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Clinical and Imaging Manifestations of Hemorrhagic Pulmonary Leptospirosis: A State-of-the-Art Review

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Abstract

Leptospirosis, a spirochetal zoonosis, is frequently unrecognized due to its manifestation as an undifferentiated fever. It is an emerging infectious disease that has changed from an occupational disease of veterinarians, farmers, butchers, and other animal handlers to a cause of epidemics in poor and decayed urban communities in developing countries. Humans are infected when mucous membranes or abraded skin come into direct contact with the urine of infected animals, especially rats and dogs. Mortality from severe leptospirosis is high, even when optimal treatment is provided. The diagnosis of leptospirosis is based on clinical findings, history of direct or indirect exposure to infected animals in endemic areas, and positive serological tests. It should be considered in the differential diagnosis of patients with febrile illnesses associated with pneumonitis and respiratory failure, especially when hemoptysis is present. Severe pulmonary involvement in leptospirosis consists primarily of hemorrhagic pneumonitis. In advanced cases, adult respiratory distress syndrome and massive pulmonary hemorrhage may occur. Chest radiographs show bilateral alveolar infiltrates and/or resemble viral pneumonia, bronchopneumonia, tuberculosis, adult respiratory distress syndrome, and other causes of pulmonary hemorrhage such as Goodpasture syndrome. High-resolution computed tomography scans may show nodular infiltrates, areas of consolidation, ground-glass attenuation, and crazy-paving patterns. Bronchoalveolar lavage and autopsy studies have suggested that ground-glass opacities and air-space consolidations are secondary to pulmonary hemorrhage. Although not specific, the presence of these computed tomography findings in a febrile patient with an appropriate history should suggest a diagnosis of leptospirosis.

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References

  1. Sharma KK, Kalawat U (2008) Early diagnosis of leptospirosis by conventional methods: one-year prospective study. Indian J Pathol Microbiol 51:209–211

    Article  PubMed  Google Scholar 

  2. Charon NW, Goldstein SF (2002) Genetics of motility and chemotaxis of a fascinating group of bacteria: the spirochetes. Annu Rev Genet 36:47–73

    Article  CAS  PubMed  Google Scholar 

  3. Wang Z, Jin L, Wegrzyn A (2007) Leptospirosis vaccines. Microb Cell Fact 6:39

    Article  PubMed  Google Scholar 

  4. Herrmann-Storck C, Saint-Louis M, Foucand T, Lamaury I, Deloumeaux J, Baranton G, Simonetti M, Sertour N, Nicolas M, Salin J, Cornet M (2010) Severe leptospirosis in hospitalized patients, Guadeloupe. Emerg Infect Dis 16:331–334

    PubMed  Google Scholar 

  5. Dupont H, Dupont-Perdrizet D, Perie JL, Zehner-Hansen S, Jarrige B, Daijardin JB (1997) Leptospirosis: prognostic factors associated with mortality. Clin Infect Dis 25:720–724

    Article  CAS  PubMed  Google Scholar 

  6. Brown K, Prescott J (2008) Leptospirosis in the family dog: a public health perspective. CMAJ 178:399–401

    Article  PubMed  Google Scholar 

  7. Luchini D, Meacci F, Oggioni MR, Morabito G, D’Amato V, Gabbrielli M, Pozzi G (2008) Molecular detection of Leptospira interrogans in human tissues and environmental samples in a lethal case of leptospirosis. Int J Legal Med 122:229–233

    Article  CAS  PubMed  Google Scholar 

  8. Im JG, Yeon KM, Han MC, Kim CW, Webb WR, Lee JS, Han YC, Chang WH, Chi JG (1989) Leptospirosis of the lung: radiographic findings in 58 patients. AJR Am J Roentgenol 152:955–959

    CAS  PubMed  Google Scholar 

  9. Dolhnikoff M, Mauad T, Bethlem EP, Carvalho CRR (2007) Pathology and pathophysiology of pulmonary manifestations in leptospirosis. Braz J Infect Dis 11:142–148

