Pulmonary manifestations of leptospirosis.

BACKGROUND: Pulmonary manifestations in leptospirosis are considered a major complication and are related to a poor prognosis. We present a large series of patients with pulmonary involvement using a practical approach based on the presence of acute respiratory failure (ARF). METHODS: A retrospective study of patients with confirmed leptospirosis. RESULTS: One hundred and sixty-nine patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. One hundred and thirty-four patients (36.7±14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of ARF. Univariate analysis found the following factors related to severe pulmonary leptospirosis: dyspnoea (OR=10.14, p<0.0001), pulmonary crepitations (OR=4.8, p<0.0004), abnormal chest X-ray (OR=9.88, p<0.007) with alveolar shadowing (OR=8.12, p<0.0001), oliguria/anuria (OR=5.48, p<0.0001), hepatomegaly (OR=7.11, p< 0.0001), shock (OR=8.38, p< 0.0001), ICU admission (OR=60.08, p< 0.0001), dialysis (OR=4.87, p< 0.001), mechanical ventilation (OR=216, p< 0.0001) and development of nosocomial infection (OR=21.5, p< 0.0001). The mortality rate was significantly different between severe (40%) and non-severe (5.3%) pulmonary forms (OR=11.87, p< 0.0001). Multivariate analysis found two independent factors related to severe pulmonary involvement: dyspnoea (OR=10.18, p< 0.0001) and oliguria/anuria (OR=4.87, p< 0.0009). We performed a multivariate analysis to assess independent factors related to mortality and found: mechanical ventilation requirement (OR=27.85, p< 0.0001) and AST greater than 150 IU/L (OR=4.57, p< 0.02). Haemoptysis was associated with survival (OR=0.2, p< 0.02). CONCLUSIONS: Severe pulmonary involvement in leptospirosis is associated with extensive disease involving other organs. The association of multiple factors is associated with severe forms of the disease and a high mortality rate.

[Characteristics and management of acute exacerbations of COPD in hospital. EABPCO-CPHG study by the college of general hospital respiratory physicians]. / Caractéristiques et prise en charge des exacerbations aiguës de BPCO hospitalisées. Etude EABPCO-CPHG du Collège des pneumologues des hôpitaux généraux.

INTRODUCTION: A cohort was formed to explore the evolution of COPD patients treated in general hospitals for acute exacerbations (AE). The present article describes and compares patient characteristics according to whether COPD was diagnosed before the AE or not. METHODS: Data were analyzed for 1,824 patients admitted between October 2006 and June 2007 to 68 departments of respiratory medicine. RESULTS: Population characteristics were: male, 77%; mean age, 70.3+/-11.3 years; current smokers, 33%; baseline grade 3-4 dyspnoea, 47%; FEV1

[Pulmonary manifestations of leptospirosis]. / Manifestations pulmonaires de la leptospirose.

BACKGROUND: Pulmonary manifestations in leptospirosis are considered a major complication, and are related to a poor prognosis. We present a large series of patients with pulmonary involvement using a practical approach based on the presence of acute respiratory failure (ARF). METHODS: A retrospective study of patients with confirmed leptospirosis. RESULTS: 169 patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. 134 patients (36.7 + or - 14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of acute respiratory failure. Univariate analysis found the following factors related to severe pulmonary leptospirosis: dyspnoea (OR 10.14, p<0.0001), pulmonary crepitations (OR 4.8, p<0.0004), abnormal chest X Ray (OR 9.88, p<0.007) with alveolar shadowing (OR 8.12, p<0.0001), oliguria/anuria (OR 5.48, p<0.0001), hepatomegaly (OR 7.11, p<0.0001), shock (OR 8.38, p<0.0001), ICU admission (OR 60.08, p<0.0001), dialysis (OR 4.87, p<0.001), mechanical ventilation (OR 216, p<0.0001) and development of nosocomial infection (OR 21.5, p<0.0001). The mortality rate was significantly different between severe (40%) and non-severe (5.3%) pulmonary forms (OR 11.87, p<0.0001). Multivariate analysis found 2 independent factors related to severe pulmonary involvement: dyspnoea (OR 10.18, p<0.0001), and oliguria/anuria (OR 4.87, p<0.0009). We performed a multivariate analysis to assess independent factors related to mortality and found: Mechanical ventilation requirement (OR 27.85, p<0.0001) and ASAT>150 UI/L (OR 4.57, p<0.02). Haemoptysis was associated with survival (OR 0.2, p<0.02). CONCLUSION: Severe pulmonary involvement in leptospirosis is associated with extensive disease involving other organs. The association of multiples factors is associated with severe forms of the disease and a high mortality rate.

[Asthma on the island of Reunion: an analysis of the severity and therapeutic management]. / Asthme à l'île de la Réunion: analyse de la sévérité et de la prise en charge thérapeutique.

