Comprometimento pulmonar na leptospirose

Carvalho, Jorge Eduardo Manhães de; Marchiori, Edson dos Santos; Silva, João Batista Guedes e; Netto, Bernardino Alves de Souza; Tavares, Walter; Paula, Aloysio Veiga de

doi:10.1590/S0037-86821992000100004

Resumos

Em 23 pacientes com leptospirose apresentando comprometimento pulmonar, internados no Hospital Universitário Antônio Pedro da XJFF, Niterói, hemoptise e hemoptóicos foram observados em 21,7% e 30,4%, respectivajnente. Gasometria arterial revelou hipoxemia e hipocapnia na maioria dos casos. Radiografia de tórax em 15 pacientes mostrou comprometimento alveolar em 60%, comprometimento intersticial-reticular em 6%, padrão misto (alveolar e intersticial) em20%e ausência de alterações radiológicas em 14%. A necrópsiade 13 pacientes mostrou edema, congestão e hemorragia nos pulmões em 100% dos casos. A hemorragia foi focal em 46% e difusa em 54% dos casos. Houve formação de membrana hialina em 30% e trombos de fibrina em 46% dos pulmões estudados, o que estabelece o diagnóstico da coagulação intravascular disseminada e a ocorrência da síndrome de angústia respiratória na leptospirose.

Leptospirose; Pulmão; Pneumonia; SARA; Coagulação intravascular

Tostudy thepulmonary complications in leptospirosis case records of 23 such patients admitted at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brasil, were reviewed. Hemoptysis were seen in 21.7% and sputal blood in 30.4% of patients. Arterial gasometry detected hypoxemia and hypocapnia in most cases. Thoracic radiology showed an alveolar pattern in 60% of the patients, alveolo-interstitial in 20%, interstitial in 6%, and in 14% the lungs were considered to be normal Necropsy of 13 cases showed edema, congestion and hemorrhage in the lungs in all cases. Hyaline membrane was found in 30% and fibrin thrombi in 46% of these cases, resulting in a diagnosis of adult respiratory distress syndrome and acute disseminated intravascular coagulation (consumption coagulopathy) in leptospirosis.

Leptospirosis; Lung; Consumption coagulopathy; ARDS; Adult respiratory distress syndrome

ARTIGOS

Comprometimento pulmonar na leptospirose

Jorge Eduardo Manhães de Carvalho; Edson dos Santos Marchiori; João Batista Guedes e Silva; Bernardino Alves de Souza Netto; Walter Tavares; Aloysio Veiga de Paula^* * In memorian. Trabalho realizado no Hospital Universitário Antônio Pedro da Universidade Federal Fluminense, Niterói, RJ.

^{Endereço para correspondência} Endereço para correspondência: Dr. Jorge Eduardo Manhães áe Carvalho. Serviço de Pneumologia Hospital Universitário Antônio Pedro/UFF. Rua Marquês do Paraná 303 24030-000 Niterói, RJ.

RESUMO

Em 23 pacientes com leptospirose apresentando comprometimento pulmonar, internados no Hospital Universitário Antônio Pedro da XJFF, Niterói, hemoptise e hemoptóicos foram observados em 21,7% e 30,4%, respectivajnente. Gasometria arterial revelou hipoxemia e hipocapnia na maioria dos casos. Radiografia de tórax em 15 pacientes mostrou comprometimento alveolar em 60%, comprometimento intersticial-reticular em 6%, padrão misto (alveolar e intersticial) em20%e ausência de alterações radiológicas em 14%. A necrópsiade 13 pacientes mostrou edema, congestão e hemorragia nos pulmões em 100% dos casos. A hemorragia foi focal em 46% e difusa em 54% dos casos. Houve formação de membrana hialina em 30% e trombos de fibrina em 46% dos pulmões estudados, o que estabelece o diagnóstico da coagulação intravascular disseminada e a ocorrência da síndrome de angústia respiratória na leptospirose.

Palavras-chave: Leptospirose. Pulmão. Pneumonia. SARA. Coagulação intravascular.

ABSTRACT

Tostudy thepulmonary complications in leptospirosis case records of 23 such patients admitted at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brasil, were reviewed. Hemoptysis were seen in 21.7% and sputal blood in 30.4% of patients. Arterial gasometry detected hypoxemia and hypocapnia in most cases. Thoracic radiology showed an alveolar pattern in 60% of the patients, alveolo-interstitial in 20%, interstitial in 6%, and in 14% the lungs were considered to be normal Necropsy of 13 cases showed edema, congestion and hemorrhage in the lungs in all cases. Hyaline membrane was found in 30% and fibrin thrombi in 46% of these cases, resulting in a diagnosis of adult respiratory distress syndrome and acute disseminated intravascular coagulation (consumption coagulopathy) in leptospirosis.