    Article  PubMed  Google Scholar 

  10. McBride AJA, Athanazio DA, Reis MG, Ko AI (2005) Leptospirosis. Curr Opin Infect Dis 18:376–386

    Article  PubMed  Google Scholar 

  11. Trevejo RT, Rigau-Perez JG, Ashford DA, McClure EM, Jarquin-Gonzalez C, Amador JJ, Reyes JO, Gonzalez A, Zaki SR, Shieh WJ, McLean RG, Nasci RS, Weyant RS, Bolin CA, Bragg SL, Perkings BA, Spiegel RA (1998) Epidemic leptospirosis associated with pulmonary hemorrhage—Nicaragua, 1995. J Infect Dis 178:1457–1463

    Article  CAS  PubMed  Google Scholar 

  12. Paganin F, Bourdin A, Dalban C, Courtin JP, Poubeau P, Borgherini G, Michault A, Sally JC, Tixier F, Genin R, Arvin-Berod C (2007) Leptospirosis in Reunion Island (Indian Ocean): analysis of factors associated with severity in 147 confirmed cases. Intensive Care Med 33:1959–1966

    Article  CAS  PubMed  Google Scholar 

  13. Vieira SRR, Brauner JS (2002) Leptospirosis as a cause of acute respiratory failure: clinical features and outcome in 35 critical care patients. Braz J Infect Dis 6:135–139

    Article  PubMed  Google Scholar 

  14. Abgueguen P, Delbos V, Blanvillain J, Chennebault JM, Cottin J, Fanello S, Pichard E (2008) Clinical aspects and prognostic factors of leptospirosis in adults. Retrospective study in France. J Infect 57:171–178

    Article  PubMed  Google Scholar 

  15. Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, Banga SS, Sharma M (2010) Increasing trends of leptospirosis in northern India: a clinicoepidemiological study. PLoS Negl Trop Dis 4:e579

    Article  PubMed  Google Scholar 

  16. Lacerda HG, Monteiro GR, Oliveira CCC, Suassuna FB, Queiroz JW, Barbosa JDA, Martins DR, Reis MG, Ko AI, Jerônimo SMB (2008) Leptospirosis in a subsistence farming community in Brazil. Trans R Soc Trop Med Hyg 102:1233–1238

    Article  PubMed  Google Scholar 

  17. Zavala-Velazquez J, Cárdenas-Marrufo M, Vado-Solís I, Cetina-Cámara M, Cano-Tur J, Laviada-Molina H (2008) Hemorrhagic pulmonary leptospirosis: three cases from the Yucatan peninsula, Mexico. Rev Soc Bras Med Trop 41:404–408

    Article  PubMed  Google Scholar 

  18. Plank R, Dean D (2000) Overview of the epidemiology, microbiology, and pathogenesis of Leptospira spp. in humans. Microbes Infect 2:1265–1276

    Article  CAS  PubMed  Google Scholar 

  19. Houpikian P, Perolat P, Baranton G, Brouqui P (2002) Leptospiroses. Encycl Méd Chir, Maladies Infectieuses, 8-039-Q-10

  20. Dassanayake DL, Wimalaratna H, Agampodi SB, Liyanapathirana VC, Piyarathna TA, Goonapienuwala BL (2009) Evaluation of surveillance case definition in the diagnosis of leptospirosis, using the microscopic agglutination test: a validation study. BMC Infect Dis 9:48

    Article  PubMed  Google Scholar 

  21. Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM (2003) Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 3:757–771

    Article  PubMed  Google Scholar 

  22. Levett PN, Haake DA (2010) Leptospira species (Leptospirosis). In: Mandell GL, Bennett JE, Dolin R (eds) Mandell, Douglas and Bennett’s principles and practice of infectious diseases, 7th edn. Churchill-Livingstone, Philadelphia

    Google Scholar 

  23. Simpson FG, Green KA, Haug GJ, Brookes DL (1998) Leptospirosis associated with severe pulmonary haemorrhage in Far North Queensland. Med J Aust 169:151–153

    CAS  PubMed  Google Scholar 

  24. Croda J, Neto AN, Brasil RA, Pagliari C, Nicodemo AC, Duarte MI (2010) Leptospirosis pulmonary haemorrhage syndrome is associated with linear deposition of immunoglobulin and complement on the alveolar surface. Clin Microbiol Infect 16:593–599

