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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2019, vol. 25, issue3
Subject Area: Medicine
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DOI: 10.5272/jimab.2019253.2622
Published online: 22 July 2019
Original article
J of IMAB. 2019 Jul-Sep;25(3):2622-2627;
RESPIRATORY MANIFESTATIONS OF LEPTOSPIROSIS
Galya Gancheva
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Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Faculty of Public Health, Medical University – Pleven, Bulgaria.
ABSTRACT:
Purpose: Respiratory manifestations in leptospirosis can vary from subtle symptoms to deadly pulmonary hemorrhage and ARDS. Our objective was to analyze respiratory symptoms and to assess their prognostic value in leptospirosis.
Material and methods: We performed analysis of clinical data and X-ray findings in 100 consecutive cases of leptospirosis, treated in Clinic of Infectious Diseases at University Hospital – Pleven (1976-2018) (mean age 37±18 years, 90 male, 13% lethal outcome). Statistical methods – t-test and χ2 test (for parametric and non-parametric distributions, respectively; p<0.05 was considered as significant); Pirson’s test (φ-coefficient: weak correlation in φ<0.3, moderate – 0.3< φ<0.7 and strong in φ>0.7); odds ratio (OR).
Results: The characteristic manifestations were fever (100%), hepatomegaly (92%), myalgia (86%), vomiting (84%), splenomegaly (74%), oliguria (69%), jaundice (63%), hypotension (49%), abdominal pain (41%), and hemorrhagic diathesis (37%). The most frequent respiratory symptoms (especially in icteric cases) were decreased breath (37%), rales (17%), tachypnea (15%), and dyspnea (13%). Comparative study of respiratory symptoms in different according to severity forms revealed higher prevalence in severe cases (p<0.001). X-rays (in 34 severe cases) revealed infiltrative changes in nine cases and interstitial and alveolar congestion (suggesting lung edema) in thirteen. Comparative analysis of survived and deceased severe cases revealed that mentioned above respiratory symptoms occur more often in deceased patients (p<0.001). The lethal outcome strongly correlated with lung edema (OR 25.00; φ=0.66).
Conclusions: Respiratory dysfunctions in our study were nonspecific and correlated with severity. The lung edema is important factor for death, and its prevention requires prompt intensive interdisciplinary treatment.
Keywords: leptospirosis, respiratory symptoms, X-ray,
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Please cite this article as: Gancheva G. Respiratory Manifestations of Leptospirosis. J of IMAB. 2019 Jul-Sep;25(3):2622-2627. DOI: 10.5272/jimab.2019253.2622
Correspondence to: Galya Gancheva, Clinic of Infectious Diseases, University Hospital Pleven; 8a, Georgi Kochev str., 5800 Pleven, Bulgaria; E-mail: galya_gancheva@abv.bg
REFERENCES:
1. Levett PN. Leptospirosis. Clin Microbiol Rev. 2001 Apr;14(2):296-326. [PubMed] [Crossref]
2. Spichler AS1, Vilaca PJ, Athanazio DA, Albuquerque JO, Buzzar M, Castro B, et al. Predictors of lethality in severe leptospirosis in urban Brazil. Am J Trop Med Hyg. 2008 Dec;79(6):911-4. [PubMed]
3. Marotto PC, Nascimento CM, Eluf-Neto J, Marotto MS, Andrade L, Sztajnbok J, et al. Acute lung injury in leptospirosis: clinical and laboratory features, outcome, and factors associated with mortality. Clin Infect Dis. 1999 Dec;29(6):1561-3. [PubMed] [Crossref]
4. Martinez Garcia MA, de Diego Damia A, Menendez Villanueva R, et al. Pulmonary involvement in leptospirosis. Eur J Clin Microbiol Infect Dis. 2000 Jun;19(6):471-4. [PubMed]
5. Divate SA, Chaturvedi R, Jadhav NN, Vaideeswar P. Leptospirosis associated with diffuse alveolar haemorrhage. J Postgrad Med. 2002 Apr-Jun;48(2):131-2. [PubMed]
6. Vijayachari P, Sugunan AP, Singh SS, Mathur PP. Leptospirosis among the self-supporting convicts of Andaman Island during the 1920s—the first report on pulmonary haemorrhage in leptospirosis? Indian J Med Res. 2015 Jul;142(1):11-22. [PubMed] [Crossref]
7. Panaphut T, Domrongkitchaiporn S, Thinkamrop B. Prognostic factors of death in leptospirosis: a prospective cohort study in Khon Kaen, Thailand. Int J Infect Dis. 2002 Mar;6(1):52-9. [PubMed]
8. Tantitanawat S, Tanjatham S. Prognostic factors associated with severe leptospirosis. J Med Assoc Thai. 2003 Oct;86(10):925-931.
9. Magazine R, Rao S, Chogtu B, Venkateswaran R, Shahul HA, Goneppanavar U. Epidemiological profile of acute respiratory distress syndrome patients: A tertiary care experience. Lung India. 2017 Jan-Feb;34(1):38-42. [PubMed] [Crossref]
10. Seijo A, Coto H, San Juan J, Videla J, Deodato B, Cernigoi B, et al. Lethal leptospiral pulmonary hemorrhage: an emerging disease in Buenos Aires, Argentina. Emerg Infect Dis. 2002 Sep;8(9):1004-5. [PubMed] [Crossref]
11. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2095-128. [PubMed] [Crossref].
12. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis. 2015 Sep 17;9(9):e0003898. [PubMed] [Crossref]
13. Torgerson PR, Hagan JE, Costa F, Calcagno J, Kane M, Martinez-Silveira MS, et al. Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years. Plos Negl Trop Dis. 2015 Oct 2;9(10):e0004122. [PubMed] [Crossref]
14. Karnik ND, Gupta AV. Predicting Survival in ARDS. J Assoc Physicians India. 2015 Nov;63(11):11-3. [PubMed]
15. Gancheva G. [Complex studies on leptospirosis]. PhD dissertation, Medical University – Pleven, Bulgaria, 2006:72-73. [in Bulgarian] >
16. Dolhnikoff M, Mauad T, Bethlem EP, Carvalho CR. Pathology and pathophysiology of pulmonary manifestations in leptospirosis. Braz J Infect Dis. 2007 Feb;11(1):142-8. [PubMed]
17. Agrawal VK, Bansal A, Pujani M. A rare case of leptospirosis with isolated lung involvement. Indian J Crit Care Med. 2015 Mar;19(3):174-6. [PubMed] [Crossref]
18. Mel'nik GV, Zhukova LI. [Pathomorphogenesis of the liver, kidneys, and lungs in patients with icteric leptospirosis]. [in Russian] Arkh Patol. 2004 Jan-Feb;66(1):3-7. [PubMed]>
19. Pires-Neto RC, Del Carlo Bernardi F, Alves de Araujo P, Mauad T, Dolhnikoff M. The Expression of Water and Ion Channels in Diffuse Alveolar Damage Is Not Dependent on DAD Etiology. PLoS One. 2016 Nov 11;11(11):e0166184. [PubMed] [Crossref]
20. Tanomkiat W, Poonsawat P. Pulmonary radiographic findings in 118 leptospirosis patients. Southeast Asian J Trop Med Public Health. 2005 Sep;36(5):1247-51. [PubMed].
Received: 02 January 2019
Published online: 22 July 2019