Leptospirosis is a zoonosis caused by a pathogenic spirochete \"leptospira interrogans.\" Severe form of leprospira infection is usually associated with jaundice and renal involvement, leading to major hemorrhagic complications. Lung involvement can vary from subtle clinical features to deadly pulmonary hemorrhage and acute respiratory distress syndrome (ARDS). We recently managed a case of leptospirosis with isolated lung involvement as alveolar hemorrhage and ARDS. Our patient had acute febrile illness with respiratory symptoms associated with radiological picture of pulmonary hemorrhage. Patient was managed with noninvasive ventilation with high flow oxygen, antibiotic and pulse steroids therapy. In conclusion, leptospirosis can present with predominant pulmonary involvement, instead of the classical triad of Weil disease. High index of suspicion should be kept in acute febrile illness patients with respiratory symptoms and alveolar hemorrhage. Early diagnosis and management with oxygenation, antibiotics and immunosuppresents can prevent complications and mortality.
Shivakumar S. Leptospirosis-current scenario in India. In, Bichile SK. Ed. API Medicine Update, Mumbai 2008;18:799-809.
Kamath SA, Joshi SR. Re-emerging of infections in urban India - focus leptospirosis. J Assoc Physicians India 2003;51:247-8.
Pappas G, Papadimitriou P, Siozopoulou V, Christou L, Akritidis N. The globalization of leptospirosis: Worldwide incidence trends. Int J Infect Dis 2008;12:351-7.
Carvalho CR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med 2002;23:469-78.
Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, et al. Leptospirosis: A zoonotic disease of global importance. Lancet Infect Dis 2003;3:757-71.
Estavoyer JM, Racadot E, Couetdic G, Leroy J, Grosperrin L. Tumor necrosis factor in patients with leptospirosis. Rev Infect Dis 1991;13:1245-6.
Werts C, Tapping RI, Mathison JC, Chuang TH, Kravchenko V, Saint Girons I, et al. Leptospiral lipopolysaccharide activates cells through a TLR2-dependent mechanism. Nat Immunol 2001;2:346-52.
Nicodemo AC, Duarte MI, Alves VA, Takakura CF, Santos RT, Nicodemo EL. Lung lesions in human leptospirosis: Microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia. Am J Trop Med Hyg 1997;56:181-7.
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.
Clavel M, Lhéritier G, Weinbreck N, Guerlin A, Dugard A, Denes E, et al. Leptospirosis: An unusual cause of ARDS. Crit Care Res Pract 2010;2010:408365.
Brett. Major DM, Coldren R. Antibiotics for leptospirosis. Cochrane Database of Systemic Review 2012;2:CD008264
Guidugli F, Castro AA, Atallah AN. Antibiotics for treating leptospirosis. Cochrane Database Syst Rev 2000;2:CD001306.
Trivedi SV, Chavda RK, Wadia PZ, Sheth V, Bhagade PN, Trivedi SP, et al. The role of glucocorticoid pulse therapy in pulmonary involvement in leptospirosis. J Assoc Physicians India 2001;49:901-3.
Shenoy VV, Nagar VS, Chowdhury AA, Bhalgat PS, Juvale NI. Pulmonary leptospirosis: An excellent response to bolus methylprednisolone. Postgrad Med J 2006;82:602-6.
Trivedi SV, Vasava AH, Bhatia LC, Patel TC, Patel NK, Patel NT. Plasma exchange with immunosuppression in pulmonary alveolar haemorrhage due to leptospirosis. Indian J Med Res 2010;131:429-33.
Wakabayashi Y, Kamijou Y, Soma K, Ohwada T. Removal of circulating cytokines by continuous haemofiltration in patients with systemic inflammatory response syndrome or multiple organ dysfunction syndrome. Br J Surg 1996;83:393-4.