Severe pulmonary haemorrhage accompanying hepatorenal failure in fulminant leptospirosis

Abstract

Leptospirosis is a re-emerging spirochetal zoonosis with a worldwide distribution affecting both animals and humans. The clinical syndromes may vary from a subclinical infection to a severe illness. Although it may potentially have a fulminant and fatal course, leptospirosis usually remains as an underdiagnosed cause of multiorgan failure. In this study, we report a patient with leptospirosis who presented with a fulminant course of diffuse alveolar haemorrhage and hepatorenal failure. His clinical condition deteriorated, despite appropriate antibiotic therapy and haemodialysis. However, he showed prompt clinical improvement when corticosteroids and plasma exchange were instituted in addition to the original therapy. We conclude that leptospirosis should be considered in any case presenting with pulmonary haemorrhage and hepatorenal failure. Plasma exchange and corticosteroids may be a choice of treatment in selected patients unresponsive to conventional therapy. Potential benefits of plasma exchange and corticosteroids may be based on a toxin- and/or cytokine-mediated pathogenesis of the disease.

Specific CD4+T-Cell Reactivity and Cytokine Release in Different Clinical Presentations of Leptospirosis

“…Furthermore, cytokine production must be much more prominent to be detected by serum analysis than by direct intracellular analysis of cytokines produced by CD4 ϩ T cells. Consistent with the idea of an association between, first, an overwhelming inflammatory reaction and cytokine release and, second, disease severity, case reports of severe leptospirosis have been published which hint that glucocorticosteroid therapy may have a positive effect on the course of disease (29,30). One of our patients among those severely ill with pulmonary hemorrhages was also successfully treated with glucocorticosteroids to ameliorate an extensive immune reaction.…”

Fulminant Leptospirosis (Weil's disease) in an urban setting as an overlooked cause of multiorgan failure: a case report

“…In the current case, the improvement of the patient's renal dysfunction, thrombocytopenia and hemoptysis may be attributed to the introduction of steroids. Several case reports have described the beneficial effects of glucocorticoids in severe leptospirosis with pulmonary hemorrhage [8], thrombocytopenia [9] and renal failure [10,11]. …”

Application of pulsed-field gel electrophoresis for the discrimination of leptospiral isolates in Brazil

“…Leptospirosis, a zoonotic infection caused by pathogenic members of the genus Leptospira, is most common in tropical regions where incidence peaks during the rainy season (Levett 2001;Palaniappan et al 2007). The symptoms of leptospirosis are extremely broad, ranging from mild symptoms to meningitis, jaundice, renal failure and haemorrhage, and can lead to mortality and morbidity (Ko et al 1999;Faine et al 1999;Romero et al 2003;Dursun et al 2007;DallÁ ntonia et al 2008;Gouveia et al 2008). Some symptoms can mimic other tropical diseases such as dengue fever and malaria.…”