title: Clinicopathological and immunohistochemical features of the severe pulmonary form of leptospirosis.
abstract: Four cases of severe pulmonary form of leptospirosis (SPFL) are described. In all four of these blood culture proven cases, there was severe pulmonary injury characterized by alveolar hemorrhage and acute respiratory failure. Three patients died in less than 48 hours after onset of the first respiratory signs. Leptospiral antigen detection in lung tissues was positive by immunoperoxidase in all three of these cases, suggesting that the microorganism exerts a local direct destructive action. Patients with SPFL should be carefully monitored, as the abrupt onset of severe alveolar hemorrhage can lead to respiratory insufficiency and death. The authors emphasize the importance of radiological findings and blood gas analysis for prompt clinical diagnosis, and suggest that corticosteroids, associated with antibiotics, early respiratory support, and platelet transfusions are useful as an attempt to prevent further development of SPFL.
authors.affiliation: Disciplina de Doenças Infecciosas e Parasitária, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ. dipuff@zipmail.com.br
authors.forename: João José Pereira
authors.initials: JJ
authors.lastname: Silva
authors.forename: Marcos Olivier
authors.initials: MO
authors.lastname: Dalston
authors.forename: Jorge Eduardo Manhães
authors.initials: JE
authors.lastname: Carvalho
authors.forename: Sérgio
authors.initials: S
authors.lastname: Setúbal
authors.forename: Janice Mery Chiarino
authors.initials: JM
authors.lastname: Oliveira
authors.forename: Martha Maria
authors.initials: MM
authors.lastname: Pereira
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000150:complications / Q000473:pathology; D008171:Lung Diseases / Q000150:complications / Q000382:microbiology* / Q000473:pathology; D008297:Male; D012131:Respiratory Insufficiency / Q000382:microbiology* / Q000473:pathology