title: Pulmonary manifestations of leptospirosis.
abstract: 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
  One hundred and sixty-nine patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. One hundred and thirty-four patients (36.7±14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of ARF. 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 two 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 AST greater than 150 IU/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 multiple factors is associated with severe forms of the disease and a high mortality rate.
authors: Service de pneumologie et maladies infectieuses, GHSR, BP 350, Saint-Pierre, Reunion. f.paganin@orange.fr
authors: F
authors: F
authors: Paganin
authors: A
authors: A
authors: Bourdin
authors: G
authors: G
authors: Borgherini
authors: C
authors: C
authors: Dalban
authors: P
authors: P
authors: Poubeau
authors: F
authors: F
authors: Tixier
authors: A
authors: A
authors: Gouix
authors: J-B
authors: JB
authors: Noel
authors: L
authors: L
authors: Cotte
authors: C
authors: C
authors: Arvin-Berod
mesh_terms: D000328:Adult; D000818:Animals; D002423:Cause of Death; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007922:Leptospirosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051381:Rats; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D015047:Zoonoses / Q000453:epidemiology