Leptospirosis pulmonary haemorrhage syndrome

Abstract

Sri Lanka remains a hotspot for leptospirosis and the incidence has been rising over the past few decades. Leptospirosis Pulmonary Haemorrhage Syndrome (LPHS) is a severe manifestation of leptospirosis, characterized by acute respiratory distress and significant pulmonary haemorrhage leading to devastating clinical outcomes. Recent epidemiological studies indicate a concerning rise in mortality rates attributed to LPHS, particularly in endemic regions such as Sri Lanka. This article explores the clinical features, patho-physiology, diagnosis and management options of LPHS, emphasizing the need for heightened awareness among healthcare professionals. As a re-immerging zoonotic disease in an endemic country like Sri Lanka, severe leptospirosis such as LPHS needs prompt clinical diagnosis and management. Furthermore, we discuss the potential mechanisms underlying pulmonary haemorrhage, including immune-mediated injury due to cytokine storm and coagulopathy, which contribute to adverse outcomes in affected patients. Among severe manifestations of leptospirosis, LPHS carries a high rate of mortality. Therefore, high degree of clinical suspicion is necessary, especially in resource poor settings where access to intensive care is limited. Thus, early diagnosis and timely inter-vention remain paramount in improving prognosis. Antibiotics, pulse steroid therapy, therapeutic plasma exchange and ventilatory support remains the main management options. In severe refractory hypoxemia veno-venous extra corporeal membrane oxygenation has been tried with some success. We highlight the importance of continuous surveillance and ongoing research to further enhance the knowledge regarding LHPS and its therapeutic options to address the growing public health challenge posed by this severe complication of leptospirosis.