Keywords: Leptospirosis. Lung. Consumption coagulopathy. ARDS. Adult respiratory distress syndrome.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

2. Almeida FSBM. Pulmão na Leptospirose. Revista Divisão Nacional Tuberculose 21:427-433, 1977.

3. AreanV M. Thepathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). American Journal Pathology 40:293-423, 1962.

4. Ayrosa Galvão PA. Leptospiroses humanas. ARS Curandi 4:82-90, 1971.

5. Bone RC, Francis PB, Pierce AIC. Intravascular coagulation associated with the adult respiratory distress syndrome. American Journal of Medicine 61:585-589, 1976.

6. Brito T, Böhm GM, Yasuda PH. Vascular damage in acute experimental leptospiroses of the Guinea- pig. Journal Pathology 128:177-182, 1979.

7. Burke BJ, Jearle JF, Mattingly D. Leptospirosis presenting with profuse haemoptysis. Bristish Medical Journal 2:982, 1976.

8. Carré PH, Awia-Berod C, Duval G, Michault A. Manifestations pulmonaires predominantes au cours des leptospiroses ictero-hemorragiques. Révue Maladie Respiratoire 2:343-349, 1985.

9. Colman RN, Rubin RN. Disseminated intravascular coagulation: Etiologies, diagnosis and therapy. Infections in Medicine 1:23-28, 1986.

10. Comby F, Gauthier R, Naziwoff O. Nouvelle contribution a l'étude des leptospiroses a la reunion II. Anatomopathologie de dix cas mortels. Bulletin Société Pathologie Exotique 1:92-101, 1969.

11. Duval G, Michault A, Corsin JC, Awin-Berod C, Carré P, Geniu R. Syndrome dedétresse respiratoire aigué revelateur d'une leptospirose ictero- hemorragique deux observations. La Presse Medicale 14:167-172, 1985.

12. Edwards GA, Domm BM. Human leptospirosis. Medicine 39:117-156, 1960.

13. Farrar WE. Leptospira species (Leptospirosis) In: Mandell GL (ed) Principles and practiceof infectious diseases. 2edition, John Wiley & Sons, New York p. 1338-1343, 1985.

14. Feigin RD, Anderson DE. Human leptospirosis. CRC Critical Reviews in Clinical Laboratory Sciences 5:413-467, 1975.

15. Inada R, Ido Y. The etiology, mode of infection and specific therapy of Weil's disease spirochaetosis icterohemorragica. Journal Expect Medicine 23:397, 1916.

16. Keogh BA, Crystal RG. Alveolitis: the key to the interstitial lung desordens. Thorax 37:1-10, 1982.

17. Liebow AA, Carrington CB. The Interstitial pneumonias. In: Simon M (ed) Frontiersofpulmonary radiology. Grune & Stratton, New York, 1969.

18. Macedo V, Figueiredo JFM, Carvalho E, Barbosa E. Coagulação intravascular disseminada na leptospirose. Revista de Patologia Tropical 3:363- 366, 1973.

19. Martin L, Pettit A. Spirochetoseicterohémorragique. In: Monografias do Institute Pasteur, Libraries de L'Académie Médicine, Masson et Cience, Paris p.1-11, 1919.

20. Miller NG, Allen JE, Wilson RB. The pathogenesis of hemorrhage in the lung of the hamster during acute leptospirosis. Medical Microbiology Immunology 160:269-278, 1974.

21. Nery LE, Paula AB, Nakatani J, Santos ML, Ratto OR. Clinical radiological an functional pulmonary manifestation in patients with leptospirosis. Revista do Instituto de Medicina Tropical de São Paulo 19:366-373, 1977.

22. Paula A. Da tisio lo gia à pneumologia. Uma evolução em meio século. Jornal Brasileiro de Medicina 46:41-68, 1984.

23. Pereira da Silva JJ. Formas graves de leptospirose - contribuição ao seu estudo clínico. Tese de Mestrado, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 1974.

24. Pereira da Silva JJ, Paiva LM, Silva JBG, Alves Netto B. Estudo do Comprometimento pulmonar na doença de Well. Revista do Instituto de Medicina Tropical de São Paulo 18:387-392, 1976.

