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Weil's Disease-Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota. Biomolecules 2022; 12:biom12121830. [PMID: 36551258 PMCID: PMC9775223 DOI: 10.3390/biom12121830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Leptospirosis is an important zoonotic disease, causing about 60,000 deaths annually. In this review, we have described in detail the immunopathogenesis of leptospirosis, the influence of cytokines, genetic susceptibility on the course of the disease, and the evasion of the immune response. These data are combined with information about immunological and pathomorphological changes in the kidneys, liver, and lungs, which are most affected by Weil's disease. The review also suggests a possible role of the gut microbiota in the clinical course of leptospirosis, the main mechanisms of the influence of gut dysbiosis on damage in the liver, kidneys, and lungs through several axes, i.e., gut-liver, gut-kidney, and gut-lungs. Modulation of gut microbiota by probiotics and/or fecal microbiota transplantation in leptospirosis may become an important area of scientific research.
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2
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Bassat Q, Varo R, Hurtado JC, Marimon L, Ferrando M, Ismail MR, Carrilho C, Fernandes F, Castro P, Maixenchs M, Rodrigo-Calvo MT, Guerrero J, Martínez A, Lacerda MVG, Mandomando I, Menéndez C, Martinez MJ, Ordi J, Rakislova N. Minimally Invasive Tissue Sampling as an Alternative to Complete Diagnostic Autopsies in the Context of Epidemic Outbreaks and Pandemics: The Example of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2021; 73:S472-S479. [PMID: 34910176 PMCID: PMC8672745 DOI: 10.1093/cid/ciab760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Infectious diseases’ outbreak investigation requires, by definition, conducting a thorough epidemiological assessment while simultaneously obtaining biological samples for an adequate screening of potential responsible pathogens. Complete autopsies remain the gold-standard approach for cause-of-death evaluation and characterization of emerging diseases. However, for highly transmissible infections with a significant associated lethality, such as COVID-19, complete autopsies are seldom performed due to biosafety challenges, especially in low-resource settings. Minimally invasive tissue sampling (MITS) is a validated new approach based on obtaining postmortem samples from key organs and body fluids, a procedure that does not require advanced biosafety measures or a special autopsy room. Methods We aimed to review the use of MITS or similar procedures for outbreak investigation up to 27 March 2021 and their performance for evaluating COVID-19 deaths. Results After a literature review, we analyzed in detail the results of 20 studies conducted at international sites, whereby 216 COVID-19–related deaths were investigated. MITS provided a general and more granular understanding of the pathophysiological changes secondary to the infection and high-quality samples where the extent and degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related damage could be evaluated. Conclusions MITS is a useful addition in the investigation and surveillance of infections occurring in outbreaks or epidemics. Its less invasive nature makes the tool more acceptable and feasible and reduces the risk of procedure-associated contagion, using basic biosafety measures. Standardized approaches protocolizing which samples should be collected—and under which exact biosafety measures—are necessary to facilitate and expand its use globally.
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Affiliation(s)
- Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Mamudo R Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, Institut D'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - José Guerrero
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Antonio Martínez
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane-ILMD, Manaus, Brazil
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Miguel J Martinez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
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Sonderegger F, Nentwig A, Schweighauser A, Francey T, Marti E, Mirkovitch J, Schuller S. Association of markers of endothelial activation and dysfunction with occurrence and outcome of pulmonary hemorrhage in dogs with leptospirosis. J Vet Intern Med 2021; 35:1789-1799. [PMID: 34076314 PMCID: PMC8295707 DOI: 10.1111/jvim.16163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Endothelial dysfunction might contribute to the development of leptospiral pulmonary hemorrhage syndrome (LPHS). Hypothesis Serum concentrations of markers of endothelial activation and dysfunction are higher in dogs with leptospirosis and correlate with the occurrence of LPHS and a higher case fatality rate. Animals Clinically healthy dogs (n = 31; 10/31 dogs confirmed healthy based on no detected abnormalities on blood work), dogs with leptospirosis with LPHS (n = 17) and without LPHS (n = 15), dogs with acute kidney injury not due to leptospirosis (AKI‐nL, n = 34). Methods Observational study. Serum concentrations of soluble intercellular adhesion molecule 1 (sICAM‐1), vascular endothelial growth factor (VEGF), and angiopoietin‐2 (Ang‐2) at admission were compared between groups. Correlations with outcome and the accuracy to predict LPHS were examined. Results Soluble intercellular adhesion molecule (sICAM‐1), VEGF, and Ang‐2 concentrations were higher in dogs with AKI‐nL (sICAM‐1 34.7 ng/mL, interquartile range [IQR] = 24.4‐75.5; VEGF 43.1 pg/mL, IQR = 12.3‐79.2; Ang‐2 8.5 ng/mL, IQR = 6.2‐12.3), leptospirosis without LPHS (sICAM‐1 45.1 ng/mL, IQR = 30.6‐59.0; VEGF 32.4 pg/mL, IQR = 12.5‐62.6; Ang‐2 9.6 ng/mL, IQR = 6.9‐19.3), and LPHS (sICAM‐1 69.7 ng/mL, IQR = 42.1‐89.1; VEGF 51.8 pg/mL, IQR = 26.3‐96.7; Ang‐2 8.0 ng/mL, IQR = 5.6‐12.2) compared to controls (P < .001). In dogs with leptospirosis, VEGF and sICAM‐1 were higher in nonsurvivors (sICAM‐1 89.4 ng/mL, IQR = 76.5‐101.0; VEGF 117.0 pg/mL, IQR = 90.3‐232.4) than survivors (P = .004) and sICAM‐1 predicted the development of LPHS. Conclusions Soluble intercellular adhesion molecule 1, VEGF, and Ang‐2 do not discriminate leptospirosis from AKI‐nL. In dogs with leptospirosis, sICAM‐1 and VEGF predict outcome and sICAM‐1 might identify dogs at risk for LPHS.
