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Volume 14, Number 3—March 2008

Dispatch

Leptospirosis-associated Severe Pulmonary Hemorrhagic Syndrome, Salvador, Brazil

Edilane L. Gouveia*, John Metcalfe†, Ana Luiza F. de Carvalho*, Talita S.F. Aires*, José Caetano Villasboas-Bisneto*, Adriano Queirroz*, Andréia C. Santos*, Kátia Salgado‡, Mitermayer G. Reis*, and Albert I. Ko*§Comments to Author 
Author affiliations: *Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil; †University of California, San Francisco, California, USA; ‡Hospital Couto Maia, Secretaria da Saúde do Estado da Bahia, Salvador, Bahia, Brazil; §Weill Medical College of Cornell University, New York, New York, USA;

Main Article

Table 1

Characteristics of leptospirosis patients identified during active surveillance in metropolitan Salvador, Brazil, from 2003 through 2005, according to presence of SPHS

Characteristics With SPHS
Without SPHS
p value*
No. responses No. (%) 
or mean ± SD No. responses No. (%) 
or mean ± SD
Age, y 44 37.6 ± 19.4 427 34.9 ± 14.5 0.57
Female sex
47
14 (30)

427
55 (13)
0.002
Clinical manifestations
Days of symptoms before hospitalization 43 6.3 ± 3.6 419 6.1 ± 2.8 0.70
Respiratory insufficiency† 47 20 (42) 427 73 (17) 0.001
Hemoptysis 47 7 (15) 427 27 (6) 0.03
Jaundice 47 40 (85) 427 363 (85) 0.99
Total serum bilirubin, mg/dL 22 17.8 ± 13.4 140 13.9 ± 10.3 0.22
Oliguria 47 22 (47) 427 106 (25) 0.001
Blood urea nitrogen, mg/dL 33 121 ± 78 254 128 ± 79 0.60
Serum creatinine, mg/dL 33 3.9 ± 2.3 254 3.8 ± 2.7 0.64
Hypotension‡ 42 12 (28) 387 85 (22) 0.33
Leukocyte count, 103 cells/mm3 45 15.3 ± 8.0 422 14.4 ± 6.5 0.71
Hematocrit, % 23 31.8 ± 7.1 135 33.6 ± 6.1 0.11
Thrombocytopenia§
21
6 (29)

120
32 (27)
0.86
Therapeutic interventions
Dialysis 47 25 (53) 425 89 (21) 0.001
Packed erythrocyte transfusion 47 28 (60) 424 42 (10) 0.001
Intensive care unit admission
47
44 (94)

424
112 (26)
0.001
Hospital outcome
Death 47 35 (74) 427 49 (12) 0.001
Days of hospitalization for patients who died 35 3.2 ± 2.5 49 4.8 ± 5.9 0.91
Days of hospitalization for survivors
12
20.8 ± 15.0

378
9.1 ± 8.4
0.02
Confirmed case¶ 47 37 (79) 427 351 (82) 0.56
Serovar Copenhageni as the presumptive 
 infecting agent# 23 22 (96) 316 285 (90) 0.71

*The χ2 and Student t tests were used to evaluate for significant differences (p value <0.05) for proportions and continuous data, respectively. SPHS, severe pulmonary hemorrhagic syndrome; SD, standard deviation.
†Respiratory rate >30 per min or use of supplemental oxygen therapy.
‡Systolic arterial blood pressure <90 mm Hg or use of vasoactive drugs.
§Platelet count <50,000 cells/mm3.
¶The microscopic agglutination test (MAT) and immunoglobulin M ELISA were used for laboratory confirmation.
#Proportions are shown for patients who had an MAT-confirmed diagnosis of leptospirosis and highest agglutination titers against Leptospirosis interrogans serovar Copenhageni.

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