INTRODUCTION: Asthma is a common condition on the island of La Reunion but there are no epidemiological studies that analyse the prevalence, severity and management of the patients. METHODS: Two studies were undertaken: a CPAM (health insurance) study of 187 patients and an analysis of the data from 253 patients attending a specialist hospital clinic. RESULTS: In these two studies we found 40% of patients were in GINA group 3 compared with 10% in metropolitan France. Recourse to the emergency department and admission to intensive care were common. There was under-evaluation by the treating physicians who did not classify patients correctly. This under-evaluation also occurred in prescribing with only 1/3 of asthmatics in stages 2 and 3 receiving inhaled corticosteroids. Patient education was poor with 30% receiving a demonstration of inhaler technique and 31% a functional evaluation. CONCLUSION: These studies show that the severity profile of asthma on La Reunion is comparable to that in other oceanic countries like Australia and New Zealand rather than metropolitan France. A population study is needed to assess the prevalence of asthma on the island of La Reunion.

[Clinical aspects and genetic specificities of cystic fibrosis in Reunion Island]. / Aspects cliniques et spécificités génétiques de la mucoviscidose à l'île de la Réunion.

OBJECTIVES: Evaluation of the phenotype-genotype correlation of a specific mucoviscidosis mutation, "Y122X", in Reunion Island. This mutation represents 25% of our cases. PATIENTS AND METHODS: Retrospective study of a cohort of 84 children presenting cystic fibrosis (CF) during a 5-year period (1994-1998). Diagnosis was based on one or two identified genetic mutations and/or minimum two abnormal chloride sweat tests (Cl > 70 mmol/l). Follow-up of this cohort was performed in the two referral centers of the Island following the French national guidelines (INSERM U 155). RESULTS: In our population, we identified 10 mutations, of which three of them represented more than 80% of the cases: Delta F508 (51.8%), Y122X (24.4%) and 3120 + 1G --> A (4.8%). The authors report clinical significant differences in children with the homozygote mutation Y122X as compared with children presenting the Delta F508 CF-mutation: failure to thrive affecting mainly the height with, paradoxically, a relatively normal weight development, and a better pulmonary function. CONCLUSION: The frequent Y122X CF-mutation reported in "la Reunion" seems to affect mainly height in children with a relatively good nutritional outcome. This failure to thrive does not seem to be of digestive origin. These results suggest that growth gene(s) located nearby the cystic fibrosis transmembrane conductance regulator (CFTR) may have suffered the same segregation than the Y122X mutation or that clusters of this specific Caucasian population known as "petits blancs" in la Reunion are smallest for ethnic reasons.

[Chemotherapy with paclitaxel for lung metastases of cystic adenoid carcinoma. A case report and review of the literature]. / Chimiothérapie par paclitaxel dans les métastases pulmonaires des carcinomes adénoïdes kystiques. A propos d'un cas et revue de la littérature.

Cystic adenoid carcinoma, which generally develops in the salivary glands, is a rare primary lung tumor. Locoregional treatment classically associates surgery and radiotherapy. Approximately half of the patients develop metastases; appropriate treatment with chemotherapy remains to be defined. We report the case of a woman who developed lung and pleural metastases of a right submaxillary cystic adenoid carcinoma. Chemotherapy with paclitaxel provided partial tumor response after three cycles. We present a review of the literature on chemotherapy for cystic adenoid carcinoma.

[Patent and occult intra-alveolar hemorrhage in leptospirosis]. / Hémorragies intra-alvéolaires patentes et occultes au cours des leptospiroses.

PURPOSE: Pulmonary involvement (PI) is common in leptospiral infection, usually characterized by hemoptysis and diffuse bilateral infiltrates on chest radiographs. Alveolar haemorrhage (AH) has already been proved by autopsy and some case-reports with fiberoptic bronchoscopy (FB) and bronchoalveolar lavage (BAL). The purpose of this study was 1/to evaluate the incidence of AH in leptospirosis 2/to define the impact of BAL on the early diagnosis of the infection. PATIENTS AND METHODS: FB with BAL were performed in 23 consecutive patients with leptospirosis (13 patients with patent signs of PI: group 1, 10 patients without: group 2). AH was defined by a percentage of siderophages > or = 20% and/or a Golde score > 100 and/or an haemorrhagic aspect of BAL fluid. Culture tests were performed on specific medium. RESULTS: We diagnosed AH in all patients of group 1 and in 7 patients of group 2. Filaments were seen in 6 specimens of BAL fluid, initially thought to be leptospires, but culture tests were negative. CONCLUSION: AH is identified in all cases of leptospirosis with PI. Occult AH often occurs to patients without any respiratory symptom. Physicians should consider leptospiral infection in the differential diagnosis of AH. Culture-tests for leptospirosis in BAL do no help in diagnosing leptospirosis.

[Respiratory manifestations of leptospirosis. A retrospective study of 91 cases (1978-1984)]. / Les manifestations respiratoires de la leptospirose. Etude rétrospective de 91 cas (1978-1994).

