<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0873-2159</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Pneumologia]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Pneumol]]></abbrev-journal-title>
<issn>0873-2159</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Pneumologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0873-21592007000600005</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Leptospirose pulmonar]]></article-title>
<article-title xml:lang="en"><![CDATA[Pulmonary leptospirosis]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pereira]]></surname>
<given-names><![CDATA[João Cláudio Barroso]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
<xref ref-type="aff" rid="A02"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Grijó]]></surname>
<given-names><![CDATA[Amorita]]></given-names>
</name>
<xref ref-type="aff" rid="A03"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mackay]]></surname>
<given-names><![CDATA[Maria Cristina B]]></given-names>
</name>
<xref ref-type="aff" rid="A03"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vitral]]></surname>
<given-names><![CDATA[Beatriz Guerra]]></given-names>
</name>
<xref ref-type="aff" rid="A03"/>
</contrib>
</contrib-group>
<aff id="A01">
<institution><![CDATA[,Hospital Municipal Nelson de Sá Earp  ]]></institution>
<addr-line><![CDATA[Petrópolis Rio de Janeiro]]></addr-line>
<country>Brasil</country>
</aff>
<aff id="A02">
<institution><![CDATA[,SAE - Serviço da Assistência Especializada  ]]></institution>
<addr-line><![CDATA[Belford Roxo Rio de Janeiro]]></addr-line>
<country>Brasil</country>
</aff>
<aff id="A03">
<institution><![CDATA[,Faculdade de Medicina de Petrópolis  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2007</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2007</year>
</pub-date>
<volume>13</volume>
<numero>6</numero>
<fpage>827</fpage>
<lpage>839</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0873-21592007000600005&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0873-21592007000600005&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0873-21592007000600005&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[No presente artigo, os autores discutem brevemente sobre a leptospirose, realçando a forma pulmonar da doença. Revê-se a patologia, achados clínicos, diagnóstico por métodos de imagem e broncoscopia e tratamento da leptospirose pulmonar. É também lembrado o diagnóstico clínico e radiológico precoces, para que se possa iniciar terapêutica adequada. Os autores concluem que a forma pulmonar da leptospirose deve ser sempre considerada como causa e diagnóstico diferencial da hemorragia alveolar difusa e síndroma de dificuldade respiratória do adulto.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[In this article, the authors discuss briefly the leptospirosis, emphasizing mainly the pulmonary form of disease. The authors review pathology, clinical findings, imaging and broncoscopy diagnosis, treatment of pulmonary leptospirosis. It is also remembered about early clinics and radiology diagnosis to start therapeutics. The authors conclude that pulmonary form of disease must always be remembered and considered as cause and differential diagnosis of Diffuse Alveolar Hemorrhage and Adult Respiratory Distress Syndrome.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Leptospirose]]></kwd>
<kwd lng="pt"><![CDATA[manifestações respiratórias]]></kwd>
<kwd lng="pt"><![CDATA[hemorragia alveolar difusa e síndroma da dificuldade respiratória do adulto]]></kwd>
<kwd lng="en"><![CDATA[Leptospirosis]]></kwd>
<kwd lng="en"><![CDATA[respiratory manifestations]]></kwd>
