title: Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden.
abstract: 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 (>or=10(4) leptospires/mL) in most fatal cases; 1 patient, from whom tissue specimens were obtained at autopsy, had >or=10(5) 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.
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Eddy R
authors.initials: ER
authors.lastname: Segura
authors.forename: Christian A
authors.initials: CA
authors.lastname: Ganoza
authors.forename: Kalina
authors.initials: K
authors.lastname: Campos
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Ricaldi
authors.forename: Sonia
authors.initials: S
authors.lastname: Torres
authors.forename: Hermann
authors.initials: H
authors.lastname: Silva
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Céspedes
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthias
authors.forename: Mark A
authors.initials: MA
authors.lastname: Swancutt
authors.forename: Renzo
authors.initials: R
authors.lastname: López Liñán
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: Humberto
authors.initials: H
authors.lastname: Guerra
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Vinetz
mesh_terms: D000293:Adolescent; D000328:Adult; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology*; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology*; D008297:Male; D009527:Nicaragua / Q000453:epidemiology