25. Petricevic I, Tomljenovic V. Milijarne plucne promjene u toku leptospiroze prikaz bolesnika. Lijecnicki Vjesnik 102:135-136, 1980.

26. Poh SC, Soh CS. Lung manifestations in leptospirosis. Thorax 25:751-755, 1970.

27. Ramachandran S, Pereira MVF. Cardiac and pulmonary involvement in leptospirosis. Transactions of the Royal Society of Tropical Medicine and Hygiene 71:56-59, 1977.

28. Silverstein CM. Pulmonary manifestation of leptospirosis. Radiology 61:327-334, 1953.

29. Sitprija V, Pipatanagul V, Mertowidjojo K, Boonpucknavig V, Boonpucknavig S. Pathogenesis of renal disease in leptospirosis: clinical and experimental studies. Kidney Internal 17:827-836, 1980.

30. Vinh T, Adler B, FayneS. Glycoliprotein cytotoxin from Leptospira interrogans serovar copenhageni. Journal General Microbiology 132:111-123, 1986.

Recebido para publicação em 12/11/90.

1. Alexander AD. Leptospira. In: Lennete EH, Balous A, Hausler Junior WS, Shadomy HS (eds) Manual of A, Hausler Junior WS, Shadomy HS (eds) Manual of for Microbiology, Washington p.473-478, 1985.
2. Almeida FSBM. Pulmão na Leptospirose. Revista Divisão Nacional Tuberculose 21:427-433, 1977.
3. Arean VM. Thepathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). American Journal Pathology 40:293-423, 1962.
4. Ayrosa Galvão PA. Leptospiroses humanas. ARS Curandi 4:82-90, 1971.
5. Bone RC, Francis PB, Pierce AIC. Intravascular coagulation associated with the adult respiratory distress syndrome. American Journal of Medicine 61:585-589, 1976.
6. Brito T, Böhm GM, Yasuda PH. Vascular damage in acute experimental leptospirose of the Guinea pig. Journal Pathology 128:177-182, 1979.
7. Burke BJ, Jearle JF, Mattingly D. Leptospirosis presenting with profuse haemoptysis. Bristish Medical Journal 2:982, 1976.
8. Carré PH, Awia-Berod C, Duval G, Michault A. Manifestations pulmonaires predominantes au cours des leptospiroses ictero-hemorragiques. Révue Maladie Respiratoire 2:343-349, 1985.
9. Colman RN, Rubin RN. Disseminated intravascular coagulation: Etiologies, diagnosis and therapy. Infections in Medicine 1:23-28, 1986.
10. Comby F, Gauthier R, Naziwoff O. Nouvelle contribution a l'étude des leptospiroses a la reunion II. Anatomopathologie de dix cas mortels. Bulletin Société Pathologie Exotique 1:92-101, 1969.
11. Duval G, Michault A, Corsin JC, Awin-Berod C, Carré P, Geniu R. Syndrome dedétresse respiratoire aigué revelateur d'une leptospirose ictero- hemorragique deux observations. La Presse Medicale 14:167-172, 1985.
12. Edwards GA, Doram BM. Human leptospirosis. Medicine 39:117-156, 1960.
13. Farrar WE. Leptospira species (Leptospirosis). In: Mandell GL (ed) Principles and practice of infectious diseases. 2edition, John Wiley & Sons, New York p. 1338-1343, 1985.
14. Feigin RD, Anderson DE. Human leptospirosis. CRC Critical Reviews in Clinical Laboratory Sciences 5:413-467, 1975.
15. Inada R, Ido Y. The etiology, mode of infection and specific therapy of Weil's disease spirochaetosis icterohemorragica. Journal Expect Medicine 23:397, 1916.
16. Keogh BA, Crystal RG. Alveolitis: the key to the interstitial lung desordens. Thorax 37:1-10, 1982.
17. Liebow AA, Carrington CB. The Interstitial ! pneumonias. In: Simon M (ed) Frontiers ofpulmonary radiology. Grune & Stratton, New York, 1969.
18; Macedo V, Figueiredo JFM, Carvalho E, Barbosa E. Coagulação intravascular disseminada na leptospirose. Revista de Patologia Tropical 3:363- 366, 1973.
19. Martin L, Pettit A. Spirochetoseicterohémorragique. In: Monografias do Institute Pasteur, Libraries de L'Acadcmie Médicine, Masson et Cience, Paris p.1-11, 1919.
20. Miller NG, Allen JE, Wilson RB. The pathogenesis of hemorrhage in the lung of the hamster during Immunology 160:269-278, 1974.
21. Nery LE, Paula AB, Nakatani J, Santos ML, Ratto OR. Clinical radiological an functional pulmonary manifestation in patients with leptospirosis. Revista do Instituto de Medicina Tropical de São Paulo 19:366-373, 1977.
22. Paula A. Datisiologiaàpneumologia. Uma evolução em meio século. Jornal Brasileiro de Medicina 46:41-68, 1984.
23. Pereira da Silva JJ. Formas graves de leptospirose - contribuição ao seu estudo clínico. Tese de Mestrado, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 1974.
24. Pereira da Silva JJ, Paiva LM, Silva JBG, Alves Netto B. Estudo do Comprometimento pulmonar na doença de Well. Revista do Instituto de Medicina Tropical de São Paulo 18:387-392, 1976.
25. Petricevic I, Tomljenovic V. Milijarne plucne promjene u toku leptospiroze prikaz bolesnika. Lijecnicki Vjesnik 102:135-136, 1980.
26. Poh SC, Soh CS. Lung manifestations in leptospirosis. Thorax 25:751-755, 1970.
27. Ramachandran S, Pereira MVF. Cardiac and pulmonary involvement in leptospirosis. Transactions of the Royal Society of Tropical Medicine and Hygiene 71:56-59, 1977.
28. Silverstein CM. Pulmonary manifestation of leptospirosis. Radiology 61:327-334, 1953.
29. Sitprija V, Pipatanagul V, Mertowidjojo K, Boonpucknavig V, Boonpucknavig S. Pathogenesis of renal disease in leptospirosis: clinical and experimental studies. Kidney Internal 17:827-836, 1980.
30. Vinh T, Adler B, FayneS. Glycoliproteincytotoxin from Leptospira interrogans serovar copenhageni. Journal General Microbiology 132:111-123, 1986.
31. Wang CN, Liu J, Chang TF, Cheng WJ, Wo MY, Hung AT. Studies on anicteric leptospirosis III Roent Genelogic observations ofpulrnonary changes. Chinese Medical Journal 84:298-306, 1965.
32. Zaltzman M, Kallenbach JM, Goss GO, Lewis M, Zwi S, Gear JHS. Adult respiratory distress syndrome in Leptospira canicola infection. British Medical Journal 283:519-520, 1981.