<kwd lng="en"><![CDATA[diffuse alveolar hemorrhage and adult respiratory distress syndrome]]></kwd>
</kwd-group>
</article-meta>
</front><body><![CDATA[ <p><b>Leptospirose pulmonar</b></p>     <p>&nbsp;</p>      <p><b>Pulmonary leptospirosis</b></p>     <p>&nbsp;</p>          <p><b>João Cláudio Barroso Pereira <a href="#1">1</a><a name="top1"></a></b></p>      <p><b>Amorita Grijó </b><a href="#2"><b>2</b></a><a name="top2"></a></p>      <p><b>Maria Cristina B Mackay <a href="#3">3</a><a name="top3"></a></b></p>      <p><b>Beatriz Guerra Vitral <a href="#4">4</a><a name="top4"></a></b></p>          <p>&nbsp;</p>     <p align="center"><b>Resumo</b></p>      ]]></body>
<body><![CDATA[<p>No presente artigo, os autores discutem brevemente sobre a leptospirose, realçando    a forma pulmonar da doença. Revê-se a patologia, achados clínicos, diagnóstico    por métodos de imagem e broncoscopia e tratamento da leptospirose pulmonar.    É também lembrado o diagnóstico clínico e radiológico precoces, para que se    possa iniciar terapêutica adequada. Os autores concluem que a forma pulmonar    da leptospirose deve ser sempre considerada como causa e diagnóstico diferencial    da hemorragia alveolar difusa e síndroma de dificuldade respiratória do adulto.</p>      <p><b>Palavras-chave: </b>Leptospirose, manifestações respiratórias, hemorragia    alveolar difusa e síndroma da dificuldade respiratória do adulto.</p>     <p>&nbsp;</p>     <p>&nbsp;</p>      <p align="center"><b>Abstracts</b></p>      <p>In this article, the authors discuss briefly the leptospirosis, emphasizing mainly the pulmonary form of disease. The authors review pathology, clinical findings, imaging and broncoscopy diagnosis, treatment of pulmonary leptospirosis. It is also remembered about early clinics and radiology diagnosis to start therapeutics. The authors conclude that pulmonary form of disease must always be remembered and considered as cause and differential diagnosis of Diffuse Alveolar Hemorrhage and Adult Respiratory Distress Syndrome.</p>              <p><b>Key-words: </b>Leptospirosis, respiratory manifestations, diffuse alveolar    hemorrhage and adult respiratory distress syndrome.</p>     <p>&nbsp;</p>     <p>Texto completo disponível apenas em PDF.</p>     <p>Full text only available in PDF format.</p>     ]]></body>
<body><![CDATA[<p>&nbsp;</p>     <p>&nbsp;</p>      <p align="center"><b>Bibliografia</b></p>     <p align="center">&nbsp;</p>      <!-- ref --><p>1. Martins FSV, Castiñeras TMPP. Leptospirose. <i>n</i>: Schechter M Doenças Infecciosas-Conduta Diagnóstica e Terapêutica. Primeira Edição. Rio de Janeiro: Guanabara –Koogan, 1994: 145-52.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;[&#160;<a href="javascript:void(0);" onclick="javascript: window.open('/scielo.php?script=sci_nlinks&ref=000027&pid=S0873-2159200700060000500001&lng=','','width=640,height=500,resizable=yes,scrollbars=1,menubar=yes,');">Links</a>&#160;]<!-- end-ref --><p>2. Huston CD, Petri JWA. Leptospirosis. <i>In </i>Cecil Textbook of Medicine.22nd Edition,single volume, Philadelphia, Pennsylvania: Saunders, 2004: 1939-41.</p>      <p>3. Sambasiva RR, Gupta Naveen RRS, Bhalla P, Agarwal SK. Leptospirosis in India    and the Rest of the World.The Brazilian Journal of Infectious Diseases 2003;    7(3):178-93.</p>      <p>4. Hüttner MD <i>et al</i>. Pneumonia por leptospirose. J Pneumol 2002; 28(4):229-232.</p>      <p>5. Gomes Ribeiro MZ, Carvalho Pereira MC, Condé E. Rotina de Leptospirose do Instituto Estadual de Infectologia Infectologia São Sebastião. Reproduzida pela Secretaria Estadual de Saúde. Serviço Único de Saúde-Coordenação de Epidemiologia, Dezembro de 1995.</p>      <p>6. Lomar AV,Veronesi R, Brito T, Diament D. Leptospiroses. In Veronesi R, Focaccia R. Tratado de Infectologia. São Paulo: Ed Atheneu 1996: 987-1003.</p>      ]]></body>
