaks, 5,14 in which a high percentage of cases are marked by pulmonary hemorrhage or as sporadic cases, 2,6,7 while in other instances, outbreaks of leptospirosis occur in which pulmonary involvement is not striking. 18 It is not known what factors influence the relative virulence and spectrum of clinical manifestations seen in human leptospirosis.…”

Leptospirosis in the tropics and in travelers

“…Given the detailed, comprehensive population surveillance carried out in this investigation, it is reasonable to conclude that SPFL was not prominent in Salvador in the early to mid-1990s. However, in other urban areas of Brazil, including São Paulo and Rio de Janeiro, SPFL was first noted to emerge in the early 1990s and remains an important complication of leptospiral infection [46,53,54]. Recently, SPFL has also been observed to be emerging in Salvador as a complication of leptospirosis (Ko, personal communication).…”