Lethal Leptospiral Pulmonary Hemorrhage: An Emerging Disease in Buenos Aires, Argentina

Seijo, Alfredo; H, Coto; Juan, Jorge San; Videla, Juan; Deodato, Bettina; Cernigoi, Beatriz; Messina, Oscar García; Collia, Oscar; Bassadoni, Diana de; Schtirbu, Ricardo; Olenchuk, A; Mazzonelli, G. Dorta de; Parma, A

doi:10.3201/eid0809.010499

Cited by 52 publications

(31 citation statements)

References 5 publications

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“…Four patients died with suspected leptospirosis, three of them with confirmed diagnosis. Two of these patients died due to pulmonary hemorrhage, characterizing the first report of this clinical form of presentation in the metropolitan area of Buenos Aires [26].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Dolhnikoff¹,

Mauad²,

Bethlem³

et al. 2007

Braz J Infect Dis

121

102

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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.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Dolhnikoff¹,

Mauad²,

Bethlem³

et al. 2007

Braz J Infect Dis

121

102

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“…Emergence of serovars is attributed to introduction of new hosts in an area, adaptation to these hosts, and local ecological changes [7]. As clinical diagnosis is difficult, early laboratory diagnosis of leptospirosis is important [8]. Isolation of leptospires is time consuming and has low sensitivity.…”

Section: Introductionmentioning

confidence: 99%

Serovar prevalence of Leptospira in semirural India and the development of an IgM-based indirect ELISA

Chandy

Lokeshwaran

Hemavathy

et al. 2017

J Infect Dev Ctries

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Introduction: Leptospirosis is a major public health problem in India. However, it has been underreported and under-diagnosed due to a lack of awareness of the disease, a functional surveillance system, and appropriate laboratory diagnostic facilities. Methodology: This multicenter study aimed to understand the Leptospira serovars causing leptospirosis in seven secondary-level hospitals in six states in India. Since early and accurate diagnosis of leptospirosis is one of the challenges faced by clinicians in India due to the poor specificity and sensitivity of commercially available diagnostic systems, an in-house indirect enzyme-linked immunosorbent assay (ELISA) was developed. Genomic DNA from L. interrogans serovar Canicola was used for polymerase chain reaction amplification, cloning, and expression of the lipL32 gene in E. coli to amplify, clone, and express the lipL32 gene. Results: Australis was the common serovar seen at all the study centers. Serovar Icterohaemorrhagiae was seen in samples from Tamil Nadu and Assam. In-house ELISA was standardized using the purified recombinant LipL32 polypeptide and was used to evaluate serum. Subsequently, acute serum samples from leptospirosis patients (n = 60) were screened. Compared to the gold standard, the microscopic agglutination test, sensitivity and specificity of the in-house ELISA was 95% and 90%, respectively. Conclusions: Understanding Leptospira serovars circulating in leptospirosis-endemic areas will help to formulate better vaccines. LipL32-based ELISA may serve as a valuable tool for early diagnosis of leptospirosis.

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“…Recent reviews of human leptospirosis have highlighted the significance of pulmonary involvement. 1,2 It is clear that the severe pulmonary form of leptospirosis (SPFL) 6 may occur as distinct outbreaks, 5,14 in which a high percentage of cases are marked by pulmonary hemorrhage or as sporadic cases, 2,6,7 while in other instances, outbreaks of leptospirosis occur in which pulmonary involvement is not striking. 18 It is not known what factors influence the relative virulence and spectrum of clinical manifestations seen in human leptospirosis.…”

mentioning

confidence: 99%

“…1,2 The purpose of this study was to address the etiology and pathogenesis of the hemorrhagic diathesis seen in leptospirosis, and in particular, in the severe pulmonary form of the disease. [3][4][5][6][7] The hemorrhagic potential of leptospirosis has been noted since the first description of the features of severe human infection by Weil in 1886. 8 When the causative spirochete was first cultivated in 1916 by Inada, he accordingly named it "spirocheta icterohaemorrhagiae."…”

mentioning

confidence: 99%

Alveolar Septal Deposition of Immunoglobulin and Complement Parallels Pulmonary Hemorrhage in a Guinea Pig Model of Severe Pulmonary Leptospirosis

Nally¹,

Chantranuwat²,

Wu³

et al. 2004

The American Journal of Pathology

182

185

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Human patients suffering from leptospirosis present with a diverse array of clinical manifestations, including the more severe and often fatal pulmonary form of the disease. The etiology of pulmonary hemorrhage is unclear. Isolates of Leptospira acquired from patients suffering from pulmonary hemorrhage were used to develop a guinea pig model of pulmonary hemorrhage. Gross findings post-infection confirmed extensive hemorrhage in the lungs and on peritoneal surfaces as the likely cause of death. Immunohistochemistry confirmed the presence of large numbers of leptospires in kidney, liver, intestinal tissues, and spleen, but few inflammatory cells were seen. In marked contrast, few leptospires were detected in infected hemorrhagic lung tissue. Blood chemistries and hematology did not reveal the etiology of the hemorrhage observed. There was no chemical or microscopic evidence for disseminated intravascular coagulation. To ascertain an immunopathologic role during disease, immunofluorescence was performed on infected lung tissues and confirmed the presence of IgM, IgG, IgA, and C3 along the alveolar basement membrane. This suggests that an autoimmune process may be the etiology of fatal pulmonary hemorrhage in lep-

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Lethal Leptospiral Pulmonary Hemorrhage: An Emerging Disease in Buenos Aires, Argentina

Cited by 52 publications

References 5 publications

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Serovar prevalence of Leptospira in semirural India and the development of an IgM-based indirect ELISA

Alveolar Septal Deposition of Immunoglobulin and Complement Parallels Pulmonary Hemorrhage in a Guinea Pig Model of Severe Pulmonary Leptospirosis

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