[Pulmonary manifestations of leptospirosis].
BACKGROUND
Pulmonary manifestations in leptospirosis are considered a major complication, and are related to a poor prognosis. We present a large series of patients with pulmonary involvement using a practical approach based on the presence of acute respiratory failure (ARF).


METHODS
A retrospective study of patients with confirmed leptospirosis.


RESULTS
169 patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. 134 patients (36.7 + or - 14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of acute respiratory failure. Univariate analysis found the following factors related to severe pulmonary leptospirosis: dyspnoea (OR 10.14, p<0.0001), pulmonary crepitations (OR 4.8, p<0.0004), abnormal chest X Ray (OR 9.88, p<0.007) with alveolar shadowing (OR 8.12, p<0.0001), oliguria/anuria (OR 5.48, p<0.0001), hepatomegaly (OR 7.11, p<0.0001), shock (OR 8.38, p<0.0001), ICU admission (OR 60.08, p<0.0001), dialysis (OR 4.87, p<0.001), mechanical ventilation (OR 216, p<0.0001) and development of nosocomial infection (OR 21.5, p<0.0001). The mortality rate was significantly different between severe (40%) and non-severe (5.3%) pulmonary forms (OR 11.87, p<0.0001). Multivariate analysis found 2 independent factors related to severe pulmonary involvement: dyspnoea (OR 10.18, p<0.0001), and oliguria/anuria (OR 4.87, p<0.0009). We performed a multivariate analysis to assess independent factors related to mortality and found: Mechanical ventilation requirement (OR 27.85, p<0.0001) and ASAT>150 UI/L (OR 4.57, p<0.02). Haemoptysis was associated with survival (OR 0.2, p<0.02).


CONCLUSIONS
Severe pulmonary involvement in leptospirosis is associated with extensive disease involving other organs. The association of multiples factors is associated with severe forms of the disease and a high mortality rate.
Paganin
F
F
Service de Pneumologie et Maladies Infectieuses, GHSR, Saint-Pierre, Réunion, France. f.paganin@orange.fr
Bourdin
A
A
Borgherini
G
G
Dalban
C
C
Poubeau
P
P
Tixier
F
F
Gouix
A
A
Noel
J-B
JB
Cotte
L
L
Arvin-Berod
C
C
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D000328:Adult; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007922:Leptospirosis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009894:Opportunistic Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D017508:Reunion; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult