Lung Lesions in Human Leptospirosis: Microscopic, Immunohistochemical, and Ultrastructural Features Related to Thrombocytopenia

Nicodemo, Antônio Carlos; Duarte, Maria Irma Seixas; Alves, Venâncio Avancini Ferreira; Takakura, C F H; Santos, R. T. M.; Nicodemo, Elisabeth Lima

doi:10.4269/ajtmh.1997.56.181

Cited by 146 publications

(134 citation statements)

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“…PH concomitant with jaundice or renal failure has been reported (BOUR-DAIS et al, 1988;NICODEMO et al, 1997). However, TREVEJO et al (1998) reported recently that death in epidemic leptospirosis with PH in Nicaragua occurred without any jaundice and without renal manifestations; no laboratory data or necropsy findings were given to assess the degree of hepatic and/or renal involvement in this patient series.…”

Section: Discussionmentioning

confidence: 84%

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Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

Yersin

Bovet

Mérien

et al. 2000

Transactions of the Royal Society of Tropical Medicine and Hygi

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We examined the cause of death during a 12-month period (1995196) in all consecutive patients admitted to hospital with leptospiral infection in Seychelles (Indian Ocean), where the disease is endemic. Leptospirosis was diagnosed by use of the microscopic agglutination test and a specific polymerase chain reaction assay on serum samples. Seventy-five cases were diagnosed and 6 patients died, a case fatality of 8%. All 6 patients died within 9 days of onset of symptoms and within 2 days of admission for 5 of them (5 days for the 6th). On autopsy, diffuse bilateral pulmonary haemorrhage (PH) was found in all fatalities. Renal, cardiac, digestive and cerebral haemorrhages were also found in 5,3,3 and 1 case(s), respectively. Incidentally, haemoptysis and lung infiltrate on chest radiographs, which suggest PH, were found in 8 of the 69 non-fatal cases. Dengue and hantavirus infections were ruled out. In conclusion, PH appeared to be a main cause of death in leptospirosis in this population, although haemorrhage in other organs may also have contributed to fatal outcomes. This cause of death contrasts with the findings generally reported in endemic settings.

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Section: Discussionmentioning

confidence: 84%

“…Coagulation disturbances have been postulated but not conclusively demonstrated (EDWARDS et al, 1986). Low platelet count, a common finding in leptospiral infection (EDWARDS etal., 1982;NICODEMO et al. 1997).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

Yersin

Bovet

Mérien

et al. 2000

Transactions of the Royal Society of Tropical Medicine and Hygi

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“…Hyaline membrane formation may occur, characterizing a picture of diffuse alveolar damage [14,32,36] (Figures 3 and 4). Leptospires may be seen within endothelial cells in interalveolar septa, and attached to capillary endothelial cells [37].…”

Section: Histological Findings and Pathophysiology In Human Pulmonarymentioning

confidence: 99%

“…Various mechanisms could be implicated in platelet activation, such as mechanisms related to endothelial cells, and action of bacterial endotoxins. Lipopolysacharides and cytokines could also stimulate endothelial cells and alter their equilibrium to a pro-coagulant state [37].…”

Section: Histological Findings and Pathophysiology In Human Pulmonarymentioning

confidence: 99%

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Dolhnikoff¹,

Mauad²,

Bethlem³

et al. 2007

Braz J Infect Dis

119

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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“…Essa patogênese ganha força quando lembramos que leptospiras possuem lipopolissacaríde-os reconhecidamente capazes de funcionar como endotoxinas (Vinh et al 1986, Estavoyer et al 1991, Souza & Koury 1992, Dobrina et al 1995, Lee et al 2002 e embora ainda não seja comprovada, é suspeitada há décadas tanto para cães (Green et al 1964, Keenan et al 1978, quanto para humanos (Brito 1968) e cobaios (Faine 1957). Ultra-estruturalmente, danos às células endoteliais do pulmão de humanos também foram descritos (Nicodemo et al 1997), e mais recentemente (Croda et al 2010), uma base imunomediada foi proposta.…”

Section: Discussionunclassified

Aspectos anatomopatológicos da leptospirose em cães: 53 casos (1965-2011)

et al. 2012

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Os aspectos anatomopatológicos da leptospirose foram estudados em 53 cães que tiveram diagnóstico definitivo confirmado por imuno-histoquímica do tecido renal. Na necropsia, as principais lesões observadas incluíram icterícia (79,2%) e hemorragia (75,5%), principalmente no pulmão (56,6%). Alterações macroscópicas hepáticas (56,6%) e renais (50,9%) foram frequentes e caracterizavam-se principalmente por descolorações (30,2% e 32,1% respectivamente), acentuação do padrão lobular hepático (26,4%) e estriações brancas na superfície de corte dos rins (22,6%). Lesões extrarrenais de uremia ocorreram na metade dos casos (50,9%). Hepatomegalia (11,3%), nefromegalia (9,4%) e irregularidade da superfície capsular dos rins (3,8%) foram menos comuns. Na histologia dos rins (n=53), as lesões encontradas (98,1%) foram quase que exclusivamente agudas ou subagudas (96,2%) e caracterizavam-se por graus variados de nefrose tubular (86,8%) e nefrite intersticial não supurativa (60,4%), com evidente dissociação degenerativo-inflamatória. Na histologia do fígado (n=42), as lesões encontradas (97,6%) eram constituídas principalmente por dissociação dos cordões de hepatócitos (78,6%), colestase intra-canalicular (33,3%) e necrose hepática (31%). Lesões reativas, como hipertrofia das células de Kupffer, leucocitostase sinusoidal e infiltrado inflamatório mononuclear nos espaços porta, foram vistas em muitos casos (42,8%). Na histologia do pulmão (n=28), hemorragia (85,7%) e edema (57,1%) alveolares foram muito prevalentes. Neutrófilos e macrófagos nos espaços alveolares (35,7%) e neutrófilos no interior de pequenos vasos pulmonares (17,9%) também foram achados frequentes. Os resultados aqui demonstrados devem servir de alerta aos patologistas veterinários brasileiros, pois a apresentação anatomopatológica da leptospirose canina em nossa região (Região Central do Rio Grande do Sul, Brasil) não se modificou nos últimos 50 anos, mantendo-se semelhante àquela descrita internacionalmente até a década de 1980, mas muito diferente do que é atualmente reconhecido para os Estados Unidos, o Canadá e parte da Europa Ocidental. Recomendamos que os critérios histopatológicos para o diagnóstico da leptospirose canina devem incluir a presença concomitante de nefrite tubulointersticial aguda ou subaguda, hepatite reativa não específica e lesão alveolar difusa, incluindo hemorragia alveolar difusa com capilarite, em um cão que durante a necropsia demonstre icterícia, hemorragias e lesões extrarrenais de uremia na ausência de esplenomegalia.

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Lung Lesions in Human Leptospirosis: Microscopic, Immunohistochemical, and Ultrastructural Features Related to Thrombocytopenia

Cited by 146 publications

References 0 publications

Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Aspectos anatomopatológicos da leptospirose em cães: 53 casos (1965-2011)

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