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Leptospirosis-associated severe pulmonary hemorrhagic syndrome, Salvador, Brazil.

Gouveia EL, Metcalfe J, de Carvalho AL, Aires TS, Villasboas-Bisneto JC, Queirroz A, Santos AC, Salgado K, Reis MG, Ko AI - Emerging Infect. Dis. (2008)

Bottom Line: We report the emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) in slum communities in Salvador, Brazil.Although active surveillance did not identify SPHS before 2003, 47 cases were identified from 2003 through 2005; the case-fatality rate was 74%.By 2005, SPHS caused 55% of the deaths due to leptospirosis.

View Article: PubMed Central - PubMed

Affiliation: Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil.

ABSTRACT
We report the emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) in slum communities in Salvador, Brazil. Although active surveillance did not identify SPHS before 2003, 47 cases were identified from 2003 through 2005; the case-fatality rate was 74%. By 2005, SPHS caused 55% of the deaths due to leptospirosis.

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Active hospital-based surveillance for leptospirosis in Salvador, Brazil, 2000–2005, including total number of suspected leptospirosis cases (A) and deaths (B) among case-patients. Case-patients with and without severe pulmonary hemorrhagic syndrome are shown by black and gray bars, respectively.
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Figure 1: Active hospital-based surveillance for leptospirosis in Salvador, Brazil, 2000–2005, including total number of suspected leptospirosis cases (A) and deaths (B) among case-patients. Case-patients with and without severe pulmonary hemorrhagic syndrome are shown by black and gray bars, respectively.

Mentions: Among the 47 SPHS case-patients, 7 (15%) and 20 (42%) had pulmonary hemorrhage and respiratory insufficiency, respectively, at the time of hospitalization (Table 1). Pulmonary hemorrhage was identified in 19 (40%) patients only after endotracheal intubation (Table 2). Except for respiratory insufficiency, hemoptysis, and oliguria, SPHS case-patients had similar clinical manifestations to those of non-SPHS patients at the time of initial evaluation (Table 1). However, 7 (15%) and 16 (34%) of the 47 SPHS patients did not have signs of jaundice and acute renal insufficiency, respectively. Respiratory failure developed in all SPHS patients. Acute lung injury was documented in 25 (76%) of the 33 patients for whom arterial blood gas measurements were obtained (Table 2). Although patients received supportive care with mechanical ventilation (94%), dialysis (53%), and packed erythrocyte transfusion (60%), case-fatality rate for SPHS was 74% and significantly higher than that (12%) for non-SPHS leptospirosis (Table 1). By 2005, SPHS was the cause of 55% of the deaths among leptospirosis patients (Figure).


Leptospirosis-associated severe pulmonary hemorrhagic syndrome, Salvador, Brazil.

Gouveia EL, Metcalfe J, de Carvalho AL, Aires TS, Villasboas-Bisneto JC, Queirroz A, Santos AC, Salgado K, Reis MG, Ko AI - Emerging Infect. Dis. (2008)

Active hospital-based surveillance for leptospirosis in Salvador, Brazil, 2000–2005, including total number of suspected leptospirosis cases (A) and deaths (B) among case-patients. Case-patients with and without severe pulmonary hemorrhagic syndrome are shown by black and gray bars, respectively.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2570821&req=5

Figure 1: Active hospital-based surveillance for leptospirosis in Salvador, Brazil, 2000–2005, including total number of suspected leptospirosis cases (A) and deaths (B) among case-patients. Case-patients with and without severe pulmonary hemorrhagic syndrome are shown by black and gray bars, respectively.
Mentions: Among the 47 SPHS case-patients, 7 (15%) and 20 (42%) had pulmonary hemorrhage and respiratory insufficiency, respectively, at the time of hospitalization (Table 1). Pulmonary hemorrhage was identified in 19 (40%) patients only after endotracheal intubation (Table 2). Except for respiratory insufficiency, hemoptysis, and oliguria, SPHS case-patients had similar clinical manifestations to those of non-SPHS patients at the time of initial evaluation (Table 1). However, 7 (15%) and 16 (34%) of the 47 SPHS patients did not have signs of jaundice and acute renal insufficiency, respectively. Respiratory failure developed in all SPHS patients. Acute lung injury was documented in 25 (76%) of the 33 patients for whom arterial blood gas measurements were obtained (Table 2). Although patients received supportive care with mechanical ventilation (94%), dialysis (53%), and packed erythrocyte transfusion (60%), case-fatality rate for SPHS was 74% and significantly higher than that (12%) for non-SPHS leptospirosis (Table 1). By 2005, SPHS was the cause of 55% of the deaths among leptospirosis patients (Figure).

Bottom Line: We report the emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) in slum communities in Salvador, Brazil.Although active surveillance did not identify SPHS before 2003, 47 cases were identified from 2003 through 2005; the case-fatality rate was 74%.By 2005, SPHS caused 55% of the deaths due to leptospirosis.

View Article: PubMed Central - PubMed

Affiliation: Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil.

ABSTRACT
We report the emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) in slum communities in Salvador, Brazil. Although active surveillance did not identify SPHS before 2003, 47 cases were identified from 2003 through 2005; the case-fatality rate was 74%. By 2005, SPHS caused 55% of the deaths due to leptospirosis.

Show MeSH
Related in: MedlinePlus