Abstract
Leptospirosis is a relevant infectious disease when there is a patient with an ictero-hemorrhagic syndrome, especially in tropical countries such as Colombia. The following is the case of a 21-year-old male patient, with an acute clinical picture given by fever, elevated bilirubin, associated with diarrhea and thrombocytopenia. Initially, a presumptive diagnosis of dengue was made. However, during his evolution, he presented hemorrhage and respiratory distress with a hematic secretion that required endotracheal intubation. After inquiring about the epidemiological data, leptospirosis was considered a differential diagnosis. Serial serology for leptospira IgM was requested and was positive. It is essential to know this type of case due to pulmonary affections as a rare manifestation but highly associated with mortality. Finally, with adequate antibiotic and supportive management, a good clinical evolution of this patient was obtained.
References
Cortés JA, Romero Moreno LF, Aguirre León CA, Pinzón Lozano L, Cuervo SI. Enfoque clínico del síndrome febril agudo en Colombia. Infectio. 2017;21(1):39-50.
Romero-Vivas CM, Falconar AK. Leptospira spp. y leptospirosis humana. Salud Uninorte. 2016;32(1):123-43.
Bautista TB, Bulla CD, López BH, Díaz AA, Pulido MM. Leptospirosis: enfermedad de importancia en salud pública. Rev Colombiana Cienc Anim Recia. 2019;11(2):Artículo727.
Abela-Ridder B, Sikkema R, Hartskeerl RA. Estimating the burden of human leptospirosis. Int J Antimicrob Agents. 2010;36(supp-S1):S5–7.
Hartskeerl RA, Collares-Pereira M, Ellis WA. Emergence, control and re-emerging leptospirosis: Dynamics of infection in the changing world. Clin Microbiol Infect. 2011;17(4):494–501.
Taylor AJ, Paris DH, Newton PN. A systematic review of the mortality from untreated leptospirosis. PLoS Negl Trop Dis. 2015;9(6):2–19.
Pappas G, Papadimitriou P, Siozopoulou V, Christou L, Akritidis N. The globalization of leptospirosis: worldwide incidence trends. Int J Infect Dis. 2008;12(4):351–7.
Boletín Epidemiológico Semanal. Instituto Nacional de Salud de Colombia. Semana 52. [Internet]. 2021. p. 27. Available from: https://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2022_Bolet%C3%ADn_epidemiologico_semana_52.pdf.
LeptospirosisSociety WHO. World Health Organization/International LeptospirosisSociety. Human leptospirosis: guidance for diagnosis, surveillance and control. 2003.
Helmerhorst HJF, van Tol EN, Tuinman PR, de Vries PJ, Hartskeerl RA, Grobusch MP, et al. Severe pulmonary manifestation of leptospirosis. Neth J Med. 2012;70(5):215–21.
Marchiori E, Lourenço S, Setúbal S, Zanetti G, Gasparetto TD, Hochhegger B. Clinical and imaging manifestations of hemorrhagic pulmonary leptospirosis: A state of the art review. Lung. 2011;189(1):1–9.
Reyes P, Gil P, Escudero M. Hemorragia alveolar pulmonar como presentación poco frecuente de infección por Leptospira spp: una enfermedad ocupacional del personal militar en zonas tropicales. Rev Chil Enferm Respir. 2021;37:233–40.
Instituto Nacional de Salud. Protocolo de Vigilancia en Salud Pública de Leptospirosis. 2022. Versión 1.
Haake DA, Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol. 2015;387:65–97.
Carranza A, Chang D, Gutierrez Y. Leptospirosis y enfermedad de Weil. Rev Médica Sinerg. 2020;5(3).
Galloway RL, Schafer IJ, Stoddard RA. Chapter 4: Travel-Related Infectious Diseases. In: Brunette GW, editor. CDC Yellow Book 2020. New York: Oxford University Press; 2019. p. Leptospirosis.
Bunnell JE, Hice CL, Watts DM, Montrueil V, Tesg RB, Vinetz JM. Detection of pathogenic Leptospira spp. infections among mammals captured in the Peruvian Amazon basin region. Am J Trop Med Hyg. 2000;63(5):255–8.
Mattar S, Tique V, Miranda J, Montes E, Garzon D. Undifferentiated tropical febrile illness in Cordoba, Colombia: Not everything is dengue. J Infect Public Health. 2017;10(5):507–12.
Núñez-Garbín A, Espinoza-Figueroa J, Sihuincha-Maldonado M, Luis S-O. Coinfección por dengue y leptospirosis en una niña de la amazonía peruana. Rev Peru Med Exp Salud Publica. 2015;32(1):179–82.
Mosquera G, Vela F, Álvarez C. Reporte de catorce casos de leptospirosis en un hospital universitario de IV nivel entre 2010 y 2012. Univ Médica. 2014;55(1):93–100.
Picardeau M. Diagnosis and epidemiology of leptospirosis. Med Mal Infect. 2013;43(1):1–9.
Picardeau M, Bertherat E, Jancloes M, Skouloudis AN, Durski K, Hartskeerl RA. Rapid tests for diagnosis of leptospirosis: current tools and emerging technologies. Diagn Microbiol Infect Dis.2014;78(1):1–8.
Rojas-Jaimes J, Parrales-Donayre RM, Quispe-Anquise I. Cuadro ictérico hemorrágico grave causado por Leptospira interrogans Serovar Icterohaemorrhagiae. CES Med. 2016;30(2):244– 250.
Velásquez R, Pinedo JL. Hemorragia alveolar pulmonar como presentación inicial de leptospirosis. Rev Cuerpo Med HNAAA. 2017;10(3):152–4.
Abuauada MC, Osorio G, Rojas JL, Pino L. Leptospirosis: Presentación de una infección fulminante y revisión de la literatura. Rev Chilena Infectol. 2005;22(1):93–7.
Matos ED, Costa E, Sacramento E, Caymmi AL, Neto CA, Barreto M, et al. Chest radiograph abnormalities in patients hospitalized with leptospirosis in the city of Salvador, Bahia, Brazil. Braz J Infect Dis. 2001;5(2):73–7.
Von Ranke F, Zanetti G, Escuissato D, Hochhegger B, Marchiori E. Pulmonary leptospirosis with diffuse alveolar hemorrhage: High-resolution computed tomographic findings in 16 patients. J Comput Assist Tomogr. 2016;40(1):91–95.
Paganin F, Bourdin A, Dalban C, Courtin JP, Poubeau P, Borgherini G, et al. Leptospirosis in Reunion Island (Indian Ocean): Analysis of factors associated with severity in 147 confirmed cases. Intensive Care Med. 2007;33(11):1959– 1966.
Suputtamongkol Y, Niwattayakul K, Suttinont C, Losuwanaluk K, Limpaiboon R, Chierakul W, et al. An Open, Randomized, Controlled Trial of Penicillin, Doxycycline, and Cefotaxime for Patients with Severe Leptospirosis. Clin Infect Dis. 2004;39(10):1417–1424.
Rodrigo C, De Silva NL, Goonaratne R, Samarasekara K, Wijesinghe I, Parththipan B, et al. High dose corticosteroids in severe leptospirosis: A systematic review. Trans R Soc Trop Med Hyg. 2014;108(12):743–750.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2022 Médicas UIS