Journal Article

Clinical Spectrum of Pulmonary Involvement in Leptospirosis in a Region of Endemicity, with Quantification of Leptospiral Burden

Eddy R. Segura, Christian A. Ganoza, Kalina Campos, Jessica N. Ricaldi, Sonia Torres, Hermann Silva, Manuel J. Céspedes, Michael A. Matthias, Mark A. Swancutt, Renzo López Liñán, Eduardo Gotuzzo, Humberto Guerra, Robert H. Gilman and Joseph M. Vinetz

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 3, pages 343-351
Published in print February 2005 | ISSN: 1058-4838
Published online February 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/427110
Clinical Spectrum of Pulmonary Involvement in Leptospirosis in a Region of Endemicity, with Quantification of Leptospiral Burden

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Background. Pulmonary involvement in leptospirosis remains poorly recognized in regions where it is endemic, despite reports of recent outbreaks and epidemic disease.

Methods. A prospective, population-based study was carried out to identify febrile patients exposed to Leptospira in urban and rural contexts in Iquitos, Peru. Evidence of exposure to Leptospira was obtained by serologic testing, and diagnosis of leptospirosis was confirmed in pulmonary cases by culture or quantitative real-time PCR assay.

Results. Of 633 consecutively enrolled febrile patients, 321 (50.7%) had antileptospiral IgM antibodies or high titers of antileptospiral antibodies. Seven patients with histories of only urban exposure to leptospires had severe pulmonary manifestations; of these, 5 patients died; 4 of the deaths were caused by pulmonary hemorrhage, and 1 was caused by acute respiratory distress syndrome and multiorgan failure. Real-time, quantitative PCR assay showed high levels of leptospiremia (⩾104 leptospires/mL) in most fatal cases; 1 patient, from whom tissue specimens were obtained at autopsy, had ⩾105 leptospires/g of lung, kidney, and muscle tissue.

Discussion. This study demonstrates the underdiagnosis of leptospirosis in a region of high endemicity and the underrecognition of grave pulmonary complications. Pulmonary involvement in leptospirosis was present in urban but not rural areas. Presumptive treatment for leptospirosis should be initiated immediately in the appropriate epidemiological and clinical context.

Journal Article.  4303 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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