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Affiliation(s)
- Franziska Sonderegger
- Department Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | | | - Ariane Schweighauser
- Department Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Thierry Francey
- Department Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Eliane Marti
- Department of Clinical Research and Veterinary Public Health (DCR-VPH), Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Jelena Mirkovitch
- Department of Clinical Research and Veterinary Public Health (DCR-VPH), Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Simone Schuller
- Department Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
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Nicodemo AC, Duarte-Neto AN. Pathogenesis of Pulmonary Hemorrhagic Syndrome in Human Leptospirosis. Am J Trop Med Hyg 2021; 104:1970-1972. [PMID: 33872210 DOI: 10.4269/ajtmh.20-1000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/26/2021] [Indexed: 11/07/2022] Open
Abstract
Based on a previous study and by incorporating new knowledge, the goal of our study was to understand more fully the pathogenesis of hemorrhagic pneumonia of severe human leptospirosis, highlighting the onset of capillary lesions by Leptospira itself and/or its antigenic/toxic products acting on the endothelium and binding to cadherins. Both events lead to loss of endothelial integrity, alter permeability, cause rupture, and open intercellular junctions, contributing to the hemorrhagic phenomena associated with severe leptospirosis.
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Affiliation(s)
- Antonio C Nicodemo
- 1Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, Brazil
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5
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Moreno-Torres A, Malvido-Jiménez IR, de la Peña-Moctezuma A, Castillo Sánchez LO, Fraga TR, Barbosa AS, Isaac L, Sahagún-Ruiz A. Culture-attenuated pathogenic Leptospira lose the ability to survive to complement-mediated-killing due to lower expression of factor H binding proteins. Microbes Infect 2019; 21:377-385. [DOI: 10.1016/j.micinf.2019.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 01/24/2019] [Accepted: 03/08/2019] [Indexed: 01/07/2023]
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6
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Ultrasound-guided minimally invasive autopsy as a tool for rapid post-mortem diagnosis in the 2018 Sao Paulo yellow fever epidemic: Correlation with conventional autopsy. PLoS Negl Trop Dis 2019; 13:e0007625. [PMID: 31329590 PMCID: PMC6675127 DOI: 10.1371/journal.pntd.0007625] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/01/2019] [Accepted: 07/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background New strategies for collecting post-mortem tissue are necessary, particularly in areas with emerging infections. Minimally invasive autopsy (MIA) has been proposed as an alternative to conventional autopsy (CA), with promising results. Previous studies using MIA addressed the cause of death in adults and children in developing countries. However, none of these studies was conducted in areas with an undergoing infectious disease epidemic. We have recently experienced an epidemic of yellow fever (YF) in Brazil. Aiming to provide new information on low-cost post-mortem techniques that could be applied in regions at risk for infectious outbreaks, we tested the efficacy of ultrasound-guided MIA (MIA-US) in the diagnosis of patients who died during the epidemic. Methodology/principal findings In this observational study, we performed MIA-US in 20 patients with suspected or confirmed YF and compared the results with those obtained in subsequent CAs. Ultrasound-guided biopsies were used for tissue sampling of liver, kidneys, lungs, spleen, and heart. Liver samples from MIA-US and CA were submitted for RT-PCR and immunohistochemistry for detection of YF virus antigen. Of the 20 patients, 17 had YF diagnosis confirmed after autopsy by histopathological and molecular analysis. There was 100% agreement between MIA-US and CA in determining the cause of death (panlobular hepatitis with hepatic failure) and main disease (yellow fever). Further, MIA-US obtained samples with good quality for molecular studies and for the assessment of the systemic involvement of the disease. Main extrahepatic findings were pulmonary hemorrhage, pneumonia, acute tubular necrosis, and glomerulonephritis. One patient was a 24-year-old, 27-week pregnant woman; MIA-US assessed the placenta and provided adequate placental tissue for analysis. Conclusions MIA-US is a reliable tool for rapid post-mortem diagnosis of yellow fever and can be used as an alternative to conventional autopsy in regions at risk for hemorrhagic fever outbreaks with limited resources to perform complete diagnostic autopsy. Reliable mortality information is of paramount importance to establish sound public health policies. Autopsy is an important tool not only for determining the cause of death, but also for the detection of novel diseases. In the last decades, we have been globally identifying an unprecedented number of emerging infections. Therefore, there is great interest in the development of less invasive and low-cost tools for the accurate post-mortem diagnosis in fatal cases. Minimally invasive autopsy (MIA), conceived as targeting diagnostic biopsies of key organs by needle puncture, has been proposed as an alternative to conventional autopsy (CA) for the determination of cause of death in developing countries. In this research, we tested the efficacy of MIA in the post-mortem diagnosis of 20 patients with suspected or confirmed yellow fever who died during the recent epidemic of yellow fever that occurred in Brazil. There was a perfect agreement between MIA and CA in determining the cause of death (hepatic failure) and main disease (yellow fever) in all patients with confirmed yellow fever. This finding indicates that MIA can be used as an alternative to CA in regions at risk for infectious disease outbreaks with limited resources to perform conventional autopsies.
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7
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Acute respiratory distress syndrome in leptospirosis. J Crit Care 2019; 51:165-169. [DOI: 10.1016/j.jcrc.2019.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
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8
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Chin VK, Basir R, Nordin SA, Abdullah M, Sekawi Z. Pathology and Host Immune Evasion During Human Leptospirosis: a Review. Int Microbiol 2019; 23:127-136. [DOI: 10.1007/s10123-019-00067-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 02/08/2019] [Accepted: 02/19/2019] [Indexed: 12/21/2022]
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9
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Carstens GR, Paulino BBA, Katayama EH, Amato-Lourenço LF, Fonseca GH, Souza R, Aiello VD, Mauad T. Clinical relevance of pulmonary vasculature involvement in sickle cell disease. Br J Haematol 2019; 185:317-326. [PMID: 30739309 DOI: 10.1111/bjh.15795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/14/2018] [Indexed: 12/21/2022]
Abstract
Pulmonary complications are frequent in patients with sickle cell disease (SCD), but few studies have described lung pathology in SCD. We studied the lung tissue of 30 deceased SCD patients (1994-2012). Demographics, genotype, clinical characteristics, cause of death and associated conditions are presented. We quantified the presence of pulmonary arterial changes, thrombosis and venous thickening. Alveolar capillary abnormalities were demonstrated using CD34 expression and confocal microscopy. Autopsy and echocardiography reports were reviewed to classify heart abnormalities. Tissue expression of markers of endothelial activation (vascular cell adhesion molecule 1, intercellular adhesion molecule 1 and vascular endothelial growth factor) was quantified in pulmonary vessels. Median age was 33 years; genotype was SS in 19, SC in 7 and Sβ in 4, and there were 18 males. Hypertensive arterial changes were present in 76% of the patients, recent thrombosis in 80% and old thrombosis in 43%. Venous thickening was present in 23% and pulmonary capillary haemangiomatosis foci in 87%. Ten percent of the patients presented right ventricular hypertrophy. There was no increased expression of endothelial activation markers when compared to controls. SCD affects the whole pulmonary vascular tree and reflects the multiple burden on lung vasculature imposed by the disease upon time.
