Skip to main content

Advertisement

SpringerLink
Log in

Severe pulmonary haemorrhage syndrome in leptospirosis in a returning traveller

  • Case Report
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Clinical presentation of leptospirosis ranges from asymptomatic infection to fulminant, life-threatening disease. Pulmonary involvement in terms of severe pulmonary haemorrhage syndrome (SPHS) has recently become a more frequently reported facet of leptospirosis and correlates with high mortality rates. It has not yet been described in returning German travellers. We present a case of a healthy young man developing massive pulmonary haemorrhage and severe ARDS requiring mechanical ventilation and high-dose catecholamines after travelling to Indonesia. Leptospirosis was verified by blood PCR as well as serology and treated with high-dose, intravenous penicillin. Outcome was favourable, the patient recovered completely. Leptospirosis and SPHS should be taken into account as an emerging infectious disease in patients with fever and lung involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sehgal S, Murhekar M, Sugunan A. Outbreak of leptospirosis with pulmonary involvement in north Andaman. Indian J Med Res. 1995;102:9–12.

    CAS  PubMed  Google Scholar 

  2. Trevejo RT, Rigau-Pérez JG, Ashford DA, McClure EM, Jarquín-González C, Amador JJ, et al. Epidemic leptospirosis associated with pulmonary hemorrhage—Nicaragua, 1995. J Infect Dis. 1998;178:1457–63.

    Article  CAS  PubMed  Google Scholar 

  3. Gouveia EL, Metcalfe J, De Carvalho ALF, Aires TS, Villasboas-Bisneto JC, Queirroz A, et al. Leptospirosis-associated severe pulmonary hemorrhagic syndrome, Salvador, Brazil. Emerg Infect Dis. 2008;14:505.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Brehm TT, Schulze Zur Wiesch J, Lutgehetmann M, Tappe D, Eisermann P, Lohse AW, et al. Epidemiology, clinical and laboratory features of 24 consecutive cases of leptospirosis at a German infectious disease center. Infection. 2018. https://doi.org/10.1007/s15010-018-1181-x.

    Article  PubMed  Google Scholar 

  5. Weil A. Peculiar acute infection with splenic enlargement, jaundice and nephritis. Dtsch Arch Klin Med. 1886;39:209.

    Google Scholar 

  6. Hartskeerl RA, Collares-Pereira M, Ellis WA. Emergence, control and re-emerging leptospirosis: dynamics of infection in the changing world. Clin Microbiol Infect. 2011;17:494–501. https://doi.org/10.1111/j.1469-0691.2011.03474.x.

    Article  CAS  PubMed  Google Scholar 

  7. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis. 2015;9:e0003898.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Brockmann S, Piechotowski I, Bock-Hensley O, Winter C, Oehme R, Zimmermann S, et al. Outbreak of leptospirosis among triathlon participants in Germany, 2006. BMC Infect Dis. 2010;10:91.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Moeschlin S. Lungeninfiltrate beim Ikterus infectiosus Weil. Schwabe, Basel 1943.

  10. Carvalho CRR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med. 2002;23:469–78.

    Article  PubMed  Google Scholar 

  11. Silva JJPD, Dalston MO, Carvalho JEMD, Setúbal S, Oliveira JMCD, Pereira MM. Clinicopathological and immunohistochemical featuresof the severe pulmonary form of leptospirosis. Rev Soc Bras Med Trop. 2002;35:395–9.

    Article  PubMed  Google Scholar 

  12. Vieira SR, Brauner JS. Leptospirosis as a cause of acute respiratory failure: clinical features and outcome in 35 critical care patients. Braz J Infect Dis. 2002;6:135–9.

    Article  PubMed  Google Scholar 

  13. Spichler AS, Vilaça PJ, Athanazio DA, Albuquerque JO, Buzzar M, Castro B, et al. Predictors of lethality in severe leptospirosis in urban Brazil. Am J Trop Med Hyg. 2008;79:911–4.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Budiono E, Sumardi B, Hisyam B, Hartopo AB. Pulmonary involvement predicts mortality in severe leptospirosis patients. Acta Med Indones. 2009;41:11–4.

    PubMed  Google Scholar 

  15. Liao C-Y, Ben R-J, Wu H-M, Chang S-K, Liu M-Y, Chin H-K, et al. Acute respiratory distress syndrome manifested by leptospirosis successfully teated by extracorporeal membrane oxygenation (ECMO). Intern Med. 2015;54:2943–6.

    Article  PubMed  Google Scholar 

  16. Cantwell T, Ferre A, Jan NVS, Blamey R, Dreyse J, Baeza C, et al. Leptospirosis-associated catastrophic respiratory failure supported by extracorporeal membrane oxygenation. J Artif Organs. 2017;20:1–6.

    Article  Google Scholar 

  17. Jayakrishnan B, Abid FB, Balkhair A, Alkaabi JK, Al-Rawas OA, George J, et al. Severe pulmonary involvement in leptospirosis: alternate antibiotics and systemic steroids. Sultan Qaboos Univ Med J. 2013;13:318.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kularatne SA, Budagoda BSS, de Alwis VKD, Wickramasinghe WS, Bandara JRP, Pathirage LMM, et al. High efficacy of bolus methylprednisolone in severe leptospirosis: a descriptive study in Sri Lanka. Postgrad Med J. 2011;87:13–7.

    Article  CAS  PubMed  Google Scholar 

  19. Wani H. Ueber die prophylaxe der Spirochaetosis icterohaemorrhagica Inada (Weilschen Krankheit) durch schutzimpfung. Z Immun Exp Ther. 1933;79:1–26.

    Google Scholar 

  20. Benbrik E, Pouliquen P, Dômont A. Evaluation de la tolérance de la vaccination contre Leptospira icterohaemorrhagiae chez 50 employés de canaux. Arch Mal Prof Méd Travail. 2001;62:35–40.

    Google Scholar 

  21. Grassmann AA, Souza JD, McBride AJA. A universal vaccine against leptospirosis: are we going in the right direction? Front Immunol. 2017;8:256.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany

    Andreas Schönfeld, B. Jensen, H. M. Orth, T. Feldt & D. Häussinger

  2. Bernhard-Nocht-Institute of Tropical Medicine, Hamburg, Germany

    D. Tappe

Authors
  1. Andreas Schönfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. M. Orth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Tappe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Feldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Häussinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Schönfeld.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schönfeld, A., Jensen, B., Orth, H.M. et al. Severe pulmonary haemorrhage syndrome in leptospirosis in a returning traveller. Infection 47, 125–128 (2019). https://doi.org/10.1007/s15010-018-1220-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1220-7

Keywords

Search

Navigation