Table 2.

Summary of clinical information on patients with severe pulmonary leptospirosis.

	Age in years, sex	Clinical data
Patient		Presentation	Epidemiologic factors	Treatment	Outcome	Laboratory data	Chest radiograph findings	Results of leptospiral tests
1	15, M	7 days with undifferentiated fever; 4 days with dark urine, icteric sclerae, dyspnea, and bloody sputum; hematuria; oliguria.	Lived in a brick-and-mortar house in San Juan district between Iquitos airport and the city; poor sanitation; no running water; well in backyard; mother died of undi agnosed disease with fever- and jaundice 1 year before	Intravenous ceftriaxone administered every 2 h after admission	Died of respiratory failure while receiving ventilator support on day 2 of hospitalization	Hb, 9.3; Hct, 30%; WBC count, 10,900 cells/mm3; Tbil, 7.2 mg/dL; Dbil, 5.6 mg/dL; SCr, 1.6 mg/dL; calculated ClCr, 67.5 mL/min; 2 smears negative for malaria parasites	Diffuse patchy infiltrates with lower-lobe pre- dominance; right-side pleural-based density	Blood culture, positive for L. interrogans serovar Icterohaemorrhagiae; MAT/ELISA results, negative; acute-phase serum PCR results, positive; urine PCR results, negative
2	43, M	Abrupt onset of fever, increased cough, dyspnea, and hemoptysis, preceded by a 2-week afebrile period of productive, nonbloody cough. Fulminant deteriora tion with respiratory failure; no jaundice; refractory hypotension.	Lived 1 block from Moronacocha lake in urban Iquitos; house had running water; rats seen in home; dogs ubiquitous in the area	Regimen of intravenous ceftriaxone started 6 h after admission	Died 17 h after hospital admission	Not done	Diffuse patchy infiltrates with lower-lobe predominance	Blood culture, positive for L. interrogans serovar Canicola; MAT/ELISA results, negative; acute-phase serum PCR results, positive; urine PCR results, negative
3	19, F	3 Weeks of fever, malaise, nonproductive cough, dyspnea; no hemoptysis. Plasmodium vivax parasitemia was diagnosed 2 weeks before presentation, but fever did not respond to chloroquine; refractory shock on day 7.	Lived in San Juan; 2 deep-water wells in backyard, one enclosed, one at ground- level and subject to runoff from ground water	Regimen of ceftriaxone was started 12 h after admission; antitubercu lous drugs	Died	WBC count, 6700 cells/mm3; urinalysis, 30 WBCs/hpf; 3 blood smears negative for malaria parasites	Diffuse “ground-glass” pulmonary infiltrates typical of acute respira tory distress syndrome	ELISA results, negative; MAT results, positive (1/1600 against strain Var10 but not to other serovars); acute-phase serum PCR results, negative; urine PCR results, positive
4	19, M	6 Days with fever, chills, headache, and sore throat; 3 days with jaundice and severe calf pain; abdominal and retrosternal pain; 1 day with blood-tinged vomit. Physical examination showed tachypnea and icteric sclerae and skin, hepatosplenomegaly, and right upper quadrant tenderness. Complications during hospitalization included hyperpyrexia; pericardial friction rub; bleeding from oral mucosa, lips and gums; subconjunctival hemorrhage; hemoptysis; and oliguric renal failure.	Lived in brick-and-mortar house in urban Iquitos; bitten by rat 5 days prior to onset of illness; no other information available	Regimen of intravenous ceftriaxone started 4 h after admission	Died 5 days after hospitalization; autopsy showed frankly hemorrhagic lungs (figure 1, bottom); liver was green; otherwise, viscera normal with no evidence of retroperitoneal hemorrhage	Hb, 9.1; Tbil, 7.4 mg/dL; Dbil, 6.7 mg/dL; SCr, 5.2 mg/dL; arterial blood gas: Po2 = 61 mm Hg; Pco2 =23 mm Hg	Diffuse alveolar infiltrates with lower-lobe pre- dominance (figure 1, top)	Blood and urine culture results, negative; MAT and ELISA results, negative; acute-phase serum, urine, and tissue PCR results, positive
5	53, M	5 Days with fever, headache, myalgia, leg pain, sore throat, and abdominal pain. The patient was seen at the out-patient fever clinic and was sent home with a course of antipyretics. Two weeks later at a follow-up visit, the patient revealed that he had hemoptysis 4 days after being seen at the fever clinic. Two sputum smears negative for M. tuberculosis.	Fruit farmer in San Juan district of Iquitos; rats noticed sporadically at home and at work	Self-medicated with amoxicillin	Symptoms resolved	None available	None available	Blood culture, positive for L. interrogans serovar Icterohaemorrhagiae; acute-phase ELISA results, negative; convalescent-phase ELISA results, positive; MAT titer for acute- phase serum, 6400 against serovar Australis; for convalescent- phase serum, 3200 against serovars Australis and Icterohaemorrhagiae; acute-phase serum PCR results, negative; urine PCR results at admission, at 90 days after hospitalization, and at 121 days, positive
6	63, M	9 Days of fever, abdominal pain, diarrhea, anorexia, and jaundice; self-resolving episodes of hemoptysis 4–5 days before admission. Physical examination: temperature, 383C; tachypnea, normotensive; alert and oriented; icteric sclerae and skin; pulmonary rales; hepatomegaly.	Lived in Iquitos, worked in newspaper printing plant; rats seen there; traveled to oil drilling area in Amazon region of Loreto to do manual field labor	Regimen of intravenous penicillin started 6 h after admission	Disease resolved; patient discharged after 11 days	Hb, 10.8 g/dL, WBC count, 7200 cells/mm3; SCr, 0.65 mg/dL; urinalysis, 10–12 leukocytes/hpf; thick smears negative for malaria parasites	Diffuse, bilateral lower-lobe infiltrates, with right-side predominance	Acute- and convalescent-phase ELISA results, positive; MAT titer on acute-phase serum, 51,200 against serovars Icterohaemorrhagiae and Bratislava (6400 at 30 days after hospitalization and 1600 at 60 days); acute-phase serum PCR results, negative; urine PCR results at 60 days, positive
7	37, F	2 Weeks with generalized myalgia; 4 days with jaundice and acute onset of diffuse, colicky abdominal pain. Physical examination: temperature, 36.53C; normotensive; not tachypneic; icteric mucous membranes and skin; lungs normal; hepatosplenomegaly; abdominal distension and diffuse tenderness on palpation; legs tender bilaterally. Fever, copious hemoptysis, and mucosal hemorrhage (gums, lips) began on day 2 of hospitalization; progressive respiratory deterioration, anuria, and obtundation.	Lived for 1 year in Punchana, a district of Iquitos near the Bellavista Nanay port on the Amazon River	Regimen of intravenous ceftriaxone started 2 h after admission	Died 6 days after presentation	Hypoglycemia (glucose, 60 mg/dL); Hb, 7.5 g/dL; Hct, 24%; platelet count, 302,000 platelets/mL; WBC count, 6300 cells/mL with normal differential; SCr, 5.2 mg/dL	Not done	ELISA results, negative; MAT results, 3200 only against isolate Var10; acute-phase serum PCR results, negative; urine PCR results, positive

NOTE. ClCr, creatinine clearance; Dbil, direct bilirubin; Hb, hemoglobin level; Hct, hematocrit; SCr, serum creatinine level; Tbil, total bilirubin.