Leptospirosis, an ubiquitous zoonotic disease, is a systemic infection usually producing fever with hepatorenal involvement, meningoenephalitis, and hemorrhage. Respiratory manifestations are less well known but have been described in certain regions such as Southeast Asia or the Reunion Island. From January 1978 through December 1994, 154 cases of documented leptospirosis were admitted to the South Reunion Hospital Center. Pulmonary involvement was observed in 91 of these cases (59.1%) with hemoptysis (37.4%) and radiological evidence of bilateral reticulonodular infiltration (40%). Extra-pulmonary manifestations in most cases suggested leptospirosis at admission. Thirteen consecutive patients underwent endoscopy explorations with bronchoalveolar lavage: intra-alveolar hemorrhage was evidenced in all cases. This highly typical pattern of cytolysis would emphasize (20.8%) when the classical extra-pulmonary signs are too discrete to suggest the diagnosis. In this series, 10 patients required ventilatory assistance and 2 were given corticosteroid boluses for massive hemoptysis. Mortality due to leptospirosis is two-fold higher in cases with pulmonary involvement.

[Efficacy of octreotide acetate in the treatment of a pancreatic-pleural fistula. Apropos of a case]. / Efficacité de l'acétate d'octréotide dans le traitement d'une fistule pancréatico-pleurale. A propos d'un cas.

Diseases organs below the diaphragm should be considered in the aetiologic diagnosis of liquid effusion in the pleura. We observed a cases of pleuritis resulting from chronic pancreatitis and present here the diagnostic methods and therapeutic protocol undertake for cure. The level of amylase (including the isoforms) should be measured in the pleural effusion. The effectiveness of octreotide acetate in the treatment of pancreatico-pleural fistula was confirmed in this case.

[Diffuse alveolar hemorrhage and myositis in icterohemorrhagic leptospirosis. Rapid control by a single bolus of corticoids]. / Hémorragie alvéolaire diffuse et myosite au cours d'une leptospirose ictéro-hémorragique. Contrôle rapide par un seul bolus de corticoïdes.

Leptospirosis is one of the commonest causes of diffuse alveolar haemorrhage. Despite good sensitivity to penicillin and current techniques of ventilation, there remains a considerable mortality which is particularly linked to the initial pulmonary disease at presentation. The authors describe a new case of a gravely ill patient with leptospirosis and sever hypoxaemia. There was diffuse alveolar haemorrhage and myositis thus a bolus of corticosteroids was used over the first 24 hours complementary to the traditional treatment.

[Interstitial pulmonary involvements in polymyositis and dermatopolymyositis. Apropos of 3 cases. Review of the literature]. / Atteintes pulmonaires interstitielles des polymyosites (PM) et dermatopolymyosites (DP). A propos de 3 observations. Revue de la littérature.

The authors report 3 cases of myositis associated with pulmonary lesions that preceded or succeeded the muscular disorder. In one of these cases, which was particularly difficult to diagnose, the patient's serum was positive for the anti-Jol antibody. These 3 cases have encouraged the authors to review the literature with particular attention to the diagnostic approach, the latest physiopathological data and the therapeutic basis of the "specific" pulmonary lesions associated with polymyositis and dermatomyositis.

[Interstitial pulmonary involvement of polymyositis and dermatomyositis. Apropos of 3 cases. Review of the literature]. / Atteintes pulmonaires interstitielles des polymyosites (PM) et dermatopolymyosites (DP). A propos de 3 observations. Revue de la littérature.

The authors report 3 new cases of myositis associated with pulmonary lesions that preceded or succeeded the muscular disorder. In one of these cases, which was particularly difficult to diagnose, the patient's serum was positive for the anti-Jo1 antibody. These 3 cases have encouraged the authors to review the literature with particular attention to the diagnostic approach, the latest physiopathological data and the therapeutic basis of the "specific" pulmonary lesions associated with polymyositis and dermatomyositis.

[Predominant pulmonary manifestations in leptospirosis icterohemorrhagica]. / Manifestations pulmonaires prédominantes au cours des leptospiroses ictéro-hémorragiques.

14 cases of leptospirosis ictero-haemorrhagica observed on Reunion island with predominant or isolated pulmonary symptoms are described. Hospitalisation was motivated in every case by haemoptysis, at times profuse, which occurred in patients with fever and myalgia. The chest radiographs revealed an alveolar and/or a bilateral alveolar pattern of variable severity. In spite of the importance of chest radiography port raying an extensive and serious pneumonia in one case out of every two, the outcome was favourable with a mean time lag of one week. In three cases, an adult respiratory distress syndrome (ARDS) was seen requiring assisted ventilation and one death occurred. The diagnosis of leptospirosis may be considered, even in countries of low endemicity, in a case pneumonia with extensive haemoptysis or an adult respiratory distress syndrome whose cause is not established by the usual tests.