Ruwanpura R, Rathnaweera A, Hettiarachchi M, Dhahanayake K, Amararatne S
Karapitiya Teaching Hspital, Galle, Southern, Sri Lanka.
Med J Malaysia. 2012 Dec;67(6):595-600.
According to statistical unit of the Karapitiya Teaching Hospital, Galle, the main tertiary care institution of the Southern Province serving approximately three million population, in 2008, there were 459 patients with clinical diagnosis of leptospirosis, with 25 fatalities, 21 out of which were referred for autopsy examination.
The present study to study and correlate pathological changes in deaths associated with pulmonary form of leptospirosis with clinico-diagnostic aspects of the infection.
There had been 21 leptospirosis related autopsy examinations performed at forensic medicine unit of the Karapitiya Teaching Hospital from January to December 2008. The clinical, laboratory and autopsy findings of these cases were recorded in detail and analyzed.
The characteristic autopsy feature of all these cases was a moderate to severe pulmonary haemorrhage in association with hepato-renal, myocardial and cerebral lesions. The histology of the lung tissues in most cases showed extensive alveolar haemorrhages, hyaline like deposits, neutrophilic infiltrations, swollen septa with congested blood vessels.
Severe pulmonary complications are mostly responsible for all fatalities due to leptospirosis in our series. Though there are no reliable clinical indicators that suggest probability of developing pulmonary haemorrhages, we emphasize that respiratory functions and haematological parameters need to be closely monitored in all hospitalized patients with leptospirosis for early detection and prevention of haemorrhagic complications.
据加勒市卡拉皮蒂亚教学医院（南部省主要的三级医疗机构，服务人口约三百万）的统计单位数据，2008年有459例临床诊断为钩端螺旋体病的患者，其中25例死亡，21例被送去进行尸检。
本研究旨在研究与钩端螺旋体病肺部感染形式相关的死亡病例的病理变化，并将其与感染的临床诊断方面进行关联。
2008年1月至12月期间，卡拉皮蒂亚教学医院法医学科对21例与钩端螺旋体病相关的病例进行了尸检。详细记录并分析了这些病例的临床、实验室和尸检结果。
所有这些病例的典型尸检特征是中度至重度肺出血，并伴有肝肾、心肌和脑部病变。大多数病例的肺组织组织学检查显示广泛的肺泡出血、透明样沉积物、中性粒细胞浸润、间隔肿胀伴血管充血。
在我们的研究系列中，严重的肺部并发症是钩端螺旋体病所有死亡病例的主要原因。尽管没有可靠的临床指标提示发生肺出血的可能性，但我们强调，对于所有住院的钩端螺旋体病患者，都需要密切监测呼吸功能和血液学参数，以便早期发现并预防出血性并发症。
