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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinico-pathological features of cardiac and pulmonary involvement were studied in seven cases of fatal leptospirosis. Petechial haemorrhages occurred in the heart and pericardium in all cases with blood-stained pericardial effusions in five. Interstitial myocarditis was noted in five patients and probably caused the changing electrocardiographic abnormalities and clinical cardiovascular effects during the illness. Sub-pleural and intrapulmonary haemorrhages occurred in all seven cases with pleural effusions in four. Pulmonary oedema was a striking feature during the early stages of the illness, while in patients surviving the first week of the disease infiltrative and proliferative lesions were common. The latter type of pulmonary changes occurred at a stage when acute renal failure was improving and were not related to the presence and severity of jaundice. The clinico-pathological profile of pulmonary involvement in leptospirosis appears to fall into an adult respiratory distress syndrome and, when present, carries a serious prognosis and would then be a prime factor in mortality. As clinical manifestations of pulmonary involvement appear late during the clinical illness and may be of abrupt onset, auscultatory and radiological surveillance becomes mandatory in severe leptospiral infections.
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PMID:Cardiac and pulmonary involvement in leptospirosis. 87 Oct 34

The respiratory manifestations of leptospirosis are usually benign. A case is reported of leptospirosis with serious pulmonary affection. Pulmonary involvement in leptospirosis is infrequently predominant and usually without bearing on prognosis. Clinical and roentgenological features are reviewed. Severe forms with massive hemoptysis or acute respiratory failure occur occasionally. The clinical symptoms, the radiological manifestations and haemodynamic investigation were suggestive of an acute respiratory distress by non haemodynamic pulmonary oedema. In accordance with other authors, one could be justified in including this acute respiratory failure as part of the adult respiratory distress syndrome. Since leptospirosis has extremely diverse clinical features, physicians should have this diagnosis in mind in many circumstances and should request the appropriate examinations at the right moment. Carefully performed microbiological techniques may reduce the problems encountered in isolating leptospires. Serological tests requested after the 12th day of the disease and repeated several times should improve the diagnosis confirmation. The potential severity of certain forms justifies curative antibiotic therapy.
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PMID:[Acute adult respiratory distress syndrome in leptospirosis]. 193 30

During the summer of 1984, in the Montefeltro area an epidemic of leptospirosis took place from a common source. In 15% of the people affected, the disease involved the lungs. In 3 patients the disease had a deadly course; one decrease was due to ARDS. The clinical, anatomopathological, and radiological features are described of the patients who presented with lung involvement. Such an outcome proved to be more likely than we thought. X-ray pattern of the chest was a polymorphous appearance, in spite of the same anatomopathological substratum, characterized by lung edema and endoalveolar hemorrhages.
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PMID:[Clinico-radiological observations on pulmonary manifestations of leptospirosis during the Montefeltro epidemic]. 339 10

Six cases of leptospirosis with pulmonary complications are reported. Three cases were accompanying an hepato-nephritis due to L. icterohaemorrhagiae. The first patient died with massive hemoptysis. The second, presenting a bilateral pneumopathy predominant on the left side, recovered after plasma exchange and hemofiltration. The third case concerned a pulmonary edema complicating a vascular refilling in a shock syndrome it simply recovered. The three other cases were observed in an anicteric leptospirosis: in two cases, L. Australis was responsible; in the last, L. icterohaemorrhagiae was involved. The first patient had a radiologic picture simulating miliary tuberculosis. The second had pulmonary edema complicating a vascular refilling in a shock syndrome. The last was an acute respiratory distress syndrome, treated with artificial ventilation with penicillin therapy and corticotherapy. All these 3 patients recovered. The diagnostic, physiopathologic and therapeutic problems of these pulmonary complications of leptospirosis are discussed. The lesional nature of the pulmonary edema is proved by the low pulmonary wedge pressures observed with the Swan-Ganz Catheter.
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PMID:[Respiratory complications of leptospirosis. Apropos of 6 cases, 3 of which show hemodynamic studies]. 340 72

The respiratory manifestations of leptospirosis are usually benign. A case is reported of anicteric leptospirosis with serious pulmonary affection. The clinical symptoms, the radiological manifestations and haemodynamic investigation were suggestive of an acute respiratory distress by non-haemodynamic pulmonary oedema. In accordance with other authors, one would be justified in including this acute respiratory failure as part of the acute respiratory distress syndrome of the adult (ARDS).
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PMID:[Acute respiratory distress disclosing leptospirosis]. 382 92

We have studied retrospectively 30 cases of leptospirosis observed in Aquitaine (South West France) from 1980 till 1992. This review was made in three internal and a nephrology department in Bordeaux hospital. Most cases occurred by indirect contact with infected animals or by occupational exposures. Onset was brutal with fever often associated with painful syndrome and sometimes conjunctival suffusion. Jaundice (70%), acute renal failure (67%), meningitis (50%) and hemorrhagic signs (50%) were among the major visceral manifestations. Diagnosis was always confirmed by micro-agglutination test. Leptospira ictero-hemorrhage was the predominant serogroup found. The outcome was favorable in 22 patients; reversible complications were seen in six cases (five acute renal failure with hemodialysis myocarditis and pulmonary edema in two hemodialysed patients, polyradiculoneuritis). Two patients died (acute respiratory failure and meningo-encephalitis with diffuse hemorrhagic syndrome). The characteristic of our series is the high frequency of hepatorenal syndrome due to the importance of our nephrologist recruitment. Furthermore our study confirm the vital prognostic characters of the pulmonary, renal, hemorrhagic and neurologic complications. No absolute relationship was found between the clinical and laboratory findings and the serotype of leptospira. Penicillin remains the treatment of choice and should be started as soon as possible the avoid the life threatening visceral complications.
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PMID:[Epidemiological, clinical, biological and developmental aspects of leptospirosis: apropos of 30 cases in Aquitaine]. 793 56

