| Summary: | Purpose: Respiratory manifestations in leptospirosis can vary from subtle symptoms to deadly pulmonary hemorrhage and ARDS. Our objective was to analyze respiratory symptoms and to assess their prognostic value in leptospirosis.
Material and methods: We performed analysis of clinical data and X-ray findings in 100 consecutive cases of leptospirosis, treated in Clinic of Infectious Diseases at University Hospital – Pleven (1976-2018) (mean age 37±18 years, 90 male, 13% lethal outcome). Statistical methods – t-test and χ2 test (for parametric and non-parametric distributions, respectively; p<0.05 was considered as significant); Pirson’s test (φ-coefficient: weak correlation in φ<0.3, moderate – 0.3< φ<0.7 and strong in φ>0.7); odds ratio (OR).
Results: The characteristic manifestations were fever (100%), hepatomegaly (92%), myalgia (86%), vomiting (84%), splenomegaly (74%), oliguria (69%), jaundice (63%), hypotension (49%), abdominal pain (41%), and hemorrhagic diathesis (37%). The most frequent respiratory symptoms (especially in icteric cases) were decreased breath (37%), rales (17%), tachypnea (15%), and dyspnea (13%). Comparative study of respiratory symptoms in different according to severity forms revealed higher prevalence in severe cases (p<0.001). X-rays (in 34 severe cases) revealed infiltrative changes in nine cases and interstitial and alveolar congestion (suggesting lung edema) in thirteen. Comparative analysis of survived and deceased severe cases revealed that mentioned above respiratory symptoms occur more often in deceased patients (p<0.001). The lethal outcome strongly correlated with lung edema (OR 25.00; φ=0.66).
Conclusions: Respiratory dysfunctions in our study were nonspecific and correlated with severity. The lung edema is important factor for death, and its prevention requires prompt intensive interdisciplinary treatment.
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