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Affiliation(s)
- German R Carstens
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Hospital Eduardo Schütz Schroeder, Puerto Montt, Chile
| | - Bianca B A Paulino
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edgard H Katayama
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luis F Amato-Lourenço
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Guilherme H Fonseca
- Department of Haematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rogerio Souza
- Pulmonary Department, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera D Aiello
- Laboratory of Pathology, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Mauad
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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10
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Cagliero J, Villanueva SYAM, Matsui M. Leptospirosis Pathophysiology: Into the Storm of Cytokines. Front Cell Infect Microbiol 2018; 8:204. [PMID: 29974037 PMCID: PMC6019470 DOI: 10.3389/fcimb.2018.00204] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/31/2018] [Indexed: 12/20/2022] Open
Abstract
Leptospirosis is a neglected tropical zoonosis caused by pathogenic spirochetes of the genus Leptospira. Infected reservoir animals, typically mice and rats, are asymptomatic, carry the pathogen in their renal tubules, and shed pathogenic spirochetes in their urine, contaminating the environment. Humans are accidental hosts of pathogenic Leptospira. Most human infections are mild or asymptomatic. However, 10% of human leptospirosis cases develop into severe forms, including high leptospiremia, multi-organ injuries, and a dramatically increased mortality rate, which can relate to a sepsis-like phenotype. During infection, the triggering of the inflammatory response, especially through the production of cytokines, is essential for the early elimination of pathogens. However, uncontrolled cytokine production can result in a cytokine storm process, followed by a state of immunoparalysis, which can lead to sepsis and associated organ failures. In this review, the involvement of cytokine storm and subsequent immunoparalysis in the development of severe leptospirosis in susceptible hosts will be discussed. The potential contribution of major pro-inflammatory cytokines in the development of tissue lesions and systemic inflammatory response, as well as the role of anti-inflammatory cytokines in contributing to the onset of a deleterious immunosuppressive cascade will also be examined. Data from studies comparing susceptible and resistant mouse models will be included. Lastly, a concise discussion on the use of cytokines for therapeutic purposes or as biomarkers of leptospirosis severity will be provided.
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Affiliation(s)
- Julie Cagliero
- Group Immunity and Inflammation, Institut Pasteur International Network, Institut Pasteur in New Caledonia, Nouméa, New Caledonia
| | - Sharon Y A M Villanueva
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Manila, Philippines
| | - Mariko Matsui
- Group Immunity and Inflammation, Institut Pasteur International Network, Institut Pasteur in New Caledonia, Nouméa, New Caledonia
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11
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De Brito T, da Silva AMG, Abreu PAE. Pathology and pathogenesis of human leptospirosis: a commented review. Rev Inst Med Trop Sao Paulo 2018; 60:e23. [PMID: 29846473 PMCID: PMC5975557 DOI: 10.1590/s1678-9946201860023] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/23/2018] [Indexed: 12/23/2022] Open
Abstract
Leptospirosis is an acute bacterial septicemic febrile disease caused by pathogenic leptospires, which affect humans and animals in all parts of the world. Transmission can occur by direct contact with infected animals or, more commonly, through indirect contact with water or soil contaminated with urine from infected animals. Leptospires enter the body by penetrating mucous membranes or skin abrasions and disseminate through the hematogenic route. In humans, leptospirosis may cause a wide spectrum of symptoms. Most cases have a biphasic clinical presentation, which begins with the septicemic phase followed by immune manifestations. The severe forms of the disease may be life threatening with multisystem damage including renal failure, hepatic dysfunction, vascular damage, pulmonary hemorrhage and muscle lesions. In this review, we present and discuss the pathogenesis of the human disease and the mechanisms of cell membrane injuries, which occur mainly due to the presence of leptospires and/or their antigen/s in the host tissues.
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Affiliation(s)
- Thales De Brito
- Universidade de São Paulo, Instituto de Medicina Tropical de São
Paulo, LIM 06, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de
Patologia, São Paulo, São Paulo, Brazil
| | - Ana Maria Gonçalves da Silva
- Universidade de São Paulo, Instituto de Medicina Tropical de São
Paulo, LIM 06, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de
Patologia, São Paulo, São Paulo, Brazil
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12
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Sato H, Coburn J. Leptospira interrogans causes quantitative and morphological disturbances in adherens junctions and other biological groups of proteins in human endothelial cells. PLoS Negl Trop Dis 2017; 11:e0005830. [PMID: 28750011 PMCID: PMC5549773 DOI: 10.1371/journal.pntd.0005830] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/08/2017] [Accepted: 07/24/2017] [Indexed: 12/21/2022] Open
Abstract
Pathogenic Leptospira transmits from animals to humans, causing the zoonotic life-threatening infection called leptospirosis. This infection is reported worldwide with higher risk in tropical regions. Symptoms of leptospirosis range from mild illness to severe illness such as liver damage, kidney failure, respiratory distress, meningitis, and fatal hemorrhagic disease. Invasive species of Leptospira rapidly disseminate to multiple tissues where this bacterium damages host endothelial cells, increasing vascular permeability. Despite the burden in humans and animals, the pathogenic mechanisms of Leptospira infection remain to be elucidated. The pathogenic leptospires adhere to endothelial cells and permeabilize endothelial barriers in vivo and in vitro. In this study, human endothelial cells were infected with the pathogenic L. interrogans serovar Copenhageni or the saprophyte L. biflexa serovar Patoc to investigate morphological changes and other distinctive phenotypes of host cell proteins by fluorescence microscopy. Among those analyzed, 17 proteins from five biological classes demonstrated distinctive phenotypes in morphology and/or signal intensity upon infection with Leptospira. The affected biological groups include: 1) extracellular matrix, 2) intercellular adhesion molecules and cell surface receptors, 3) intracellular proteins, 4) cell-cell junction proteins, and 5) a cytoskeletal protein. Infection with the pathogenic strain most profoundly disturbed the biological structures of adherens junctions (VE-cadherin and catenins) and actin filaments. Our data illuminate morphological disruptions and reduced signals of cell-cell junction proteins and filamentous actin in L. interrogans-infected endothelial cells. In addition, Leptospira infection, regardless of pathogenic status, influenced other host proteins belonging to multiple biological classes. Our data suggest that this zoonotic agent may damage endothelial cells via multiple cascades or pathways including endothelial barrier damage and inflammation, potentially leading to vascular hyperpermeability and severe illness in vivo. This work provides new insights into the pathophysiological mechanisms of Leptospira infection.
