Leptospirosis of the lung: radiographic findings in 58 patients

Leptospirosis is the disease produced by any of the group of spirochetes of the genus Leptospira. The main organs involved are the liver, central nervous system, kidneys, skeletal muscle, and lungs. Thirty-seven (64%) of 58 patients with leptospirosis, proved by positive serology, had pulmonary radiographic findings. Three radiographic patterns were evident: (1) 21 (57%) of the 37 patients had small nodular densities, (2) six (16%) had large confluent areas of consolidation, and (3) 10 (27%) had diffuse, ill-defined, ground-glass density. Serial radiographs showed a tendency for the nodular pattern to be followed by confluent consolidation and/or ground-glass density. Abnormalities were bilateral, nonlobar in all cases, and had a marked tendency toward peripheral predominance. Pulmonary abnormalities resolved within 15 days, except in eight patients who died because of respiratory failure (six patients) or other causes (two patients). In order to correlate pathology with the radiographic findings, Leptospira, isolated from a patient, was injected intraperitoneally into 20 guinea pigs. All lungs from the guinea pigs showed petecheal hemorrhage, which progressed to large confluent areas of hemorrhage. The typical pulmonary radiographic findings of leptospirosis are compatible with the multifocal pulmonary hemorrhage seen in the guinea pigs.

Sonographic renal findings in 20 dogs with leptospirosis

Abdominal ultrasound examinations of 20 dogs with confirmed leptospirosis were reviewed retrospectively for renal abnormalities. Three dogs had a normal ultrasound examination. The remaining 17 dogs had sonographic abnormalities of the kidneys. These abnormalities, seen either alone or in combination, included renalmegaly (n=10), pyelectasia (n=9), increased cortical echogenicity (n=15), perinephric effusion (n=5), and a medullary band of increased echogenicity (n=6). At our institution, the medullary band of increased echogenicity has only been seen in dogs with leptospirosis and may therefore be a specific sonographic sign for this disease.

Radiographic findings in the thorax of dogs with leptospiral infection

Thoracic radiographs of 4 dogs with confirmed and 1 dog with suspected leptospirosis were reviewed. In all dogs a reticulonodular pulmonary opacity was noted, affecting the entire lung in 3 and predominantly the caudodorsal lung field in 2 dogs. The radiographic lung pattern described is associated with pulmonary hemorrhage probably due to endothelial damage and vasculitis. Pulmonary manifestations in dogs with leptospirosis may be misinterpreted and attributed to neoplasia, pneumonia, edema, hemorrhage due to disseminated intravascular coagulopathy, adult respiratory distress syndrome and pulmonary thromboembolism.

Leptospirosis associated with severe pulmonary haemorrhage in Far North Queensland

Pulmonary haemorrhage as a manifestation of leptospirosis is rarely diagnosed in developed countries. Five patients with proven leptospirosis associated with severe pulmonary haemorrhage presented to one hospital in Far North Queensland between January 1994 and June 1997. Four required admission to the intensive care unit and one patient died. Pulmonary haemorrhage is an uncommon but severe complication of leptospirosis and may be a source of diagnostic confusion in tropical areas of Australia.

Leptospirosis of the lung: high-resolution computed tomography findings in five patients

The authors report the high-resolution computed tomography findings in five patients with diffuse pulmonary hemorrhage caused by serologically proven leptospirosis. The main findings consisted of extensive ground-glass opacities and patchy areas of airspace consolidation.

Lung manifestations in leptospirosis

Two cases of leptospirosis presenting with cough and haemoptysis are described, together with their pulmonary radiological features. The various radiological chest findings are reviewed together with the pathogenesis and pathology of the lesions. Although the pulmonary involvement due to a haemorrhagic pneumonitis in leptospirosis is usually an incidental finding, occasionally it is the most pronounced clinical manifestation of the disease, and may present a difficult diagnostic problem. It has to be considered in the differential diagnosis of diffuse miliary infiltrations or consolidation seen on the chest radiographs, especially in countries where both pulmonary tuberculosis and leptospirosis are not uncommon diseases.

Acute pancreatitis caused by leptospirosis: Report of two cases

Two cases of acute pancreatitis with leptospirosis are reported in this article. Case 1: A 68-year-old woman, presented initially with abdominal pain, nausea, vomiting, and jaundice. She was in poor general condition, and had acute abdominal signs and symptoms on physical examination. Emergency laparotomy was performed, acute pancreatitis and leptospirosis were diagnosed on the basis of surgical findings and serological tests. The patient died on postoperative d 6. Case 2: A 62-year-old man, presented with fever, jaundice, nausea, vomiting, and malaise. Acute pancreatitis associated with leptospirosis was diagnosed, according to abdominal CT scanning and serological tests. The patient recovered fully with antibiotic treatment and nutritional support within 19 d.

