RESUMO
Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70 percent of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.
Assuntos
Animais , Humanos , Leptospirose/patologia , Pneumopatias/patologia , Alvéolos Pulmonares/patologia , Modelos Animais de Doenças , Hemoptise/microbiologia , Hemoptise/patologia , Leptospirose/complicações , Pneumopatias/microbiologia , Alvéolos Pulmonares/microbiologia , Síndrome do Desconforto Respiratório/microbiologia , Síndrome do Desconforto Respiratório/patologiaRESUMO
Brazilian spotted fever, caused by Rickettsia rickettsii, has been increasingly reported in Brazil especially in the southeastern states. The severe and fulminant forms of the disease are not unusual but most of the reported fatal cases have shown some typical clinical clue, which leads the attending physician to a correct diagnosis. We report a probable case of atypical fulminant Brazilian spotted fever that presented full-blown septic shock associated with Adult Respiratory Distress Syndrome (ARDS) and delayed uncharacteristic rash with an over four-fold increase in reciprocal IgM, but not IgG titer against Rickettsia rickettsii. Brazilian practitioners should be aware of the possibility of Brazilian spotted fever as a cause of fulminant primary sepsis with ARDS; improved laboratory methods are necessary for the rapid diagnosis of such cases.
Assuntos
Adolescente , Humanos , Masculino , Choque Séptico/complicações , Choque Séptico/microbiologia , Rickettsia rickettsii , Infecções por Rickettsiaceae , Síndrome do Desconforto Respiratório/complicações , Síndrome do Desconforto Respiratório/microbiologia , Anti-Infecciosos , Choque Séptico/tratamento farmacológico , Evolução Fatal , Rickettsia rickettsii , Infecções por Rickettsiaceae , Testes Sorológicos , Síndrome do Desconforto Respiratório/tratamento farmacológicoRESUMO
A patient of dengue hemorrhagic fever who progressed into acute respiratory distress syndrome (ARDS) is reported. The patient recovered after mechanical ventilation and supportive treatment.