title: Leptospiral pneumonias.
abstract: OBJECTIVE
  Pulmonary involvement in leptospirosis has been reported to be increasing in the last few years and is emerging as a serious life threat and 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, and recent data on the pathophysiology of lung damage and therapeutic implications.
  
  
  RESULTS
  Although previous reports have emphasized the increasing incidence of pulmonary manifestations in patients with leptospirosis worldwide, pulmonary involvement in leptospirosis is still under-recognized. Experimental models have been used to address new aspects of the pathogenesis of the disease, including determination of novel outer membrane proteins, characterization of dysregulation of sodium transporters of alveolar epithelial cells, and provision of new data on the role of innate immunity in the development of severe disease, thereby making major progress in understanding the mechanisms underlying lung injury.
  
  
  CONCLUSIONS
  Pulmonary hemorrhage represents the main cause of death in severe forms of leptospirosis. Although the mechanism of pulmonary impairment is still poorly understood, recent experimental studies have brought new insights to the pathogenesis of lung injury and provide new perspectives on treatment of critically ill patients.
authors.affiliation: Department of Pathology, University of São Paulo, Brazil.
authors.forename: Marisa
authors.initials: M
authors.lastname: Dolhnikoff
authors.forename: Thais
authors.initials: T
authors.lastname: Mauad
authors.forename: Eduardo P
authors.initials: EP
authors.lastname: Bethlem
authors.forename: Carlos R R
authors.initials: CR
authors.lastname: Carvalho
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D014943:Global Health; D006801:Humans; D015994:Incidence; D007919:Leptospira / Q000302:isolation & purification*; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011379:Prognosis; D013902:Radiography, Thoracic
chemical_list: D000890:Anti-Infective Agents