The chest radiograph in leptospirosis in Jamaica

A consecutive series of 44 patients with proven leptospirosis was studied to document the radiographic pulmonary abnormalities, assess their prevalence, correlate them with the clinical signs and symptoms and determine their prognostic significance. Abnormalities were found in ten patients (23%), this prevalence being less than previously noted. The abnormalities shown were non-segmental opacification (consolidation-eight cases), basal linear opacities (collapse-five cases) and pleural effusions (four cases). The first radiographic demonstration of a large pleural effusion in leptospirosis is recorded. Non-jaundiced patients had a higher prevalence (43%) of these abnormalities than jaundiced (13%). No other correlation with clinical signs or symptoms was found. The presence of these abnormalities had no prognostic significance. It is concluded that the presence of radiographic pulmonary abnormality in in-patients with leptospirosis is common. These abnormalities are non-specific and can mimic other diseases leading to diagnostic difficulty. Such abnormalities may be extensive in the absence of clinical signs and symptoms.

Leptospirosis and its pulmonary complications

OBJECTIVE

The aim of this study was to assess the incidence and factors associated with pulmonary complications of leptospirosis.

METHODOLOGY

In a retrospective study, patients with a definite diagnosis of leptospirosis following a 6-week period of severe flooding in Hadyai city, Thailand, were reviewed. Pulmonary complications of leptospirosis were defined as the occurrence of respiratory symptoms and an abnormal CXR. The clinical and laboratory test results for patients with and without pulmonary complications were compared.

RESULTS

Among the 157 patients with leptospirosis, eight patients had pulmonary complications. Three patients had acute renal failure (ARF) and pulmonary oedema. One patient had ARF and adult respiratory distress syndrome (ARDS). Two patients had ARF, congestive heart failure and pulmonary oedema. One patient had congestive heart failure and pulmonary oedema. One patient had only ARF. Factors associated with pulmonary complications were delayed antibiotic treatment and thrombocytopenia (platelet count < 100 x 10(9)/L). Three patients developed adult respiratory distress syndrome and one died from respiratory failure.

CONCLUSIONS

Pulmonary complications and death occur in a low percentage of patients with leptospirosis. Delayed antibiotic treatment and thrombocytopenia are risk factors for the development of pulmonary involvement in leptospirosis.

Lung abscess and reactive arthritis: rare complications of leptospirosis

Images

Thoracic Radiology of Infections Emerging After Natural Disasters

When natural disasters demolish shelter, destroy sources of clean drinking water, and disrupt the availability of medical care, vast numbers of people are placed at increased risk of disease. The infectious diseases that propagate under these conditions are usually common ones. Occasionally, a natural disaster alters the local environment in ways that markedly increase the prevalence of a disease that is endemic to a geographic region, occurring only as isolated cases under normal conditions. Many of these infections may affect the thorax. In this article, we discuss the radiologic findings of 4 infectious diseases, coccidioidomycosis, leptospirosis, melioidosis, and Chagas disease, which may flourish after natural disasters strike areas where they are endemic.

A case of leptospirosis and pregnancy

We present a case of leptospirosis presenting with jaundice at 28 weeks' gestation. We will discuss the clinical course and review the world literature.

Leptospirosis in pregnancy with pathological fetal cardiotocography changes

We report the case of a 33-year-old primigravida who presented at 37 weeks of gestation with symptoms suggestive of acute fatty liver of pregnancy, but was later diagnosed with leptospirosis (i.e. Weil’s disease or syndrome) on serological testing. Cardiotocography showed fetal distress, and an emergency Caesarean section was performed. A healthy neonate with no evidence of congenital leptospirosis was delivered. The patient was treated with intravenous ceftriaxone and discharged well 13 days after admission. Herein, we discuss the patient’s clinical presentation and the cardiotocography changes observed in leptospiral infection, and review the current literature.

A machine learning model of microscopic agglutination test for diagnosis of leptospirosis

Leptospirosis is a zoonosis caused by the pathogenic bacterium Leptospira. The Microscopic Agglutination Test (MAT) is widely used as the gold standard for diagnosis of leptospirosis. In this method, diluted patient serum is mixed with serotype-determined Leptospires, and the presence or absence of aggregation is determined under a dark-field microscope to calculate the antibody titer. Problems of the current MAT method are 1) a requirement of examining many specimens per sample, and 2) a need of distinguishing contaminants from true aggregates to accurately identify positivity. Therefore, increasing efficiency and accuracy are the key to refine MAT. It is possible to achieve efficiency and standardize accuracy at the same time by automating the decision-making process. In this study, we built an automatic identification algorithm of MAT using a machine learning method to determine agglutination within microscopic images. The machine learned the features from 316 positive and 230 negative MAT images created with sera of Leptospira-infected (positive) and non-infected (negative) hamsters, respectively. In addition to the acquired original images, wavelet-transformed images were also considered as features. We utilized a support vector machine (SVM) as a proposed decision method. We validated the trained SVMs with 210 positive and 154 negative images. When the features were obtained from original or wavelet-transformed images, all negative images were misjudged as positive, and the classification performance was very low with sensitivity of 1 and specificity of 0. In contrast, when the histograms of wavelet coefficients were used as features, the performance was greatly improved with sensitivity of 0.99 and specificity of 0.99. We confirmed that the current algorithm judges the positive or negative of agglutinations in MAT images and gives the further possibility of automatizing MAT procedure.

