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Volume 14, Number 3—March 2008


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;

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Table 2

Pulmonary manifestations of patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome (n = 47)

Characteristics* No. responses No. (%) or mean ± SD
Onset of massive hemoptysis
During hospital admission 47 7 (15)
After hospitalization and before endotracheal intubation 47 21 (45)
During or after endotracheal intubation
19 (40)
Chest radiographic examination
Bilateral alveolar infiltrates 24 21 (88)
Bilateral interstitial infiltrates
3 (12)
PaO2/FiO2, mm Hg 33 200 ± 155
Acute lung injury† 33 25 (76)
Acute respiratory distress syndrome‡ 33 21 (64)

*Findings at initial evaluation. SD, standard deviation.
†Defined as a ratio between arterial partial pressure of O2 and inspired O2 fraction (PaO2/FiO2) <300 mm Hg and the presence of bilateral alveolar or interstitial infiltrates on chest radiograph or bilateral crepitus on physical examination, without clinical evidence of increased left atrial pressure.
‡Defined as PaO2/FiO2 <200 mm Hg in addition to criteria for acute lung injury.

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