<body><![CDATA[<p>7. Ministério da Saúde/FUNASA/CENEPI. Manual de Leptospirose. Segunda Ed revista. Brasília: Fundação Nacional de Saúde, 1995. 98 pp.</p>      <p>8. Mascarenhas LF, Rios Gonçalves AJ, Da Cunha R, Menezes J A <i>et al</i>. Manifestações Respiratórias na Leptospirose. Arq Bras Med 1991; 65(1):49-51.</p>      <p>9. Bethlem EP. Leptospirose Manifestações Pulmonares. Aula realizada durante V Curso Nacional de Atualização em Pneumologia. Rio de Janeiro, Abril 2004: 125-31.</p>      <p>10. Centers for Disease Control and Prevention.Outbreak of acute febrile illness among participants in Ecochallenge Sabah 2000-Malaysia, 2000. Morb Mortal Wkly Rep 2000; 49:816-7.</p>      <p>11. Centers for Disease Control and Prevention. Leptospirosis and unexplained acute febrile illness among athletes participating in Triathlons-Illinois and Wiscousin, 1998. Morb Mortal WKly Rep 1998; 47:673-6.</p>      <p>12. Manhães de Carvalho JE, Oliveira JMC, Nicol AF <i>et al</i>. Identificação de Leptospirose em tecido pulmonar por broncoscopia e biópsia brônquica. Pulmão RJ 1999; 8(4):337-81.</p>      <p>13. Rios Gonçalves AJ, Manhães de Carvalho JE, Guedes e Silva JB, Rosenbaum R, Machado Vieira AR. Leptospirose pulmonar. Rev Soc Bras Med Trop 1992; 25(4): 261-70.</p>      <p>14. Teglta OF, BattagliottiC <i>et al</i>. Selected Reports-Leptospiral Pneumonia. Chest 1995; 108(3):874-9.</p>      <p>15. Machado ES, Nogueira SA. Leptospirose. <i>In</i>: Martins S, Dutra Souto MS. Manual de Emergências Médicas-Diagnóstico e Tratamento-Rotina do Serviço de Emergência do Hospital Universitário Clementino Fraga Filho-UFRJ,Segunda Edição. Rio de Janeiro: Ed Revinter, 2003: 209-302.</p>      <p>16. Ripper-Vianna MS. A transmissão da leptospirose em áreas urbanas. Cadernos de Saúde Pública 2004; 20(6):32-5.</p>      ]]></body>
<body><![CDATA[<p>17. Ercolani MG, Papa M. Osservazioni clinico-radiologiche sulle manifestazioni polmonari da leptospirosi durantte l‘epidemia de Montefeltro. La Radiologia Medica 1988; 76(1-2):64-7.</p>      <p>18. Sehgal SC, Murhekar MV <i>et al</i>. Outbreak of leptospirosis with pulmonary involviment in North Andaman. Indian Journal of Medical Research 1995; 102:9-12.</p>      <p>19. Trevejo RT, Rigau-Perez JG, Ashford DA, <i>et al</i>. Epidemic leptospirosis associated with pulmonary hemorrhage-Nicaragua, 1995. Journal of Infectious Diseases 1998; 178(5):1457-63.</p>      <p>20. Nardone A, Campese C <i>et al</i>. Les facteurs re risque de leptospirose em France: une étude cãs-témoins nationale (1999). Méd Mal Infect 2001; 31(Suppl 2):285-7.</p>      <p>21. Du Couedic L, Courtin JP, Poubeau P. <i>et al</i>. Hemorragies intra-alveolaires    patentes et occultes au cours des leptospiroses. Revue de Maladies Respiratoires    1998; 15(1):61-7.</p>      <p>22. Niwattayakul K,Howivijitkul J <i>et al</i>. Hipotension, renal failure and pulmonary complications in leptospirosis. Renal Failure 2002; 24(3):297-305.</p>      <p>23. Manhães de Carvalho JE, <i>et al</i>. Estudo do lavado broncoalveolar em pacientes com comprometimento pulmonar na leptospirose. J Bras Pneumol 2004; 30(2):134-9.</p>      <p>24. Lucks MA, <i>et al</i>. Leptospirosis presenting as Diffuse Alveolar Hemorrhage-Case Report and Literature Review. Chest 2003; 123(2):639-43.</p>      <p>25. Carré PH <i>et al</i>. Manifestations pulmonaires predominantes au cours de leptospiroses icterohémorragiques. Revue de Maladies Respiratoire 1985; 2(6):343-9.</p>      <p>26. Simpson FG, Green KA, <i>et al</i>. Leptospirosis associated with severe pulmonary haemorrhage in Far North Queensland. Medical Journal of Australia 1998; 169(3):151-3.</p>      ]]></body>