Chest radiograph abnormalities in patients hospitalized with leptospirosis in the city of Salvador, Bahia, Brazil

This study was designed to estimate the prevalence of pulmonary radiograph abnormalities and describe the distribution of the patterns of radiographic alterations among patients hospitalized with leptospirosis. Chest radiographs of 139 patients hospitalized with leptospirosis in Couto Maia Hospital, in Salvador, Bahia, Brazil, between July, 1997, and July, 1999, were analyzed. The radiographs were requested soon after hospital admission, independent of the clinical manifestations of the patients. Only the first radiograph was considered. Pulmonary radiograph alterations were recorded in 35/139 patients (25.2%); 95% mid-point confidence interval = 18.5% to 32.9%. Among the patients with radiograph alterations, alveolar infiltrate was seen in 26/35 (74.3%). The lesions were bilateral in 54.3% and located in the inferior lobes in 45.5%. Pleural effusion, represented by blunting of the costo-phrenic angle, was detected in 8.6% of the patients. The pattern of the pulmonary alterations, predominantly bilateral alveolar infiltrates, is consistent with the evidence that the basic pulmonary alteration in leptospirosis is a generalized capillaritis.

[Intra-alveolar hemorrhage associated with dengue and leptospirosis]

The intra-alveolar hemorrhage syndrome is defined by the presence of red cells in the alveolar lumen and can lead to acute respiratory failure. Among the infectious etiologies of this syndrome, leptospirosis is a common cause, whereas in dengue, the intra-alveolar hemorrhage is exceptional. We report a patient aged 46 years, with no particular history, who presented a clinical picture involving acute respiratory failure, hemoptysis, bilateral alveolar images and anemia. The intra-alveolar hemorrhage has been authenticated by bronchoalveolar lavage. The etiological showed infection by both dengue and leptospirosis.

A case of leptospirosis simulating colon cancer with liver metastases

We report a case of a 61-year-old man who presented with fatigue, abdominal pain and hepatomegaly. Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases. Due to the endoscopic finding of colon ulcer, colon cancer with liver metastases was suspected. Biochemically a slight increase of transaminases, alkaline phosphatase and gammaglutamyl transpeptidase were present; alpha-fetoprotein, carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal. Laboratory and instrumental investigations, including colon and liver biopsies revealed no signs of malignancy. In the light of spontaneous improvement of symptoms and CT findings, his personal history was reevaluated revealing direct contact with pigs and their tissues. Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira. After two mo, biochemical data, CT and colonoscopy were totally normal.

[Clinico-radiological observations on pulmonary manifestations of leptospirosis during the Montefeltro epidemic]

During the summer of 1984, in the Montefeltro area an epidemic of leptospirosis took place from a common source. In 15% of the people affected, the disease involved the lungs. In 3 patients the disease had a deadly course; one decrease was due to ARDS. The clinical, anatomopathological, and radiological features are described of the patients who presented with lung involvement. Such an outcome proved to be more likely than we thought. X-ray pattern of the chest was a polymorphous appearance, in spite of the same anatomopathological substratum, characterized by lung edema and endoalveolar hemorrhages.

Pulmonary radiographic findings in 118 leptospirosis patients

We retrospectively reviewed the medical records and chest radiographs of 118 patients who presented during January 1998 to October 2002 at Songklanagarin Hospital in Hat Yai, Songkhla Province, Thailand who had a high serum immunofluorescent assay titer for leptospirosis. Twenty-nine of 118 (24%) patients had abnormal chest films. Nearly all of these patients had respiratory symptoms and needed oxygen therapy (93% and 90%, respectively). Forty-eight of the 118 (40%) had respiratory symptoms, but only 27/48 (56%) had abnormal radiographs. Twenty-one of the 28 (75%) and 18/27 (67%) who had abnormal chest radiographs had coexisting impaired renal function or jaundice, respectively, whereas 21/69 (30%) of the patients who had impaired renal function and 18/55 (33%) of the patients with jaundice had abnormal radiographs. There were 6/27 (22%) patients who had abnormal chest radiographs without renal or liver impairment. The most common finding on the abnormal chest radiograph was bilateral diffuse air space disease, which resolved within 7 days. No permanent lung damage was seen. The patients who had an abnormal chest radiograph needed longer hospitalization, than those without an abnormal chest radiograph (average 12 days and 5 days, respectively).

Lemierre's syndrome mimicking leptospirosis

Lemierre's syndrome is a suppurative thrombophlebitis involving the internal jugular vein, most commonly associated with Fusobacterium necrophorum, usually a complication of oropharyngeal infections. This syndrome is rare and is often overlooked. We present a case of sepsis mimicking initially severe leptospirosis (Weil's disease) due to acute febrile illness with multiorgan failure and hyperbilirubinemia. Finally, blood cultures revealed Fusobacterium necrophorum and computed tomography (CT) demonstrated bilateral pulmonary nodules and a thrombus in the right internal jugular vein. Early clinical suspicion is crucial so that appropriate diagnostic investigation and antibiotic therapy can be initiated to minimize the risk of life-threatening complications.