Endereço para correspondência:

Dr. Jorge Eduardo Manhães áe Carvalho.

Serviço de Pneumologia

Hospital Universitário Antônio Pedro/UFF.

Rua Marquês do Paraná 303

24030-000

Niterói, RJ.

*

In memorian.

Trabalho realizado no Hospital Universitário Antônio Pedro da Universidade Federal Fluminense, Niterói, RJ.

Datas de Publicação

Publicação nesta coleção
23 Abr 2013
Data do Fascículo
Mar 1992

Histórico

Recebido
12 Nov 1990
Aceito
12 Nov 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alexander AD. Leptospira. In: Lennete EH, Balous A, Hausler Junior WS, Shadomy HS (eds) Manual of A, Hausler Junior WS, Shadomy HS (eds) Manual of for Microbiology, Washington p.473-478, 1985.

[2] 2. Almeida FSBM. Pulmão na Leptospirose. Revista Divisão Nacional Tuberculose 21:427-433, 1977.

[3] 3. Arean VM. Thepathologic anatomy and pathogenesis of fatal human leptospirosis (Weil's disease). American Journal Pathology 40:293-423, 1962.

[4] 4. Ayrosa Galvão PA. Leptospiroses humanas. ARS Curandi 4:82-90, 1971.

[5] 5. Bone RC, Francis PB, Pierce AIC. Intravascular coagulation associated with the adult respiratory distress syndrome. American Journal of Medicine 61:585-589, 1976.

[6] 6. Brito T, Böhm GM, Yasuda PH. Vascular damage in acute experimental leptospirose of the Guinea pig. Journal Pathology 128:177-182, 1979.

[7] 7. Burke BJ, Jearle JF, Mattingly D. Leptospirosis presenting with profuse haemoptysis. Bristish Medical Journal 2:982, 1976.

[8] 8. Carré PH, Awia-Berod C, Duval G, Michault A. Manifestations pulmonaires predominantes au cours des leptospiroses ictero-hemorragiques. Révue Maladie Respiratoire 2:343-349, 1985.

[9] 9. Colman RN, Rubin RN. Disseminated intravascular coagulation: Etiologies, diagnosis and therapy. Infections in Medicine 1:23-28, 1986.

