Fernando Shannon M, Cardinal Pierre, Brindley Peter G
Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Case Rep Crit Care. 2017;2017:9062107. doi: 10.1155/2017/9062107. Epub 2017 Oct 12.
Acute respiratory distress syndrome (ARDS), characterized by hypoxemic respiratory failure, is associated with a mortality of 30-50% and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation and thereby necessitating Intensive Care Unit (ICU) admission. The most common precipitant is community-acquired bacterial pneumonia, but other putative pathogens include viruses and fungi. On rare occasions, ARDS can be secondary to tropical disease. Accordingly, a history should include travel to endemic regions. Leptospirosis is a zoonotic disease most common in the tropics and typically associated with mild pulmonary complications. We describe a case of a 25-year-old male with undiagnosed leptospirosis, presenting with fever and severe hypoxemic respiratory failure, returning from a Costa Rican holiday. There was no other organ failure. He was intubated and received lung protective ventilation. His condition improved after ampicillin and penicillin G were added empirically. This case illustrates the rare complication of ARDS from leptospirosis, the importance of taking a travel history, and the need for empiric therapy because of diagnostic delay.
急性呼吸窘迫综合征（ARDS）以低氧性呼吸衰竭为特征，死亡率为30%至50%，由直接和间接肺部损伤引发。治疗主要是支持性的，包括肺保护性通气，因此需要入住重症监护病房（ICU）。最常见的诱因是社区获得性细菌性肺炎，但其他可能的病原体包括病毒和真菌。在极少数情况下，ARDS可能继发于热带疾病。因此，病史应包括前往流行地区的旅行史。钩端螺旋体病是一种人畜共患病，在热带地区最为常见，通常伴有轻度肺部并发症。我们描述了一例25岁男性病例，该患者未被诊断出患有钩端螺旋体病，从哥斯达黎加度假归来后出现发热和严重的低氧性呼吸衰竭，无其他器官衰竭。他接受了插管并接受肺保护性通气。经验性添加氨苄西林和青霉素G后，他的病情有所改善。该病例说明了钩端螺旋体病导致ARDS的罕见并发症、询问旅行史的重要性以及由于诊断延迟而进行经验性治疗的必要性。
