Case report: The use of Venovenous Extracorporeal Membrane Oxygenation in the Treatment of Acute Respiratory Distress Syndrome in Severe Leptospirosis
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Abstract
Leptospirosis is a globally distributed zoonosis with a clinical spectrum ranging from mild febrile illness to life-threatening disease, that can result in acute kidney injury (AKI) and severe pulmonary complications such as alveolar hemorrhage and acute respiratory distress syndrome (ARDS). We present the case of a 20-year-old man with fever and respiratory distress, diagnosed with ARDS and AKI. Venovenous (VV), extracorporeal membrane oxygenation (ECMO) and sustained low-efficiency daily dialysis (SLED) were initiated. The patient showed significant respiratory improvement after eight days and renal recovery after seventeen days. Leptospirosis serological conversion confirmed the diagnosis. This case highlights the potential of VV ECMO as an effective supportive therapy in severe respiratory failure secondary to leptospirosis. Early recognition and aggressive management, including ECMO and daily dialysis, may enhance outcomes in severe pulmonary leptospirosis.
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References
von Ranke FM, Zanetti G, Hochhegger B, Marchiori E. Infectious diseases causing diffuse alveolar hemorrhage in im-munocompetent patients: a state-of-the-art review. Lung. 2013;191(1):9-18. doi:10.1007/s00408-012-9431-7.
Hurst FP, Neff RT, Katz AR, Buchholz AE, Sasaki DM, Berg BW, Abbott KC. Acute kidney injury requiring hemodialysis in patients with anicteric leptospirosis. Clin Nephrol. 2009; 72(3):186-192. doi:10.5414/cnp72186.
Wasiński B, Dutkiewicz J. Leptospirosis--current risk factors connected with human activity and the environment. Ann Agric Environ Med. 2013;20(2):239-244.
Vanasco NB, Schmeling MF, Lottersberger J, Costa F, Ko AI, Tarabla HD. Clinical characteristics and risk factors of human leptospirosis in Argentina (1999-2005). Acta Trop. 2008;107(3):255-258. doi:10.1016/j.actatropica.2008.06.007.
Marteli AN, Genro LV, Diament D, Guasselli LA. Análise espacial da leptospirose no Brasil. Saúde debate. 2020;44(126):805-817. doi:10.1590/0103-1104202012616.
Silva JJ, Dalston MO, Carvalho JE, Setúbal S, Oliveira JM, Pereira MM. Clinicopathological and immunohistochemical features of the severe pulmonary form of leptospirosis. Rev Soc Bras Med Trop. 2002;35(4):395-399. doi:10.1590/s0037-86822002000400017.
Fonseka CL, Lekamwasam S. Role of Plasmapheresis and Extracorporeal Membrane Oxygenation in the Treatment of Lep-tospirosis Complicated with Pulmonary Hemorrhages. J Trop Med. 2018;2018:4520185. doi:10.1155/2018/4520185
Gordon A, Rabold E, Thirumala R, Husain AA, Patel S, Cheema T. Prone Positioning in ARDS. Crit Care Nurs Q. 2019;42(4):371-375. doi:10.1097/CNQ.0000000000000277.
MacLaren G, Combes A, Brodie D. Saying no until the moment is right: initiating ECMO in the EOLIA era. Intensive Care Med. 2020;46(10):1894-1896. doi:10.1007/s00134-020-06185-1.
Karpagam KB, Ganesh B. Leptospirosis: a neglected tropical zoonotic infection of public health importance-an updated review. Eur J Clin Microbiol Infect Dis. 2020;39(5):835-846. doi:10.1007/s10096-019-03797-4.
Brodie D, Slutsky AS, Combes A. Extracorporeal Life Support for Adults With Respiratory Failure and Related Indications: A Review. JAMA. 2019;322(6):557-568. doi:10.1001/jama.2019.9302.
Banfi C, Pozzi M, Siegenthaler N, Brunner M-E, Tassaux D, Obadia J-F, Bendjelid K, Giraud R. Veno-venous extracorporeal membrane oxygenation: cannulation techniques. J Thorac Dis. 2016;8(12):3762-3773. doi:10.21037/jtd.2016.12.88.
Combes A, Peek GJ, Hajage D, Hardy P, Abrams D, Schmidt M, Dechartres A, Elbourne D. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive Care Med. 2020;46(11):2048-2057. doi:10.1007/s00134-020-06248-3.
Schmidt M, Pham T, Arcadipane A, Agerstrand C, Ohshimo S, Pellegrino V, Vuylsteke A, Guervilly C, McGuinness S, Pierard S, Breeding J, Stewart C, Ching SW, Camuso JM, Stephens RS, King B, Herr D, Schultz MJ, Neuville M, Zogheib E, Mira JP, Rozé H, Pierrot M, Tobin A, Hodgson C, Chevret S, Brodie D, Combes A. Mechanical Ventilation Management during Extracor-poreal Membrane Oxygenation for Acute Respiratory Distress Syndrome. An International Multicenter Prospective Cohort. Am J Respir Crit Care Med. 2019;200(8):1002-1012. doi:10.1164/rccm.201806-1094OC.
Gajkowski E, Herrera G, Hatton L, Antonini M, Vercaemst L, Cooley E. ELSO Guidelines for Adult and Pediatric Extracorporeal Membrane Oxygenation Circuits. ASAIO J. 2022;68(2):133-152. doi:10.1097/MAT.0000000000001630.
Liao CY, Ben RJ, Wu HM, Chang SK, Liu MY, Chin H-K, Yeh Y-C. Acute Respiratory Distress Syndrome Manifested by Leptospirosis Successfully Teated by Extracorporeal Membrane Oxygenation (ECMO). Intern Med. 2015;54(22):2943-2946. doi:10.2169/internalmedicine.54.4528.
Ginete-Garcia JK, Chavez J, Chico J, Chua E, Danguilan R. Acute respiratory failure with pulmonary hemorrhage due to leptospirosis successfully managed by Extracorporeal Membrane Oxygenation: The first in the Philippines. Chest. 2019;155(4). doi:10.1016/j.chest.2019.02.096.
Andrade L, Cleto S, Seguro A. Door-to-dialysis time and daily hemodialysis in patients with leptospirosis: impact on mor-tality. Clin J Am Soc Nephrol. 2007;2(4):739-744. doi:10.2215/CJN.00680207
Daher E, de Abreu K, da Silva Junior G. Leptospirosis-associated acute kidney injury. J Bras Nefrol. 2010;32(4):400-407. doi:10.1590/S0101-28002010000400010.