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Affiliation(s)
- Hiromi Sato
- Center for Infectious Disease Research, Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jenifer Coburn
- Center for Infectious Disease Research, Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, United States of America
- * E-mail:
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13
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Raffray L, Giry C, Thirapathi Y, Reboux AH, Jaffar-Bandjee MC, Gasque P. Increased levels of soluble forms of E-selectin and ICAM-1 adhesion molecules during human leptospirosis. PLoS One 2017; 12:e0180474. [PMID: 28686648 PMCID: PMC5501535 DOI: 10.1371/journal.pone.0180474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/15/2017] [Indexed: 01/09/2023] Open
Abstract
Leptospirosis is a multisystemic zoonotic disease with infiltration of visceral organs by Leptospira. The capacity of the vascular endothelium to grant immune cell recruitment and activation in target organs during the disease course remains poorly characterized. We ascertained the levels of expression of several soluble cell adhesion molecules (CAM) notably expressed by endothelial cells in human leptospirosis. We prospectively enrolled 20 hospitalized patients and compared them to 10 healthy controls. Disease severity was defined by one or more organ failures, or death. Plasmatic concentrations of soluble CAM were assessed by multiplex bead assay at the time of patient presentation (M0) and 1 month after hospital discharge. The levels of soluble E-selectin (sCD62E) and soluble intercellular adhesion molecule 1 (sICAM-1, sCD53) were significantly increased in patients compared to controls (p<0.0001) and at 1 month (p<0.0001) with median values at 978 ng/ml (interquartile ranges 787–1164; sCD62E) and 1021 ng/ml (690–1428; sCD53). At M0, Soluble P-selectin level (sCD62P) was found to be decreased with levels at 60 ng/ml (0–631) versus 711 ng/ml (343–1113) for healthy controls (p<0.05). Levels of sICAM-3 (sCD50), sVCAM-1 (vascular cell adhesion molecule, sCD106) and sPECAM-1 (platelet endothelial cell adhesion molecule, sCD31) were not different from healthy subjects at M0. This study shows that two adhesion molecules, shed as soluble forms, are elevated during the acute phase of leptospirosis: E-selectin and s-ICAM1. These molecules may interfere with the process of immune cell recruitment to clear Leptospira at tissue levels.
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Affiliation(s)
- Loic Raffray
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Laboratoire de Biologie, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- Internal Medicine Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- * E-mail: (LR); (PG)
| | - Claude Giry
- Microbiology/Virology Laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Yoga Thirapathi
- Internal Medicine Unit, GHER Hospital, St Benoit, La Réunion, France
| | - Anne-Hélène Reboux
- Nephrology Dialysis and Transplantation Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Marie-Christine Jaffar-Bandjee
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Microbiology/Virology Laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Philippe Gasque
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Laboratoire de Biologie, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- * E-mail: (LR); (PG)
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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; 11:e0166184. [PMID: 27835672 PMCID: PMC5106024 DOI: 10.1371/journal.pone.0166184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/24/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Aquaporins and ion channels are membrane proteins that facilitate the rapid movement of water and solutes across biological membranes. Experimental and in vitro studies reported that the function of these channels and pulmonary edema resolution are impaired in acute lung injury (ALI). Although current evidence indicates that alveolar fluid clearance is impaired in patients with ALI/diffuse alveolar damage (DAD), few human studies have addressed the alterations in pulmonary channels in this clinical condition. Additionally, it is not known whether the primary cause of DAD is a relevant variable for the channel dysfunction. METHODS Autopsied lungs of 43 patients with acute respiratory failure (ARF) due to DAD of three different etiologies, non-pulmonary sepsis, H1N1 viral infection and leptospirosis, were compared to 18 normal lungs. We quantified the expression of aquaporin (AQP) 1, AQP3, AQP5, epithelial Na+ channel (ENaC) and sodium potassium ATPase (Na-K-ATPase) in the alveolar septum using immunohistochemistry and image analysis. RESULTS The DAD group presented with increased expression of AQP3, AQP5 and Na-K-ATPase and decreased expression of ENaC compared to controls. However, there was no difference in protein expression within the DAD groups of different etiologies. CONCLUSION Water and ion channels are altered in patients with ARF due to DAD. The cause of DAD does not seem to influence the level of impairment of these channels.
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Affiliation(s)
- Ruy Camargo Pires-Neto
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Priscila Alves de Araujo
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Mauad
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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15
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Raffray L, Giry C, Vandroux D, Kuli B, Randrianjohany A, Pequin AM, Renou F, Jaffar-Bandjee MC, Gasque P. Major Neutrophilia Observed in Acute Phase of Human Leptospirosis Is Not Associated with Increased Expression of Granulocyte Cell Activation Markers. PLoS One 2016; 11:e0165716. [PMID: 27802348 PMCID: PMC5089758 DOI: 10.1371/journal.pone.0165716] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/17/2016] [Indexed: 01/13/2023] Open
Abstract
It has long been known that pathogenic Leptospira can mobilize the immune system but the specific contribution of neutrophils to control the infectious challenge remains to be clarified. We herein analyzed the phenotype of circulating neutrophils of patients with leptospirosis and healthy controls for the expression of toll-like receptor (TLR) type 2 (TLR2, to sense the leptospiral LPS) and several activation markers: interleukin 8 chemokine receptor CD182 (CXCR2), CD11b of the integrin/opsonin complement receptor type 3 (CR3) and CD15 (ligand of the selectin). The plasmatic level of the main CD182 ligand, interleukin 8 (CXCL8), was measured by ELISA. Hospitalized leptospirosis cases showed marked neutrophilia, particularly in the most severe cases. Interestingly, TLR2 was significantly increased in leptospirosis but identical levels of CD182 and CD11b were detected when compared to controls. CD15 was significantly decreased on neutrophils in leptospirosis but returned to normal within 1 month. Basal levels of IL-8 were measured in control subjects and were not increased in leptospirosis cases at the initial stage of the disease. In conclusion, we observed that neutrophils failed to regulate the expression of several of the receptors involved in cell activation and recruitment. This study further emphasizes the paradigm that neutrophils may be impaired in their overall capacity to thwart bacterial infection in leptospirosis patients.
