Leptospirosis with predominant respiratory compromise. Presentation of five clinical cases

Leptospirosis is an acute general infection, re-emerging in Uruguay and the South Cone. Breath involvement is frequent but usually mild and misdiagnosed. It is unusual as starting of the disease. During the last years clinical changes have been observed with higher incidence of serious anictericia forms, non renal failure and predominant pulmonar involvement. We report on five clinical cases of 'primarily' pulmonar leptospirosis admitted in the Maciel Hospital during 2005: five young men with occupations of risk and contact with roders. They presented acute respiratory syndrome with fever, hemoptoic cough and respiratory failure (mean PO2 70 Hg mm, SaO(2) 94%), and extrapulmonary symptoms: intense myalgias, cephaleas, ocular pain and conjunctival hyperemia. Pleuropulmonar examination could be normal or may present bilateral and diffuse signs. Most of these cases did not shown ictericia and none of them had serious renal failure. Radiologically, bilateral and diffuse alveolar attern is predominant which is compatible with pulmonar haemorrage. Leptospirosis diagnosis is based on suspicion and compatible epidemiologic clinical context and confirmed by serologic tests. All patients underwent respiratory function and betalactam antibiotics treatment leading to a clinical improvement.