[10] 10. Comby F, Gauthier R, Naziwoff O. Nouvelle contribution a l'étude des leptospiroses a la reunion II. Anatomopathologie de dix cas mortels. Bulletin Société Pathologie Exotique 1:92-101, 1969.

[11] 11. Duval G, Michault A, Corsin JC, Awin-Berod C, Carré P, Geniu R. Syndrome dedétresse respiratoire aigué revelateur d'une leptospirose ictero- hemorragique deux observations. La Presse Medicale 14:167-172, 1985.

[12] 12. Edwards GA, Doram BM. Human leptospirosis. Medicine 39:117-156, 1960.

[13] 13. Farrar WE. Leptospira species (Leptospirosis). In: Mandell GL (ed) Principles and practice of infectious diseases. 2edition, John Wiley & Sons, New York p. 1338-1343, 1985.

[14] 14. Feigin RD, Anderson DE. Human leptospirosis. CRC Critical Reviews in Clinical Laboratory Sciences 5:413-467, 1975.

[15] 15. Inada R, Ido Y. The etiology, mode of infection and specific therapy of Weil's disease spirochaetosis icterohemorragica. Journal Expect Medicine 23:397, 1916.

[16] 16. Keogh BA, Crystal RG. Alveolitis: the key to the interstitial lung desordens. Thorax 37:1-10, 1982.

[17] 17. Liebow AA, Carrington CB. The Interstitial ! pneumonias. In: Simon M (ed) Frontiers ofpulmonary radiology. Grune & Stratton, New York, 1969.

[18] 18; Macedo V, Figueiredo JFM, Carvalho E, Barbosa E. Coagulação intravascular disseminada na leptospirose. Revista de Patologia Tropical 3:363- 366, 1973.

[19] 19. Martin L, Pettit A. Spirochetoseicterohémorragique. In: Monografias do Institute Pasteur, Libraries de L'Acadcmie Médicine, Masson et Cience, Paris p.1-11, 1919.

[20] 20. Miller NG, Allen JE, Wilson RB. The pathogenesis of hemorrhage in the lung of the hamster during Immunology 160:269-278, 1974.

[21] 21. Nery LE, Paula AB, Nakatani J, Santos ML, Ratto OR. Clinical radiological an functional pulmonary manifestation in patients with leptospirosis. Revista do Instituto de Medicina Tropical de São Paulo 19:366-373, 1977.

[22] 22. Paula A. Datisiologiaàpneumologia. Uma evolução em meio século. Jornal Brasileiro de Medicina 46:41-68, 1984.

[23] 23. Pereira da Silva JJ. Formas graves de leptospirose - contribuição ao seu estudo clínico. Tese de Mestrado, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 1974.

[24] 24. Pereira da Silva JJ, Paiva LM, Silva JBG, Alves Netto B. Estudo do Comprometimento pulmonar na doença de Well. Revista do Instituto de Medicina Tropical de São Paulo 18:387-392, 1976.

[25] 25. Petricevic I, Tomljenovic V. Milijarne plucne promjene u toku leptospiroze prikaz bolesnika. Lijecnicki Vjesnik 102:135-136, 1980.

[26] 26. Poh SC, Soh CS. Lung manifestations in leptospirosis. Thorax 25:751-755, 1970.

[27] 27. Ramachandran S, Pereira MVF. Cardiac and pulmonary involvement in leptospirosis. Transactions of the Royal Society of Tropical Medicine and Hygiene 71:56-59, 1977.

[28] 28. Silverstein CM. Pulmonary manifestation of leptospirosis. Radiology 61:327-334, 1953.

[29] 29. Sitprija V, Pipatanagul V, Mertowidjojo K, Boonpucknavig V, Boonpucknavig S. Pathogenesis of renal disease in leptospirosis: clinical and experimental studies. Kidney Internal 17:827-836, 1980.

[30] 30. Vinh T, Adler B, FayneS. Glycoliproteincytotoxin from Leptospira interrogans serovar copenhageni. Journal General Microbiology 132:111-123, 1986.

[31] 31. Wang CN, Liu J, Chang TF, Cheng WJ, Wo MY, Hung AT. Studies on anicteric leptospirosis III Roent Genelogic observations ofpulrnonary changes. Chinese Medical Journal 84:298-306, 1965.

[32] 32. Zaltzman M, Kallenbach JM, Goss GO, Lewis M, Zwi S, Gear JHS. Adult respiratory distress syndrome in Leptospira canicola infection. British Medical Journal 283:519-520, 1981.