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Affiliation(s)
- Loic Raffray
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Laboratoire d’immunologie clinique et expérimentale ZOI (LICE OI), CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- Internal Medicine Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- * E-mail:
| | - Claude Giry
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Microbiology/Virology Laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - David Vandroux
- Intensive Care Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Barbara Kuli
- Infectious Diseases Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | | | - Anne-Marie Pequin
- Hematology laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Frédéric Renou
- Internal Medicine Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Marie-Christine Jaffar-Bandjee
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Microbiology/Virology Laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Philippe Gasque
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Laboratoire d’immunologie clinique et expérimentale ZOI (LICE OI), CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
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16
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Cleto SA, Rodrigues CE, Malaque CM, Sztajnbok J, Seguro AC, Andrade L. Hemodiafiltration Decreases Serum Levels of Inflammatory Mediators in Severe Leptospirosis: A Prospective Study. PLoS One 2016; 11:e0160010. [PMID: 27487001 PMCID: PMC4972362 DOI: 10.1371/journal.pone.0160010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/12/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Leptospirosis is a health problem worldwide. Its most severe form is a classic model of sepsis, provoking acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), with associated mortality that remains unacceptably high. We previously demonstrated that early initiation of sustained low-efficiency dialysis (SLED) followed by daily SLED significantly decreases mortality. However, the mode of clearance can also affect dialysis patient outcomes. Therefore, the objective of this study was to compare the effects of SLED with traditional (diffusive) clearance, via hemodialysis, and SLED with convective clearance, via hemodiafiltration (SLEDf), in patients with severe leptospirosis. METHODS In this prospective study, conducted in the intensive care unit (ICU) from 2009 through 2012, we compared two groups-SLED (n = 19) and SLEDf (n = 20)-evaluating demographic, clinical, and biochemical parameters, as well as serum levels of interleukins, up to the third day after admission. All patients received dialysis early and daily thereafter. RESULTS During the study period, 138 patients were admitted to our ICU with a diagnosis of leptospirosis; 39 (36 males/3 females) met the criteria for ARDS and AKI. All patients were on mechanical ventilation and were comparable in terms of respiratory parameters. Mortality did not differ between the SLEDf and SLED groups. However, post-admission decreases in the serum levels of interleukin (IL)-17, IL-7, and monocyte chemoattractant protein-1 were significantly greater in the SLEDf group. Direct bilirubin and the arterial oxygen tension/fraction of inspired oxygen ratio were significantly higher in the SLED group. We identified the following risk factors (sensitivities/specificities) for mortality in severe leptospirosis: age ≥ 55 years (67%/91%); serum urea ≥ 204 mg/dl (100%/70%); creatinine ≥ 5.2 mg/dl (100%/58%); Acute Physiology and Chronic Health Evaluation II score ≥ 39.5 (67%/88%); Sequential Organ Failure Assessment score ≥ 20.5 (67%/85%); and inspiratory pressure ≥ 31 mmHg (84%/85%). CONCLUSIONS The mode of dialysis clearance might not affect outcomes in severe leptospirosis.
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Affiliation(s)
| | | | - Ceila Maria Malaque
- Intensive Care Unit, Emílio Ribas Institute of Infectology, Sao Paulo, Brazil
| | - Jaques Sztajnbok
- Intensive Care Unit, Emílio Ribas Institute of Infectology, Sao Paulo, Brazil
| | - Antônio Carlos Seguro
- Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Lúcia Andrade
- Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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17
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Specific CD4+ T-Cell Reactivity and Cytokine Release in Different Clinical Presentations of Leptospirosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:1276-84. [PMID: 26491036 DOI: 10.1128/cvi.00397-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/14/2015] [Indexed: 02/06/2023]
Abstract
Clinical manifestations of leptospirosis are highly variable: from asymptomatic to severe and potentially fatal. The outcome of the disease is usually determined in the immunological phase, beginning in the second week of symptoms. The underlying mechanisms, predictive factors, and individual immune responses that contribute to clinical variations are not well understood. The aim of this study was to determine the specifics of CD4(+) T-cell reactivity and cytokine release after stimulation with leptospiral antigens in patients with leptospirosis of different disease severities (patients with mild and severe symptoms) and in control subjects (with and without proven exposure to Leptospira). Whole-blood specimens were stimulated with Leptospira antigens in vitro. Subsequently, intracellular staining of cytokines was performed, and flow cytometry was used to assess the expression of CD40 ligand (CD40L) and the production of gamma interferon (IFN-γ), interleukin-10 (IL-10), IL-2, and tumor necrosis factor alpha (TNF-α) by CD4(+) T cells. The production of inflammatory cytokines such as TNF-α by CD4(+) T cells after stimulation with leptospiral antigens was highest in patients with severe disease. In contrast, the ratio of IL-10 production to TNF-α production was higher in exposed subjects than in patients with mild and severe disease. Levels of proinflammatory cytokines such as TNF-α may be useful markers of the severity of the immunological phase of leptospirosis. IL-10 production by T cells after antigen-specific stimulation may indicate a more successful downregulation of the inflammatory response and may contribute to an asymptomatic course of the disease.
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18
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Schuller S, Callanan JJ, Worrall S, Francey T, Schweighauser A, Kohn B, Klopfleisch R, Posthaus H, Nally JE. Immunohistochemical detection of IgM and IgG in lung tissue of dogs with leptospiral pulmonary haemorrhage syndrome (LPHS). Comp Immunol Microbiol Infect Dis 2015; 40:47-53. [PMID: 25963899 DOI: 10.1016/j.cimid.2015.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/30/2015] [Accepted: 04/21/2015] [Indexed: 12/31/2022]
Abstract
Leptospiral pulmonary haemorrhage syndrome (LPHS) is a severe form of leptospirosis. Pathogenic mechanisms are poorly understood. Lung tissues from 26 dogs with LPHS, 5 dogs with pulmonary haemorrhage due to other causes and 6 healthy lungs were labelled for IgG (n=26), IgM (n=25) and leptospiral antigens (n=26). Three general staining patterns for IgG/IgM were observed in lungs of dogs with LPHS with most tissues showing more than one staining pattern: (1) alveolar septal wall staining, (2) staining favouring alveolar surfaces and (3) staining of intra-alveolar fluid. Healthy control lung showed no staining, whereas haemorrhagic lung from dogs not infected with Leptospira showed staining of intra-alveolar fluid and occasionally alveolar septa. Leptospiral antigens were not detected. We conclude that deposition of IgG/IgM is demonstrable in the majority of canine lungs with naturally occurring LPHS, similar to what has been described in other species. Our findings suggest involvement of the host humoral immunity in the pathogenesis of LPHS and provide further evidence to support the dog as a natural disease model for human LPHS.