<body><![CDATA[<p>27. Nicodemo AC, <i>et al</i>. Lung lesions in human leptospirosis: microscopic, immunohistochemical and ultrastructural features related to thrombocytopenia. American Journal of Tropical Medicine and Hygiene 1997; 56(2):181-7.</p>      <p>28. Green RJ, <i>et al</i>. Pulmonary Capillaritis and Alveolar Hemorrhage–Update on Diagnosis and Management. Chest 1996; 110(5):1305-16.</p>      <p>29. Ragnaud JM, Dupon M, <i>et al</i>. Manifestations Pulmonaires au cors de leptospiroses icterohémorragiques severes. Annales de Medicine Interne 1987; 138(4): 282-6.</p>      <p>30. Manhães de Carvalho JM, Marchiori E, <i>et al</i>. Comprometimento pulmonar na leptospirose. Revista da Sociedade Brasileira de Medicina Tropical 1992; 25(1):21-30.</p>      <p>31. Vieira SRR, Brauner JS. Leptospirosis as a cause of Acute Respiratory Failure: Clinical Features and Outcome in 35 critical care patients.The Brazilian Journal of Infectious Diseases 2002; 6(3):135-9.</p>      <p>32. Guivarch G, Le Gall JR, <i>et al</i>. États de Choc au cours de Leptospiroses ictero-hémorragiques. Quatre observations. La Nouvelle Presse Medicale 1982; 11(11):837-9.</p>      <p>33. Allen P, Raffery S. Massive pulmonary hemorrhage due to leptospirosis. Intensive Care Medicine 1989; 15(5):322-4.</p>      <p>34. O‘Neil KM, <i>et al</i>. Pulmonary manifestations of leptospirosis. Review of Infectious Diseases 1991; 13(4):705-9.</p>      <p>35. Im JG, Yeon KM, Han MC <i>et al</i>. Leptospirosis of the lung: radiographic findings in 58 patients. AJR 1989; 152(5):955-9.</p>      <p>36. Vuong TK, Laaban JP, Rabbat A, <i>et al</i>. Leptospirose icterohémorragique avec syndrome de detresse respiratoire aiguê et hemorragie pulmonaire. Revue de Maladies Respiratoires 1991; 8(2):256-7.</p>      ]]></body>
<body><![CDATA[<p>37. Labalme MJ, Chaabane-Masmoudi S, Mathieu L, Perol M, <i>et al</i>. Hemorragie intra-alveolaire fébrile isoleé révelant une leptospirose. Révue de Maladies Respiratoire 1996; 13(3):310-2.</p>      <p>38. Gonçalves AJR, Carvalho JEM, <i>et al</i>. Hemoptysis and the Adult Respiratory Distress Syndrome as the cause of death in leptospirosis: changes in the clinical and anatomicopathological patterns. Revista Sociedade Brasileira de Medicina Tropical 1992; 54:382-92.</p>      <p>39. Paganin, <i>et al</i>. Bronchoalveolar lavage in rapid diagnosis of leptospirosis. Lancet 1996; 347:1483-4.</p>      <p>40. Matos ED, Costa E. Chest Radiograph abnormalities in patients hospitalized with leptospirosis in the City of Salvador, Bahia, Brazil. The Brazilian Journal of Infectious Diseases 2001; 5(2):73-7.</p>      <p>41. Lee RE, Terry SI, <i>et al</i>. The chest radiograph in leptospirosis in Jamaica. British Journal of Radiology 1981; 54(647):939-43.</p>      <p>42. Martinez Garcia MA, de Diego AD, <i>et al</i>. Pulmonary involvement in leptospirosis. European Journal of Clinical Microbiology and Infectious Diseases 2000; 19(6):471-4.</p>      <p>43. Yersin C, Bovet P, Merien F, Clement J, <i>et al</i>. Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles. Transactions of the Royal Society of Tropical Medicine and Hygiene 2000; 94(1): 71-6.</p>      <p>44. Silva JSP, Dalston MO, Manhães de Carvalho JE, Setúbal S, <i>et al</i>.    The Clinicopathological and Immunohistochemical features of the severe pulmonary    form of leptospirosis. Revista da Sociedade Brasileira de Medicina Tropical    2002; 35(4):395-9.</p>      <p>45. Marchiori E, Muller NL. Leptospirosis of the lung: high resolution computed tomography findings in five patients. Journal of Thoracic Imaging 2002; 17(2): 151-3.</p>      <p>46. Müller, Fraser, Colman and Paré. Sinais Radiológicos da Doença Torácica. <i>In </i>Diagnóstico Radiológico das Doenças do Tórax. Primeira Edição. Rio de Janeiro: Guanabara Koogan, 2003: 66-116.</p>      ]]></body>
