title: Anicteric leptospirosis-associated severe pulmonary hemorrhagic syndrome:  a case series study.
abstract: In leptospirosis, severe pulmonary hemorrhagic syndrome has replaced Weil's disease as the main cause of mortality, with rates of up to 75%. Four men, all farmers, were admitted to the intensive care unit between August 2009 and July 2010 with a diagnosis of acute respiratory distress syndrome. All patients presented with fever, hemoptysis, bilateral pulmonary infiltrates in chest radiographs, and thrombocytopenia and had compatible epidemiological history with leptospirosis; 3 patients had anemia, 3 had renal failure, 2 had increased creatine kinase, whereas bilirubin was slightly increased in only 1 patient. Leptospirosis was diagnosed serologically in all cases. Empirical therapy with ceftriaxone was administered immediately to all patients, while implementation of ARDSnet protective mechanical ventilation approach combined with an early goal-directed hemodynamic approach led to a relatively low mortality rate (25%). Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II and Sepsis-Related Organ Failure Assessment scoring systems were unable to predict the outcome of the patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome.
authors: Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
authors: Stelios F
authors: SF
authors: Assimakopoulos
authors: Fotini
authors: F
authors: Fligou
authors: Markos
authors: M
authors: Marangos
authors: Anastasia
authors: A
authors: Zotou
authors: Aristea
authors: A
authors: Psilopanagioti
authors: Kriton S
authors: KS
authors: Filos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007922:Leptospirosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone