Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Abstract

Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70% of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.

Pulmonary Involvement and Leptospirosis, Greece

“…Seven (20%) of the 35 case-patients with pulmonary involvement died, a signifi cantly higher death rate than that for case-patients without pulmonary involvement (3.4%, p<0.01). Respiratory symptoms were recognized during the fi rst phase of the disease, as other studies have reported (10). We found no signifi cant difference in death rates between males and females (p = 0.629).…”

Pulmonary Involvement and Leptospirosis, Greece

“…Weil disease was present in 27 (22%). In our case-series, jaundice appeared to be a common sign, in contrast to recent studies in other countries in which the icteric form of the disease was observed in only 10% of cases (10). Median age of the 10 patients who died was 50 years (range 39-78 years).…”

Aspectos anatomopatológicos da leptospirose em cães: 53 casos (1965-2011)

“…Em humanos, a verdadeira incidência do envolvimento pulmonar na leptospirose não é conhecida, mas lesões pulmonares são descritas em 20%-70% dos casos (O'Neil et al 1991, Tattevin et al 2005, Dolhnikoff et al 2007. Embora não haja dados de prevalência sobre lesão pulmonar na leptospirose em cães, manifestação clínica foi recentemente descrita em 70% dos casos (Kohn et al 2010) e é considerada comum em parte da Europa (Sykes et al 2011), demonstrando que além de síndrome hepatorrenal, leptospirose é também uma doença pulmonar importante para essa espécie, embora não haja sequer uma citação sobre lesão pulmonar nos capítulos referente ao sistema respiratório dos dois mais célebres livros de patologia veterinária (Caswell & Williams 2007, López 2007.…”

“…A ocorrência de sintomas pulmonares na leptospirose humana é reconhecida desde a década de 1950 (Silverstein 1953) e para alguns autores o envolvimento pulmonar pode ser a principal manifestação da doença em alguns casos (Poh & Soh 1970, Im et al 1989, Sehgal et al 1995, principalmente na forma de síndrome da angústia respiratória aguda (SARA) (Berendsen et al 1984, Allen et al 1989, Alani et al 1993, Emmanouilides et al 1994, Carvalho & Bethlem 2002, Luks et al 2003, Dolhnikoff et al 2007), entretanto, a maior parte das revisões de literatura sobre SARA sequer trazem leptospirose com causa (Luks et al 2003). Vários são os padrões histológicos que podem ocorrer em um quadro clínico de SARA, mas a lesão alveolar difusa (Ware & Matthay 2000, Patel et al 2004) e a hemorragia alveolar difusa (Im et al 1989, Yersin et al 2000, Patel et al 2004) são os mais frequentemente descritos em humanos com leptospirose.…”