    CAS  PubMed  Google Scholar 

  25. Lomar AV, Diament D, Torres JR (2000) Leptospirosis in Latin America. Infect Dis Clin North Am 14:23–39

    Article  CAS  PubMed  Google Scholar 

  26. Chakurkar G, Vaideeswar P, Pandit SP, Divate SA (2008) Cardiovascular lesions in leptospirosis: an autopsy study. J Infect 56:197–203

    PubMed  Google Scholar 

  27. Kurtoglu MG, Tuncer O, Bozkurt H, Caksen H, Berktas M, Ceylan E, Kirimi E (2003) Report of three children with leptospirosis in rural area of the east of Turkey. Tohoku J Exp Med 201:55–60

    Article  PubMed  Google Scholar 

  28. Silva AA, Ducroquet M, Pedrozo JC Jr (2009) Bilateral facial palsy associated with leptospirosis. Braz J Infect Dis 13:319–321

    PubMed  Google Scholar 

  29. Daher EdeF, Brunetta DM, de Silva Junior GB, Puster RA, Patrocinio RM (2003) Pancreatic involvement in fatal human leptospirosis: clinical and histopathological features. Rev Inst Med Trop Sao Paulo 45:307–313

    Google Scholar 

  30. Marotto PC, Marotto MS, Santos DL, Souza TN, Seguro AC (1997) Outcome of leptospirosis in children. Am J Trop Med Hyg 56:307–310

    CAS  PubMed  Google Scholar 

  31. Trivedi SV, Vasava AH, Patel TC, Bhatia LC (2009) Cyclophosphamide in pulmonary alveolar hemorrhage due to leptospirosis. Indian J Crit Care Med 13:79–84

    Article  PubMed  Google Scholar 

  32. Marotto PC, Ko AI, Murta-Nascimento C, Seguro AC, Prado RR, Barbosa MC, Cleto SA, Eluf-Neto J (2010) Early identification of leptospirosis-associated pulmonary hemorrhage syndrome by use of a validated prediction model. J Infect 60:218–223

    Article  PubMed  Google Scholar 

  33. Silva JJ, Dalston MO, Carvalho JE, Setubal S, Oliveira JM, Pereira MM (2002) Clinicopathological and immunohistochemical features of the severe pulmonary form of leptospirosis. Rev Soc Bras Med Trop 35:395–399

    PubMed  Google Scholar 

  34. Suputtamongkol Y, Pongtavornpinyo W, Lubell Y, Suttinont C, Hoontrakul S, Phimda K, Losuwanaluk K, Suwancharoen D, Silpasakorn S, Chierakul W, Day N (2010) Strategies for diagnosis and treatment of suspected leptospirosis: a cost-benefit analysis. PLoS Negl Trop Dis 4:e610

    Article  PubMed  Google Scholar 

  35. Srinivas R, Agarwal R, Gupta D (2007) Severe sepsis due to severe falciparum malaria and leptospirosis co-infection treated with activated protein C. Malar J 6:42

    Article  PubMed  Google Scholar 

  36. Spichler A, Moock M, Chapola EG, Vinetz J (2005) Weil’s disease: an unusually fulminant presentation characterized by pulmonary hemorrhage and shock. Braz J Infect Dis 9:336–340

    Article  CAS  PubMed  Google Scholar 

  37. Park SK, Lee SH, Rhee YK, Kang SK, Kim KJ, Kim MC, Kim KW, Chang WH (1989) Leptospirosis in Chonbuk Province of Korea in 1987: a study of 93 patients. Am J Trop Med Hyg 41:345–351

    CAS  PubMed  Google Scholar 

  38. Cerqueira TB, Athanazio DA, Spichler AS, Seguro AC (2008) Renal involvement in leptospirosis—new insights into pathophysiology and treatment. Braz J Infect Dis 12:248–252

    Article  PubMed  Google Scholar 

  39. Costa E, Lopes AA, Sacramento E, Costa YA, Matos ED, Lopes MB, Bina JC (2003) Penicillin at the late stage of leptospirosis: a randomized controlled trial. Rev Inst Med Trop Sao Paulo 45:141–145

