ArticlePloS one2013
Human hemorrhagic pulmonary leptospirosis: pathological findings and pathophysiological correlations.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed, 64 citations in OpenAlex.
- Article
- Leptospirosis-associated pulmonary hemorrhagic syndrome: immune mechanisms, clinical manifestations, and experimental models.Revista do Instituto de Medicina Tropical de Sao Paulo · 2026Review
- Pulmonary haemorrhage as the earliest sign of severe leptospirosis in hamster model challenged with Leptospira interrogans strain HP358.PLoS neglected tropical diseases · 2022Article
- Article
- PathogenicFrontiers in microbiology · 2022Article
- Metagenomic next-generation sequencing in the diagnosis of leptospirosis presenting as severe diffuse alveolar hemorrhage: a case report and literature review.BMC infectious diseases · 2021Review
- Pulmonary haemorrhage in Weil's disease.BMJ case reports · 2020Article
- Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality.PLoS neglected tropical diseases · 2019Article
- A simple score to predict severe leptospirosis.PLoS neglected tropical diseases · 2019Article
- Pathology and pathogenesis of human leptospirosis: a commented review.Revista do Instituto de Medicina Tropical de Sao Paulo · 2018Review
- Distinct antibody responses of patients with mild and severe leptospirosis determined by whole proteome microarray analysis.PLoS neglected tropical diseases · 2017Article
- Hypoxemic Respiratory Failure from Acute Respiratory Distress Syndrome Secondary to Leptospirosis.Case reports in critical care · 2017Article
- Increased levels of soluble forms of E-selectin and ICAM-1 adhesion molecules during human leptospirosis.PloS one · 2017Article
- Article
- Article
- Leptospirosis-Associated Severe Pulmonary Hemorrhagic Syndrome with Lower Back Pain as an Initial Symptom.The American journal of case reports · 2016Article
- High frequency oscillatory ventilation in leptospirosis pulmonary hemorrhage syndrome: A case series study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2016Review
- The Expression of Water and Ion Channels in Diffuse Alveolar Damage Is Not Dependent on DAD Etiology.PloS one · 2016Article
- Article
- Specific CD4+ T-Cell Reactivity and Cytokine Release in Different Clinical Presentations of Leptospirosis.Clinical and vaccine immunology : CVI · 2015Observational
Corrections and comments
- Erratum issued
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLeptospirosis is a re-emerging zoonosis with protean clinical manifestations. Recently, the importance of pulmonary hemorrhage as a lethal complication of this disease has been recognized. In the present study, five human necropsies of leptospirosis (Weil's syndrome) with extensive pulmonary manifestations were analysed, and the antibodies expressed in blood vessels and cells involved in ion and water transport were used, seeking to better understand the pathophysiology of the lung injury associated with this disease. PRINCIPAL
findingsProminent vascular damage was present in the lung microcirculation, with decreased CD34 and preserved aquaporin 1 expression. At the periphery and even inside the extensive areas of edema and intraalveolar hemorrhage, enlarged, apparently hypertrophic type I pneumocytes (PI) were detected and interpreted as a non-specific attempt of clearence of the intraalveolar fluid, in which ionic transport, particularly of sodium, plays a predominant role, as suggested by the apparently increased ENaC and aquaporin 5 expression. Connexin 43 was present in most pneumocytes, and in the cytoplasm of the more preserved endothelial cells. The number of type II pneumocytes (PII) was slightly decreased when compared to normal lungs and those of patients with septicemia from other causes, a fact that may contribute to the progressively low PI count, resulting in deficient restoration after damage to the alveolar epithelial integrity and, consequently, a poor outcome of the pulmonary edema and hemorrhage.
conclusionsPathogenesis of lung injury in human leptospirosis was discussed, and the possibility of primary non-inflammatory vascular damage was considered, so far of undefinite etiopathogenesis, as the initial pathological manifestation of the disease.
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