Leptospirosis manifested with severe pulmonary haemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation

Chaikajornwat, Jukkaphop; Rattanajiajaroen, Pornpan; Srisawat, Nattachai; Kawkitinarong, Kamon

doi:10.1136/bcr-2019-230075

Cited by 12 publications

(9 citation statements)

References 35 publications

(42 reference statements)

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“…Plasmapheresis and IV methylprednisolone was used in some of the cases as an immunomodulator with questionable benefit. 8 , 10 In all cases, ECMO was used as the last resort of rescue measures and was found to have high survival benefits. 11 – 14 Veno-venous form was used as the predominant ECMO modality.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Severe Pulmonary Forms of Leptospirosis: A Report of Two Cases

Sen¹,

Goyal²,

Lokhande³

2022

Indian Journal of Critical Care Medicine

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A bstract Pulmonary involvement in leptospirosis is common. Severe pulmonary forms of leptospirosis (SPFL) carry high mortality. We report two cases of an otherwise healthy adult male from the western suburbs of India, admitted with severe pulmonary hemorrhage with extremely poor oxygenation. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was used as the last-rescue life-saving measure. Both the patients showed good pulmonary recovery within 2 weeks. Despite having thrombocytopenia, we experienced lesser bleeding complications requiring transfusions during the extracorporeal membrane oxygenation (ECMO) period. How to cite this article Sen S, Goyal A, Lokhande V. Extracorporeal Membrane Oxygenation in Severe Pulmonary Forms of Leptospirosis: A Report of Two Cases. Indian J Crit Care Med 2022;26(8):966–969.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Severe Pulmonary Forms of Leptospirosis: A Report of Two Cases

Sen¹,

Goyal²,

Lokhande³

2022

Indian Journal of Critical Care Medicine

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“…It can detect Leptospira DNA in specimens quickly and accurately during the early stage of the infection. 21,22 Fifteen other reports [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] have described different diagnostic methods for severe leptospirosis requiring extracorporeal membrane oxygenation. As shown in Table 2, PCR, the MAT, ELISA, and NGS can be used to diagnose severe leptospirosis early.…”

Section: Discussionmentioning

confidence: 99%

Leptospirosis with pulmonary haemorrhage and multiple organ failure: a case report and literature review

Dong

Chen

2021

J Int Med Res

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Pulmonary haemorrhage is an important complication of leptospirosis. We herein report an uncommon case of severe pulmonary haemorrhage and multiple organ failure caused by leptospirosis in a 49-year-old man who was previously healthy. He was a farm worker who was admitted to the hospital because of haemoptysis. He had worked in a paddy field 4 days prior to admission. Chest computed tomography revealed pulmonary haemorrhage, which rapidly deteriorated into haemorrhagic shock and multiple organ failure. Based on the patient’s possible history of contact with contaminated water and the DNA sequence of Leptospira detected in his bronchoalveolar lavage fluid, the patient was diagnosed with pulmonary haemorrhagic leptospirosis. Despite the administration of a fluid bolus, norepinephrine, broad-spectrum antibiotics, and haemostatics, and even with administration of a blood transfusion and extracorporeal life support, the pulmonary haemorrhage could not be controlled effectively. The patient eventually died of haemorrhagic shock. Leptospirosis can be a life-threatening disease despite aggressive treatment, even with extracorporeal life support. Next-generation sequencing can provide important diagnostic clues for patients with atypical leptospirotic symptoms.

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“…The use of corticosteroid and desmopressin in cases with pulmonary involvement did not demonstrate survival benefit 45 . The recommendations for AKI include a high dose of RRT, conservative fluid intake and minimization of lung injury with the use of a ventilator or extracorporeal membrane oxygenation support along with hemoperfusion when indicated 46–48 …”

Section: Tropical Infectionmentioning

confidence: 99%

Acute kidney injury in the tropics

et al. 2022

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The tropics are a region consisting of more than 125 countries, accounting for 40% of the world's population. The region's population is expected to increase up to 60% in the coming decades. Many tropical countries continue to experience public health problems such as high rates of infectious diseases, lack of sanitation, climate change impacts, poor regulation of herbal medicines and low access to healthcare. These conditions produce the unique problem of tropical acute kidney injury (AKI), which is associated with high morbidity and mortality. Tropical infections such as leptospirosis, dengue and malaria have varied mechanisms of AKI, including both direct kidney invasion and indirect effects, depending on the disease characteristics. Animal toxins from snakebites and arthropods along with plant toxins, such as djenkol beans, starfruit and herbal medicine, are characterized by a harmful renal effect from each toxic substance. Environmental factors such as heat stress, natural disasters and chemical compounds also lead to AKI and have a systemic effect from their own pathogenesis. The long‐term kidney prognosis varies among these etiologies depending on the cause and severity of disease. However, all these conditions are potentially preventable and treatable. Prompt management and good preventive approaches are needed. This article will focus on the epidemiology, pathogenesis and management of AKI associated with tropical infections, toxins and environment impacts.

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Leptospirosis manifested with severe pulmonary haemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation

Cited by 12 publications

References 35 publications

Extracorporeal Membrane Oxygenation in Severe Pulmonary Forms of Leptospirosis: A Report of Two Cases

Extracorporeal Membrane Oxygenation in Severe Pulmonary Forms of Leptospirosis: A Report of Two Cases

Leptospirosis with pulmonary haemorrhage and multiple organ failure: a case report and literature review

Acute kidney injury in the tropics

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