Severe Leptospirosis with Multiple Organ Failure Successfully Treated by Plasma Exchange and High-Volume Hemofiltration

Bourquin, Vincent; Ponte, Belén; Hirschel, Bernard; Pugin, Jérôme; Martin, Pierre‐Yves; Saudan, Patrick

doi:10.1155/2011/817414

Cited by 16 publications

(21 citation statements)

References 9 publications

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“…The aim of plasmapheresis and CVVHF in leptospirosis is removal of endotoxins and inflammatory mediators as in sepsis. 8 We interestingly observed that the fever decreased dramatically when we used endotoxin-cytokine cleaning filter (Oxiris ® , Gambro Lundia AB, Sweden) for hemofiltration, whereas, the fever was persisted when we used standard hemofilter (HF1000, Gambro Lundia AB, Sweden). In recent years endotoxin cytokinecleaning filters (Oxiris ® , Gambro Lundia AB, Sweden) have been successfully used to capture increasing endotoxins and cytokines due to sepsis and systemic inflammation response syndrome.…”

Section: Discussionmentioning

confidence: 90%

Leptospirosis in a child with acute respiratory distress syndrome

et al. 2017

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Yeşilbaş O, Şevketoğlu E, Kıhtır HS, Hatipoğlu N, Yıldırım HM, Akyol MB, Aktay-Ayaz N, Gökçe İ. Leptospirosis in a child with acute respiratory distress syndrome. Turk J Pediatr 2017; 59: 688-692. Leptospirosis is an infectious vasculitis, which can occur with different clinical features. While it is generally a subclinical and self-limited infection; kidney and liver dysfunction, pulmonary hemorrhage, thrombocytopenia, and cardiovascular collapse may occurr. A six-year-old boy presented with acute respiratory distress syndrome, shock, thrombocytopenia-associated multiple organ failure, and persistent high fever secondary to leptospirosis. Persistent high fever was resistant to intravenous immunoglobulin and pulse steroid therapy. He was successfully treated with plasmapheresis and hemofiltration with endotoxin-cytokine cleaning filter. In conclusion; leptospirosis may cause thrombocytopenia-associated multiple organ failure, persistent high fever, and acute respiratory distress syndrome. Plasmapheresis and hemofiltration should be considered in cases of severe leptospirosis with multiorgan failure.

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Section: Discussionmentioning

confidence: 90%

Leptospirosis in a child with acute respiratory distress syndrome

et al. 2017

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“…Landini et al summarized 6 patients with hyperbilirubinemia, AKI, and no-specified hemorrhagic manifestations treated with plasmapheresis and noticed an improvement of hepatorenal function and bleeding [18]. Another patient with AKI and liver and cardiac involvement but without pulmonary involvement has been treated with plasmapheresis combined with continuous renal replacement therapy and high-volume hemofiltration but subsequently developed CMV colitis and resistant bacteremia and required prolonged hospital stay and was released from hospital after 70 days [19]. Another patient with multiorgan involvement (cardiac, renal, and hepatic involvement) and hemoptysis recovered following plasma exchange and systemic steroid therapy [20].…”

Section: Resultsmentioning

confidence: 99%

Role of Plasmapheresis and Extracorporeal Membrane Oxygenation in the Treatment of Leptospirosis Complicated with Pulmonary Hemorrhages

Fonseka

Lekamwasam

2018

Journal of Tropical Medicine

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Introduction Leptospirosis is an emerging infectious disease associated with multiorgan involvement and significant morbidity and mortality. Although pulmonary hemorrhage due to leptospirosis has a high fatality, specific treatment options are limited and their efficacy is not adequately proven. We opted to find out the current evidence on plasmapheresis and extracorporeal membrane oxygenation (ECMO) in pulmonary hemorrhages due to leptospirosis. Methods The first search was conducted in PubMed, OVID, Google Scholar, and Cochrane clinical trial registry using keywords “leptospirosis” OR “Leptospira” OR “Weil's disease” AND “plasmapheresis” OR “plasma exchange” AND “pulmonary hemorrhage” OR “alveolar hemorrhage” OR “lung hemorrhage” and the second search was done using keyword “leptospirosis” OR “Leptospira” OR “Weil's disease” AND “ECMO” OR “Extracorporeal membrane oxygenation.” The searches were not limited by study design or the date of publication. Only articles written in English were reviewed. Although we intended to include only clinical trials, it was decided later to include other information such as case reports and case series which addressed these treatment modalities. Two authors selected articles independently in a blinded manner using a set of inclusion and exclusion criteria and discrepancies were solved after discussions. Results The information found was very limited. This included one clinical trial which showed a significant survival benefit with plasmapheresis but the study design had many limitations. Two case reports described the benefit of plasmapheresis in severe leptospirosis with pulmonary hemorrhages. There were eight case reports where ECMO was performed and out of all only one patient has died. One retrospective study on patients with severe leptospirosis mentioned that four out of five patients with pulmonary hemorrhages survived after being treated with ECMO. Conclusions Current evidence is insufficient to recommend the routine use of plasmapheresis or ECMO for patients presenting with pulmonary hemorrhages due to leptospirosis. ECMO may be a promising mode of treatment in acute respiratory failure in leptospirosis related pulmonary hemorrhages. These treatment modalities, however, can be applied based on the availability of resources and expertise at the discretion of the clinician in charge, considering patient related factors such as cardiovascular stability and derangement of coagulation profile. Clinical trials conducted adhering to standard procedures are urgently required to establish the efficacy of these treatment modalities.

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“…Approximately two thirds of patients with leptospirosis diagnosed in Switzerland between 1970 and 2015 were autochthonous cases, most of them with exposure to natural waters, as in our case [ 21 ]. Other published cases include a fisherman from the lake of Geneva as well as a cluster of cases among river surfers from Central Switzerland [ 22 , 23 ]. Incidentally, our patient is the first published case from North-Eastern Switzerland.…”

Section: Discussionmentioning

confidence: 99%

Leptospirosis Followed by Kawasaki-Like Disease: Case Report From an Adult Swiss Patient and Review of the Literature

Baerlocher

Helfenstein

Mahr

et al. 2021

Open Forum Infectious Diseases

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Kawasaki Disease (KD) is a vasculitis that mostly occurs in children, but rare cases in adults have been reported. We describe the case of a 43-year-old Swiss male, who developed symptoms compatible with KD seven weeks after leptospirosis, which was presumably acquired after swimming in a creek in the Swiss Alps. We performed a literature review and identified 10 other cases (all in children), where Kawasaki-like disease was diagnosed in the context of leptospirosis. Outcome was favourable in most cases, including our patient. This exceptional case demonstrates both the possibility of autochthonous cases of leptospirosis in Switzerland as well as a possible association of leptospirosis with Kawasaki-like disease.

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Severe Leptospirosis with Multiple Organ Failure Successfully Treated by Plasma Exchange and High-Volume Hemofiltration

Cited by 16 publications

References 9 publications

Leptospirosis in a child with acute respiratory distress syndrome

Leptospirosis in a child with acute respiratory distress syndrome

Role of Plasmapheresis and Extracorporeal Membrane Oxygenation in the Treatment of Leptospirosis Complicated with Pulmonary Hemorrhages

Leptospirosis Followed by Kawasaki-Like Disease: Case Report From an Adult Swiss Patient and Review of the Literature

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