<body><![CDATA[<p>47. Naidich, Webb, Muller, Krinsky, Zerhouni, Siegelman. Doenças Pulmonares Difusas. In Tomografia Computadorizada e Ressonância Magnética do Tórax. Terceira Edição. Rio de Janeiro: Guanabara Koogan 2001: 365-443.</p>      <p>48. Marotto PC, Nascimento CM, Eluf Neto J, <i>et al</i>. Acute lung injury in leptospirosis: clinical and laboratory features outcome and factors associated with mortality. Clinical Infectious Diseases 1999; 29(6):1561-3.</p>      <p>49. Borer A, Metz I, Gilad J, <i>et al</i>. Massive pulmonary haemorrhage caused by leptospirosis successfully treated with nitric oxide inhalation and haemofiltration. Journal of Infection 1999; 38(1):42-5.</p>      <p>50. Courtin JP, Carre P, Poubeau P, <i>et al</i>. Hemorragie alveolaire diffuse et myosite au cours d‘une leptospirose ictero-hemorragique. Contrôle rapide par un seul bolus du corticoids. Revue de Maladies Respiratoires 1994; 11:601-3.</p>      <p>51. Kahn JB. A case of Weil’s Disease requiering steroid therapy for thrombocytopenia and bleeding. Am J Trop Med Hyg 1982; 31:1213-6.</p>      <p>52. Trivedi SV, Chavda RK, Wadia PZ, Sheth V, <i>et al</i>. The role of glucocorticoid    pulse therapy in pulmonary involvement in leptospirosis. J Am Physicians India    2001; 49:901-3.</p>     <p>&nbsp;</p>     <p>&nbsp;</p>     <p><a name="1"></a><a href="#top1">1</a> Médico da Emergência do Hospital Municipal    Nelson de Sá Earp – Município de Petrópolis, Rio de Janeiro – Brasil, e médico    tisiologista do Serviço da Assistência Especializada-SAE da prefeitura Municipal    de Belford Roxo – Rio de Janeiro-Brasil</p>     <p><a name="2"></a><a href="#top2">2</a> Médica infectologista da prefeitura de    Petrópolis e Professora da Faculdade de Medicina de Petrópolis</p>     ]]></body>
<body><![CDATA[<p><a name="3"></a><a href="#top3">3</a> Médica infectologista da prefeitura de    Petrópolis e Professora da Faculdade de Medicina de Petrópolis</p>     <p><a name="4"></a><a href="#top4">4</a> Médica infectologista da prefeitura de    Petrópolis e Professora da Faculdade de Medicina de Petrópolis</p>     <p>Administradora    do Serviço de Atendimento Especializado, Belford Roxo – Rio de Janeiro: Sra    Althair de Araújo Silva</p>     <p>Director    Geral do Hospital Municipal Nelson de Sá Earp, Petrópolis – Rio de Janeiro:    Dr Cláudio de Castro Lázaro</p>     <p>&nbsp;</p>     <p>Recebido para publicação/received for publication: 06.03.28</p>     <p>Aceite para publicação/accepted for publication: 07.06.11</p>       ]]></body><back>
<ref-list>
<ref id="B1">
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<person-group person-group-type="author">
<name>
<surname><![CDATA[Martins]]></surname>
<given-names><![CDATA[FSV]]></given-names>
</name>
<name>
<surname><![CDATA[Castiñeras]]></surname>
<given-names><![CDATA[TMPP]]></given-names>
</name>
<name>
<surname><![CDATA[Leptospirose]]></surname>
</name>
<name>
<surname><![CDATA[Schechter]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<source><![CDATA[Doenças Infecciosas-Conduta Diagnóstica e Terapêutica.]]></source>
<year>1994</year>
<edition>Primeira</edition>
<page-range>145-52</page-range><publisher-loc><![CDATA[Guanabara^eRio de Janeiro Rio de Janeiro]]></publisher-loc>
</nlm-citation>
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