Leptospirosis-associated Severe Pulmonary Hemorrhagic Syndrome, Salvador, Brazil

Gouveia, Edilane Lins; Metcalfe, John; Carvalho, Ana Luiza Flavia de; Aires, Talita S.F.; Bisneto, Jose Villasboas; Queirroz, Adriano; Santos, Andréia C.; Salgado, Katia; Reis, Mitermayer Galvão dos; Ko, Albert I.

doi:10.3201/eid1403.071064

Cited by 242 publications

(241 citation statements)

References 13 publications

(19 reference statements)

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“…Infection with serovar Icterohaemorrhagiae or Pomona is commonly associated with severe hepatic dysfunction, whereas serovar Canicola tends to cause acute interstitial nephritis (Wohl, 1996;Langston & Heuter, 2003). Although an association of specific genotypes and enhanced virulence has been suggested in human leptospirosis (Gouveia et al, 2008;Thaipadungpanit et al, 2007), differences in the virulence of Leptospira genotypes in canine leptospirosis remain unknown.…”

Section: Resultsmentioning

confidence: 99%

Multiple-locus variable-number tandem repeat analysis and clinical characterization of Leptospira interrogans canine isolates

Koizumi

Muto

Izumiya

et al. 2015

Journal of Medical Microbiology

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Canine leptospirosis occurs worldwide; however, information on the relationship between Leptospira serotypes/genotypes and virulence in dogs remains limited. We investigated the molecular characteristics of Leptospira interrogans canine isolates belonging to three serogroups using multiple-locus variable-number tandem repeat analysis (MLVA) and the effects of each serotype/genotype on the clinical characteristics of leptospirosis in dogs. MLVA using 11 loci of the three major L. interrogans serogroups in Japan, Australis (32 strains from 21 dogs), Autumnalis (12; 7) and Hebdomadis (66; 39), revealed more divergent genetic heterogeneity within each serogroup than multilocus sequence typing (MLST), and they formed two, three and five clusters (CLs), respectively. Lethal infections were caused by all Leptospira serogroup isolates (70.3 % with Hebdomadis, 83.3 % with Australis and 100 % with Autumnalis) or Leptospira isolates belonging to all the CLs (57.1-100 %) without any significant differences. A significant difference in hyperaemia and haemorrhage of mucus membrane was observed between serogroups Australis and Autumnalis (P50.03). Leptospira isolates of Australis CL2 caused no hyperaemia and haemorrhage from mucus membrane, whereas those of Australis CL1, Autumnalis CL3 and Hebdomadis CL1 and CL3 did (P,0.05). Significant differences in creatinine (Cre) levels were observed between serogroups Australis and Hebdomadis (P50.02). In addition, significant differences in blood urea nitrogen levels were observed between serogroups Australis and Hebdomadis (P50.004) and Australis and Autumnalis (P50.02). Based on MLVA types, a significant difference in Cre levels was observed between Hebdomadis CL1 and CL4 (P50.0018). Our results indicated that MLVA had a higher discriminatory power and was more concordant with serotyping than MLST. Although all Leptospira serotypes and genotypes caused lethal infections in dogs, the L. interrogans serogroup Australis strains were more likely to cause severe kidney damage than Autumnalis and Hebdomadis, which may be more critical to the outcome of infected dogs than haemorrhage. Our results also suggest that the virulence mechanisms and target organs in dogs may differ by Leptospira genotype.

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Section: Resultsmentioning

confidence: 99%

Multiple-locus variable-number tandem repeat analysis and clinical characterization of Leptospira interrogans canine isolates

Koizumi

Muto

Izumiya

et al. 2015

Journal of Medical Microbiology

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“…10 Previous studies shows that the main cause of mortality was acute renal failure, and this has changed in the last years, with pulmonary hemorrhagic complications becoming the most important cause of death in leptospirosis. 11,33 Death is also attributed to acute kidney injury in a significant number of cases. 11,12 Jauréguiberry et al 19 reported no deaths among 34 patients.…”