    PubMed  Google Scholar 

  40. Niwattayakul K, Kaewtasi S, Chueasuwanchai S, Hoontrakul S, Chareonwat S, Suttinont C, Phimda K, Chierakul W, Silpasakorn S, Suputtamongkol Y (2009) An open randomized controlled trial of desmopressin and pulse dexamethasone as adjunct therapy in patients with pulmonary involvement associated with severe leptospirosis. Clin Microbiol Infect 16:1207–1212

    Article  PubMed  Google Scholar 

  41. Tatopoulos A, Herbain D, Kazmierczak C, Bollaert PE, Gibot S (2010) Parenteral use of recombinant activated factor VII during diffuse alveolar hemorrhage secondary to leptospirosis. Intensive Care Med 36:555–556

    Article  PubMed  Google Scholar 

  42. Teglia OF, Battagliotti C, Villavicencio RL, Cunha BA (1995) Leptospiral pneumonia. Chest 108:874–875

    Article  CAS  PubMed  Google Scholar 

  43. Daher E, Zanetta DM, Cavalcante MB, Abdulkader RC (1999) Risk factors for death and changing patterns in leptospirosis acute renal failure. Am J Trop Med Hyg 61:630–644

    CAS  PubMed  Google Scholar 

  44. Medeiros FdaR, Spichler A, Athanazio DA (2010) Leptospirosis-associated disturbances of blood vessels, lungs and hemostasis. Acta Trop 115:155–162

    Article  Google Scholar 

  45. Nicodemo AC, Duarte MI, Alves VA, Takakura CF, Santos RT, Nicodemo EL (1997) Lung lesions in human leptospirosis: microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia. Am J Trop Med Hyg 56:181–187

    CAS  PubMed  Google Scholar 

  46. Yang HL, Jiang XC, Zhang XY, Li WJ, Hu BY, Zhao GP, Guo XK (2006) Thrombocytopenia in the experimental leptospirosis of guinea pig is not related to disseminated intravascular coagulation. BMC Infect Dis 6:19

    Article  PubMed  Google Scholar 

  47. Nally JE, Chantranuwat C, Wu XY, Fishbein MC, Pereira MM, Silva JJ, Blanco DR, Lovett MA (2004) Alveolar septal deposition of immunoglobulin and complement parallels pulmonary hemorrhage in a guinea pig model of severe pulmonary leptospirosis. Am J Pathol 164:1115–1127

    Article  PubMed  Google Scholar 

  48. Arean VM (1962) The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil’s disease). Am J Pathol 40:393–423

    CAS  PubMed  Google Scholar 

  49. Matos ED, Costa E, Sacramento E, Caymmi AL, Neto CA, Barreto Lopes M, Lopes AA (2001) Chest radiograph abnormalities in patients hospitalized with leptospirosis in the city of Salvador, Bahia, Brazil. Braz J Infect Dis 5:73–77

    Article  CAS  PubMed  Google Scholar 

  50. Marchiori E, Muller NL (2002) Leptospirosis of the lung: high-resolution computed tomography findings in five patients. J Thorac Imaging 17:151–153

    Article  PubMed  Google Scholar 

  51. Marchiori E, Gasparetto TD, Escuissato DL, Zanetti G (2008) Leptospirosis of the lung presenting with crazy-paving pattern: high-resolution ct and pathological findings. Rev Port Pneumol 14:887–891

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Fluminense Federal University, Rua Thomaz Cameron, 438 Valparaiso, CEP 25685.120, Petrópolis, Rio de Janeiro, Brazil

    Edson Marchiori, Sílvia Lourenço & Taisa Davaus Gasparetto

  2. Department of Clinical Medicine, Fluminense Federal University, Rio de Janeiro, Brazil

    Sérgio Setúbal

  3. Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Gláucia Zanetti & Bruno Hochhegger

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  1. Edson Marchiori
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  2. Sílvia Lourenço
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  3. Sérgio Setúbal
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  4. Gláucia Zanetti
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  5. Taisa Davaus Gasparetto
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  6. Bruno Hochhegger
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Correspondence to Edson Marchiori.

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Marchiori, E., Lourenço, S., Setúbal, S. et al. Clinical and Imaging Manifestations of Hemorrhagic Pulmonary Leptospirosis: A State-of-the-Art Review. Lung 189, 1–9 (2011). https://doi.org/10.1007/s00408-010-9273-0

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  • DOI: https://doi.org/10.1007/s00408-010-9273-0

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