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Affiliation(s)
- Simone Schuller
- University College Dublin, School of Veterinary Medicine, Dublin, Ireland; Vetsuisse Faculty Bern, Länggassstrasse 128, 3012 Bern, Switzerland.
| | - John J Callanan
- University College Dublin, School of Veterinary Medicine, Dublin, Ireland; Ross University School of Veterinary Medicine, St Kitts, West Indies
| | - Sheila Worrall
- University College Dublin, School of Veterinary Medicine, Dublin, Ireland
| | - Thierry Francey
- Vetsuisse Faculty Bern, Länggassstrasse 128, 3012 Bern, Switzerland
| | | | - Barbara Kohn
- FU Berlin, Robert-von-Ostertag-Str. 15, 14163 Berlin, Germany
| | | | - Horst Posthaus
- Vetsuisse Faculty Bern, Länggassstrasse 128, 3012 Bern, Switzerland
| | - Jarlath E Nally
- University College Dublin, School of Veterinary Medicine, Dublin, Ireland
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19
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Schuller S, Sergeant K, Renaut J, Callanan JJ, Scaife C, Nally JE. Comparative proteomic analysis of lung tissue from guinea pigs with leptospiral pulmonary haemorrhage syndrome (LPHS) reveals a decrease in abundance of host proteins involved in cytoskeletal and cellular organization. J Proteomics 2015; 122:55-72. [PMID: 25818725 DOI: 10.1016/j.jprot.2015.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/20/2015] [Accepted: 03/08/2015] [Indexed: 12/17/2022]
Abstract
UNLABELLED Leptospiral pulmonary haemorrhage syndrome (LPHS) is a particularly severe form of leptospirosis. LPHS is increasingly recognized in both humans and animals and is characterized by rapidly progressive intra-alveolar haemorrhage leading to high mortality. The pathogenic mechanisms of LPHS are poorly understood which hampers the application of effective treatment regimes. In this study a 2-D guinea pig proteome lung map was created and used to investigate the pathogenic mechanisms of LPHS. Comparison of lung proteomes from infected and non-infected guinea pigs via differential in-gel electrophoresis revealed highly significant differences in abundance of proteins contained in 130 spots. Acute phase proteins were the largest functional group amongst proteins with increased abundance in LPHS lung tissue, and likely reflect a local and/or systemic host response to infection. The observed decrease in abundance of proteins involved in cytoskeletal and cellular organization in LPHS lung tissue further suggests that infection with pathogenic Leptospira induces changes in the abundance of host proteins involved in cellular architecture and adhesion contributing to the dramatically increased alveolar septal wall permeability seen in LPHS. BIOLOGICAL SIGNIFICANCE The recent completion of the complete genome sequence of the guinea pig (Cavia porcellus) provides innovative opportunities to apply proteomic technologies to an important animal model of disease. In this study, the comparative proteomic analysis of lung tissue from experimentally infected guinea pigs with leptospiral pulmonary haemorrhage syndrome (LPHS) revealed a decrease in abundance of proteins involved in cellular architecture and adhesion, suggesting that loss or down-regulation of cytoskeletal and adhesion molecules plays an important role in the pathogenesis of LPHS. A publically available guinea pig lung proteome map was constructed to facilitate future pulmonary proteomics in this species.
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Affiliation(s)
- Simone Schuller
- University College Dublin, School of Veterinary Medicine, Belfield, Dublin 4, Ireland; Vetsuisse Faculty University of Bern, Länggassstrasse 128, 3012 Bern, Switzerland.
| | - Kjell Sergeant
- Luxembourg Institute of Science and Technology, Environmental Research and Innovation" (ERIN) department, 41, rue du Brill, 4422 Belvaux, Luxembourg
| | - Jenny Renaut
- Luxembourg Institute of Science and Technology, Environmental Research and Innovation" (ERIN) department, 41, rue du Brill, 4422 Belvaux, Luxembourg
| | - John J Callanan
- University College Dublin, School of Veterinary Medicine, Belfield, Dublin 4, Ireland; Conway Institute for Biomolecular & Biomedical Research, Belfield, Dublin 4, Ireland; Ross University School of Veterinary Medicine, St Kitts and Nevis, West Indies
| | - Caitriona Scaife
- Conway Institute for Biomolecular & Biomedical Research, Belfield, Dublin 4, Ireland
| | - Jarlath E Nally
- University College Dublin, School of Veterinary Medicine, Belfield, Dublin 4, Ireland; Conway Institute for Biomolecular & Biomedical Research, Belfield, Dublin 4, Ireland; Bacterial Diseases of Livestock Research Unit, National Animal Disease Center, Agricultural Research Service, Department of Agriculture, Ames, IA 50010, USA
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20
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Abstract
Pathogenic Leptospira has the capacity to infect a broad range of mammalian hosts. Leptospirosis may appear as an acute, potentially fatal infection in accidental hosts, or progress into a chronic, largely asymptomatic infection in natural maintenance hosts. The course that Leptospira infection follows is dependent upon poorly understood factors, but is heavily influenced by both the host species and bacterial serovar involved in infection. Recognition of pathogen-associated molecular patterns (PAMPs) by a variety of host pattern recognition receptors (PRRs) activates the host immune system. The outcome of this response may result in bacterial clearance, limited bacterial colonization of a few target organs, principally the kidney, or induction of sepsis as the host succumbs to infection and dies. This chapter describes current knowledge of how the host recognizes Leptospira and responds to infection using innate and acquired immune responses. Aspects of immune-mediated pathology and pathogen strategies to evade the host immune response are also addressed.
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Affiliation(s)
- Richard L Zuerner
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University for Agricultural Sciences, 75007, Uppsala, Sweden,
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21
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Gonçalves-de-Albuquerque CF, Burth P, Silva AR, de Moraes IMM, Oliveira FMDJ, Santelli RE, Freire AS, de Lima GS, da Silva ED, da Silva CI, Morandi V, Bozza PT, Younes-Ibrahim M, de Castro Faria Neto HC, de Castro Faria MV. Murine lung injury caused by Leptospira interrogans glycolipoprotein, a specific Na/K-ATPase inhibitor. Respir Res 2014; 15:93. [PMID: 25265888 PMCID: PMC4151191 DOI: 10.1186/s12931-014-0093-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/31/2014] [Indexed: 12/15/2022] Open
Abstract
Background Leptospiral glycolipoprotein (GLP) is a potent and specific Na/K-ATPase inhibitor. Severe pulmonary form of leptospirosis is characterized by edema, inflammation and intra-alveolar hemorrhage having a dismal prognosis. Resolution of edema and inflammation determines the outcome of lung injury. Na/K-ATPase activity is responsible for edema clearance. This enzyme works as a cell receptor that triggers activation of mitogen-activated protein kinase (MAPK) intracellular signaling pathway. Therefore, injection of GLP into lungs induces injury by triggering inflammation. Methods We injected GLP and ouabain, into mice lungs and compared their effects. Bronchoalveolar lavage fluid (BALF) was collected for cell and lipid body counting and measurement of protein and lipid mediators (PGE2 and LTB4). The levels of the IL-6, TNFα, IL-1B and MIP-1α were also quantified. Lung images illustrate the injury and whole-body plethysmography was performed to assay lung function. We used Toll-like receptor 4 (TLR4) knockout mice to evaluate leptospiral GLP-induced lung injury. Na/K-ATPase activity was determined in lung cells by nonradioactive rubidium incorporation. We analyzed MAPK p38 activation in lung and in epithelial and endothelial cells. Results Leptospiral GLP and ouabain induced lung edema, cell migration and activation, production of lipid mediators and cytokines and hemorrhage. They induced lung function alterations and inhibited rubidium incorporation. Using TLR4 knockout mice, we showed that the GLP action was not dependent on TLR4 activation. GLP activated of p38 and enhanced cytokine production in cell cultures which was reversed by a selective p38 inhibitor. Conclusions GLP and ouabain induced lung injury, as evidenced by increased lung inflammation and hemorrhage. To our knowledge, this is the first report showing GLP induces lung injury. GLP and ouabain are Na/K-ATPase targets, triggering intracellular signaling pathways. We showed p38 activation by GLP-induced lung injury, which was may be linked to Na/K-ATPase inhibition. Lung inflammation induced by GLP was not dependent on TLR4 activation.
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Shintaku M, Itoh H, Tsutsumi Y. Weil's disease (leptospirosis) manifesting as fulminant hepatic failure: report of an autopsy case. Pathol Res Pract 2014; 210:1134-7. [PMID: 24997567 DOI: 10.1016/j.prp.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/18/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
We report an autopsy case of a 60-year-old man with Weil's disease who died of fulminant hepatic failure. Ante-mortem blood culture yielded the growth of Leptospira interrogans (serovar icterohaemorrhagiae). At autopsy, the liver weighed 1210 g and showed a typical appearance of "acute yellow liver atrophy". Zone 3 (centrilobular region) showed submassive necrosis of hepatocytes accompanied by marked hemorrhage. Hepatocytes in zones 1 and 2 were well preserved, and the leptospira antigen was immunohistochemically demonstrated in several hepatocytes. Dissociation of liver cell plates was not observed. An immunohistochemical study demonstrated that CD31-positive, sinusoidal endothelial cells had almost completely disappeared in zone 3. This finding suggested that severe and selective damage to endothelial cells in zone 3 was the main cause of the submassive hepatocellular necrosis, which led to fulminant hepatic failure in the present case.
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Affiliation(s)
| | - Hirotaka Itoh
- Department of Rheumatology, Osaka Red Cross Hospital, Japan
| | - Yutaka Tsutsumi
- Department of Pathology, Fujita Health University School of Medicine, Japan
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23
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Evangelista K, Franco R, Schwab A, Coburn J. Leptospira interrogans binds to cadherins. PLoS Negl Trop Dis 2014; 8:e2672. [PMID: 24498454 PMCID: PMC3907533 DOI: 10.1371/journal.pntd.0002672] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/16/2013] [Indexed: 11/19/2022] Open
Abstract
Leptospirosis, caused by pathogenic species of Leptospira, is the most widespread zoonosis and has emerged as a major public health problem worldwide. The adhesion of pathogenic Leptospira to host cells, and to extracellular matrix (ECM) components, is likely to be necessary for the ability of leptospires to penetrate, disseminate and persist in mammalian host tissues. Previous work demonstrated that pathogenic L. interrogans binds to host cells more efficiently than to ECM. Using two independent screening methods, mass spectrometry and protein arrays, members of the cadherin family were identified as potential L. interrogans receptors on mammalian host surfaces. We focused our investigation on vascular endothelial (VE)-cadherin, which is widely expressed on endothelia and is primarily responsible for endothelial cell-cell adhesion. Monolayers of EA.hy926 and HMEC-1 endothelial cells produce VE-cadherin, bind L. interrogans in vitro, and are disrupted upon incubation with the bacteria, which may reflect the endothelial damage seen in vivo. Dose-dependent and saturable binding of L. interrogans to the purified VE-cadherin receptor was demonstrated and pretreatment of purified receptor or endothelial cells with function-blocking antibody against VE-cadherin significantly inhibited bacterial attachment. The contribution of VE-cadherin to leptospiral adherence to host endothelial cell surfaces is biologically significant because VE-cadherin plays an important role in maintaining the barrier properties of the vasculature. Attachment of L. interrogans to the vasculature via VE-cadherin may result in vascular damage, facilitating the escape of the pathogen from the bloodstream into different tissues during disseminated infection, and may contribute to the hemorrhagic manifestations of leptospirosis. This work is first to describe a mammalian cell surface protein as a receptor for L. interrogans.
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Affiliation(s)
- Karen Evangelista
- Graduate Program in Microbiology, Immunology, and Molecular Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Ricardo Franco
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Andrew Schwab
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Jenifer Coburn
- Graduate Program in Microbiology, Immunology, and Molecular Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
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24
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Chirathaworn C, Kongpan S. Immune responses to Leptospira infection: roles as biomarkers for disease severity. Braz J Infect Dis 2013; 18:77-81. [PMID: 24275371 PMCID: PMC9425245 DOI: 10.1016/j.bjid.2013.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/18/2013] [Accepted: 08/27/2013] [Indexed: 12/12/2022] Open
Abstract
Various leptospiral components have been identified and shown to be involved in tissue destruction. In addition, immune responses to leptospires have been implicated in target organ damages in severe leptospirosis cases. Several inflammatory mediators were shown to be higher in susceptible animals than in resistant hosts. Moreover, cytokines/chemokines and serum proteins induced following Leptospira infection were suggested to be biomarkers for disease severity in human leptospirosis. This review focuses on the role of immune responses in the severity of leptospirosis. Studies in both animal models and humans are discussed.