Section: Discussionmentioning

confidence: 99%

“…32 Pulmonary hemorrhage seems to be increasing among patients with leptospirosis, as suggested by a study performed in Salvador, Brazil. 33 This study identified 47 (10%) patients with severe pulmonary hemorrhagic syndrome (SPHS) among 474 patients with leptospirosis. Among the 47 SPHS case-patients, 7 (15%) and 20 (42%) had pulmonary hemorrhage and respiratory insufficiency, respectively, at the time of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary hemorrhage is reported in 40-86% of patients with leptospirosis. 33,34 The syndrome of diffuse alveolar hemorrhage, which is potentially lethal, consists of hemoptysis, bilateral airspace opacification on chest radiograph, and a decreased hematocrit secondary to bleeding from pulmonary microvasculature into the alveolar space. 35 Cardiac involvement is common in any form of leptospirosis.…”

Section: Discussionmentioning

confidence: 99%

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Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Daher¹,

Lima²,

Júnior³

et al. 2010

Braz J Infect Dis

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INTRODUCTION: leptospirosis is a zoonosis of worldwide importance. The disease is endemic in Brazil. This study was conducted to describe the clinical and laboratory presentation of leptospirosis in a metropolitan city of Brazil. METHODS: this is a retrospective study including 201 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil, between 1985 and 2006. All patients had clinical and epidemiological data suggestive of leptospirosis, and positive laboratorial test for leptospirosis (microscopic agglutination test, MAT, higher than 1:800). RESULTS: a total of 201 patients were included, with mean age of 38.9 ± 15.7 years; 79.1% were male. The mean length from onset of symptoms to admission was 7 ± 3 days. The main clinical signs and symptoms at admission were fever (96.5%), jaundice (94.5%), myalgia (92.5%), headache (74.6%), vomiting (71.6%) and dehydration (63.5%). Hemorrhagic manifestations were present in 35.8%. Acute kidney injury was found in 87% of the patients. Platelet count was less than 100,000/mm³ in 74.3%. Hematuria was found in 42.9%. Death occurred in 31 cases (15.4%). CONCLUSIONS: leptospirosis is a globally relevant disease with potential fatal outcome. Signs and symptoms suggestive of leptospirosis must be known by any physician in order to institute early adequate treatment to improve outcome. Early indication and daily hemodialysis seems to be beneficial in this group of patients

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“…Após a penetração, essas bactérias são capazes de disseminar-se pelo sistema linfático ou pela corrente sanguínea para múltiplos órgãos (Figura 2). No entanto, a evolução da doença é dependente de alguns fatores relacionados ao hospedeiro, como o estado imunológico e a idade, assim como de fatores _____________________________________________________________________Introdução 26 relacionados à própria bacteria, como o tipo de cepa e a dose infectante (CINCO, 2010;FAINE et al, 1999 COBURN, 2010;GOUVEIA et al, 2008;MAROTTO et al, 1999;SPICHLER et al, 2007;YANG, 2007 dias após o contato inicial com as leptospiras. Por isso, a busca por um método laboratorial mais rápido, fácil e preciso ainda é necessário, pois dessa forma poderá controlar de forma efetiva o agravamento da doença por proporcionar um tratamento inicial adequado (FAINE et al, 1999;GUERRA, 2013;LEVETT, 2001 LAURICHESSE et al, 2007;MARTINEZ et al, 2004;YAN et al, 2003;YANAGIHARA et al, 2007).…”

Section: Roraima Rio Grande Do Norte E Paraíba São Considerados Regiunclassified

Avaliação e caracterização de candidatos vacinais voltados para o controle da leptospirose.

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Leptospirosis-associated Severe Pulmonary Hemorrhagic Syndrome, Salvador, Brazil

Cited by 242 publications

References 13 publications

Multiple-locus variable-number tandem repeat analysis and clinical characterization of Leptospira interrogans canine isolates

Multiple-locus variable-number tandem repeat analysis and clinical characterization of Leptospira interrogans canine isolates

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Avaliação e caracterização de candidatos vacinais voltados para o controle da leptospirose.

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