During an outbreak of leptospirosis in northeastern Thailand, 148 patients with serologically diagnosed leptospirosis were seen in Loei Hospital. The clinical features were consistent with those described for the classic manifestation of the disease. However, hypotension was a common finding: noted in 94 patients (64%) upon admission or early in the course of the disease. Of these hypotensive patients, 64 (68%) had impaired renal function: 30 patients (32%) had prerenal azotemia and 34 (36%) were in renal failure. Pulmonary complications, including pulmonary edema, hemorrhage, ARDS, and interstitial pneumonitis, occurred in 22% of patients and were often associated with renal failure. A clear association existed between hypotension and renal failure and pulmonary complications. The overall mortality rate was 3.4%. The causes of death were pulmonary complications, renal failure, and sepsis. The death rate among patients with complications was 11.6%. Blood exchange, in addition to conventional treatment, was beneficial in severe leptospirosis with complications and hyperbilirubinemia.
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PMID:Leptospirosis in northeastern Thailand: hypotension and complications. 1211 44

During a recent outbreak of leptospirosis in northeastern Thailand, 148 patients with serologically diagnosed leptospirosis were seen in Loei hospital. The common serotypes were L. pyrogenes, and L. sejroe. Hypotension with a mean arterial pressure less than 70 mmHg upon admission or within 24 h after admission was observed in 94 patients or 64%. 30 patients had normal renal function; 30 patients had prerenal azotemia with mild pulmonary complication in 2; and 34 patients had acute renal failure. 29 patients with acute renal failure had pulmonary complications including pulmonary hemorrhage in 8, pulmonary edema in 3, acute respiratory distress syndrome (ARDS) in 14 and interstitial pneumonitis in 4. 54 patients had normal blood pressure. In this group 5 patients had acute renal failure; 16 had prerenal azotemia and 33 had normal renal function. Interstitial pneumonitis was noted in one patient with prerenal azotemia. Less renal complication and minimal pulmonary complication were seen in leptospirosis patients with normal blood pressure. The patients with normal renal function had no pulmonary complication. Good association existed between hypotension, renal failure and pulmonary complications.
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PMID:Hypotension, renal failure, and pulmonary complications in leptospirosis. 1216 96

Leptospirosis is a public health problem worldwide. Severe leptospirosis manifests as pulmonary edema leading to acute respiratory distress syndrome and polyuric acute renal failure (ARF). The etiology of leptospirosis-induced pulmonary edema is unclear. Lung edema clearance is largely affected by active sodium transport out of the alveoli rather than by reversal of the Starling forces. The objective of this study was to profile leptospirosis-induced ARF and pulmonary edema. We inoculated hamsters with leptospires and collected 24-h urine samples on postinoculation day 4. On day 5, the animals were killed, whole blood was collected, and the kidneys and lungs were removed. Immunoblotting was used to determine expression and abundance of water and sodium transporters. Leptospirosis-induced ARF resulted in natriuresis, lower creatinine clearance, and impaired urinary concentrating ability. Renal expression of the sodium/hydrogen exchanger isoform 3 and of aquaporin 2 was lower in infected animals, whereas that of the Na-K-2Cl cotransporter NKCC2 was higher. Leptospirosis-induced lesions, predominantly in the proximal tubule, were responsible for the polyuria and natriuresis observed. The polyuria might also be attributed to reduced aquaporin 2 expression and the attendant urinary concentrating defect. In the lungs, expression of the epithelial sodium channel was lower, and NKCC1 expression was upregulated. We found that leptospirosis profoundly influences the sodium transport capacity of alveolar epithelial cells and that impaired pulmonary fluid handling can impair pulmonary function, increasing the chance of lung injury. Greater knowledge regarding sodium transporter dysregulation in the lungs and kidneys can provide new perspectives on leptospirosis treatment.
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PMID:Leptospirosis leads to dysregulation of sodium transporters in the kidney and lung. 1766 41

Leptospirosis is recognized as a globally re-emerging zoonosis. Interstitial nephritis is the principal feature of the disease. Leptospirosis-induced acute kidney injury typically is nonoliguric and includes hypokalemia. Tubular function alterations precede a decrease in the glomerular filtration rate, which could explain the high frequency of hypokalemia. Studies in human beings and animals have shown increased urinary fractional excretion of potassium and sodium, as well as an increased potassium/sodium ratio, suggesting increased distal potassium secretion caused by increased distal sodium delivery consequent to functional impairment of proximal sodium reabsorption. Confirming these findings, Western blot studies have shown lower renal expression of the sodium/hydrogen exchanger isoform 3 and of aquaporin 2, together with higher renal expression of the Na-K-2Cl cotransporter NKCC2, in infected animals. The severe form (Weil's disease) manifests as diffuse alveolar hemorrhage, pulmonary edema, acute respiratory distress syndrome, or a combination of these features, accompanied by acute kidney injury and can be highly lethal. Antibiotic treatment is efficient in the early and late/severe phases. For critically ill leptospirosis patients, the following are recommended: daily hemodialysis, low daily net fluid intake (because of the risk for pulmonary hemorrhage), and lung-protective strategies (low tidal volumes and high positive end-expiratory pressures after recruitment maneuvers).
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PMID:Leptospiral nephropathy. 1862 Sep 61


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