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Affiliation(s)
- Chintana Chirathaworn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Sutthikarn Kongpan
- Master of Science Program in Medical Sciences, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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25
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De Brito T, Aiello VD, da Silva LFF, Gonçalves da Silva AM, Ferreira da Silva WL, Castelli JB, Seguro AC. Human hemorrhagic pulmonary leptospirosis: pathological findings and pathophysiological correlations. PLoS One 2013; 8:e71743. [PMID: 23951234 PMCID: PMC3741125 DOI: 10.1371/journal.pone.0071743] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/26/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Leptospirosis is a re-emerging zoonosis with protean clinical manifestations. Recently, the importance of pulmonary hemorrhage as a lethal complication of this disease has been recognized. In the present study, five human necropsies of leptospirosis (Weil's syndrome) with extensive pulmonary manifestations were analysed, and the antibodies expressed in blood vessels and cells involved in ion and water transport were used, seeking to better understand the pathophysiology of the lung injury associated with this disease. PRINCIPAL FINDINGS Prominent vascular damage was present in the lung microcirculation, with decreased CD34 and preserved aquaporin 1 expression. At the periphery and even inside the extensive areas of edema and intraalveolar hemorrhage, enlarged, apparently hypertrophic type I pneumocytes (PI) were detected and interpreted as a non-specific attempt of clearence of the intraalveolar fluid, in which ionic transport, particularly of sodium, plays a predominant role, as suggested by the apparently increased ENaC and aquaporin 5 expression. Connexin 43 was present in most pneumocytes, and in the cytoplasm of the more preserved endothelial cells. The number of type II pneumocytes (PII) was slightly decreased when compared to normal lungs and those of patients with septicemia from other causes, a fact that may contribute to the progressively low PI count, resulting in deficient restoration after damage to the alveolar epithelial integrity and, consequently, a poor outcome of the pulmonary edema and hemorrhage. CONCLUSIONS Pathogenesis of lung injury in human leptospirosis was discussed, and the possibility of primary non-inflammatory vascular damage was considered, so far of undefinite etiopathogenesis, as the initial pathological manifestation of the disease.
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Affiliation(s)
- Thales De Brito
- Institute of Tropical Medicine, São Paulo University Medical School, São Paulo, Brazil.
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Ranawaka N, Jeevagan V, Karunanayake P, Jayasinghe S. Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- a case report and literature survey. BMC Infect Dis 2013; 13:38. [PMID: 23347428 PMCID: PMC3560203 DOI: 10.1186/1471-2334-13-38] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 01/23/2013] [Indexed: 01/06/2023] Open
Abstract
Background Leptospirosis is a potentially fatal disease which can cause multi-organ dysfunction. It can rarely present as acute pancreatitis. This is the first ever report of leptospirosis presenting with acute pancreatitis and myocarditis followed by diffuse pulmonary hemorrhages to the best of our knowledge. Case presentation A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission. He developed tachycardia, transient hypotension, changes of electro-cardiogram and positive troponin I suggestive of myocarditis. Acute pancreatitis was diagnosed with 12 fold high serum amylase and with the evidence of computerized tomography. Then he developed diffuse pulmonary hemorrhages and later acute renal failure. Leptospirosis was confirmed by positive leptospira IgM, negative IgG and strongly positive Microscopic Agglutination Test. Other possible infective and autoimmune causes were excluded. Patient recovered completely with antibiotics and the supportive care. Conclusion This case illustrates diagnostic difficulties especially in resource poor settings where leptospirosis is common. Additionally it highlights the fact that leptospirosis should be considered in patients presenting with pancreatitis which can be complicated with myocarditis and diffuse pulmonary hemorrhages. We hypothesize that Toll like receptors may play a role in such systemic involvement.
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Affiliation(s)
- Nuwan Ranawaka
- University Medical Unit, National Hospital of Sri Lanka, Colombo, 10, 01000, Sri Lanka.
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von Ranke FM, Zanetti G, Hochhegger B, Marchiori E. Infectious diseases causing diffuse alveolar hemorrhage in immunocompetent patients: a state-of-the-art review. Lung 2012; 191:9-18. [PMID: 23128913 PMCID: PMC7102311 DOI: 10.1007/s00408-012-9431-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/10/2012] [Indexed: 12/19/2022]
Abstract
Diffuse alveolar hemorrhage (DAH) represents a syndrome that can complicate many clinical conditions and may be life-threatening, requiring prompt treatment. It is recognized by the signs of acute- or subacute-onset cough, hemoptysis, diffuse radiographic pulmonary infiltrates, anemia, and hypoxemic respiratory distress. DAH is characterized by the accumulation of intra-alveolar red blood cells originating most frequently from the alveolar capillaries. It must be distinguished from localized pulmonary hemorrhage, which is most commonly due to chronic bronchitis, bronchiectasis, tumor, or localized infection. Hemoptysis, the major sign of DAH, may develop suddenly or over a period of days to weeks; this sign may also be initially absent, in which case diagnostic suspicion is established after sequential bronchoalveolar lavage reveals worsening red blood cell counts. The causes of DAH can be divided into infectious and noninfectious, the latter of which may affect immunocompetent or immunodeficient patients. Pulmonary infections are rarely reported in association with DAH, but they should be considered in the diagnostic workup because of the obvious therapeutic implications. In immunocompromised patients, the main infectious diseases that cause DAH are cytomegalovirus, adenovirus, invasive aspergillosis, Mycoplasma, Legionella, and Strongyloides. In immunocompetent patients, the infectious diseases that most frequently cause DAH are influenza A (H1N1), dengue, leptospirosis, malaria, and Staphylococcus aureus infection. Based on a search of the PubMed and Scopus databases, we review the infectious diseases that may cause DAH in immunocompetent patients.
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Affiliation(s)
- Felipe Mussi von Ranke
- Department of Radiology, Federal University of Rio de Janeiro, 438 Rua Thomaz Cameron, Valparaiso, Petrópolis, RJ, CEP 25685.120, Brazil
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