Neumonía aguda de la comunidad y hemorragia pulmonar por leptospirosis en el área metropolitana Buenos Aires

El objetivo del trabajo es comunicar los hallazgos epidemiologicos, clinicos y de diagnostico de la neumonia y hemorragia pulmonar por leptospirosis, en el periodo enero 2007 a octubre 2009. Un 64% (20/31) de pacientes con diagnostico de leptospirosis tuvieron neumonia. Quince de ellos (75%) presentaron neumonia grave, de los cuales siete (35%) desarrollaron hemorragia pulmonar. En diez enfermos (32%) el motivo de consulta e inicio del cuadro clinico fue una gastroenteritis secretoria con fiebre y dolor abdominal. La ictericia solo se manifesto en once pacientes (35%). La tecnica de reaccion en cadena de la polimerasa (PCR) fue util para el diagnostico en muestra obtenida post mortem. De un hemocultivo se aislo una cepa clasificada dentro del serogrupo canicola. Se clasificaron las neumonias en tres tipos: neumonias de curso no grave con escasa repercusion general; neumonias graves asociadas a formas clinicas sistemicas con ictericia, insuficiencia renal, trombocitopenia y hemorragia pulmonar; tambien de curso grave, no asociada a ictericia, insuficiencia renal o trombocitopenia grave. El tratamiento antibiotico iniciado en los primeros dias de enfermedad (promedio 3.2 dias) no tuvo influencia en la evolucion de las neumonias graves. Se plantea ademas considerar tres formas clinicas de leptospirosis: anicterica, icterica (con sus variantes evolutivas) y hemorragia pulmonar.(AU) The aim of this paper is to report the epidemiological, clinical and diagnosis findings of pneumonia and pulmonary hemorrhage observed in patients with leptospirosis in the period January 2007 to October 2009. A 64% (20/31) of patients diagnosed with leptospirosis presented pneumonia. Fifteen of them (75%) had severe pneumonia, of which seven (35%) were pulmonary hemorrhage. In ten patients (32%) reason for consultation and clinical early stage was a secretory gastroenteritis with fever and abdominal pain. Jaundice was only expressed in eleven patients (35%). The technique of chain reaction (PCR) was useful for diagnosis in samples obtained post mortem. A strain classified in serogroup canicola was isolated from blood culture. Pneumonia was classified into three types: non-severe pneumonia course with little overall impact; severe pneumonia associated with systemic clinical forms with jaundice, renal failure, thrombocytopenia, and pulmonary hemorrhage, and of serious course, not associated with jaundice, kidney failure or thrombocytopenia. Antibiotic treatment started in the early stages of disease (average 3.2 days) had no influence on the development of severe pneumonia. It is puggested to consider three clinical forms of leptospirosis: anicteric, icteric (with its evolutionary variants) and pulmonary hemorrhage.(AU)