Pulmonary Involvement and Leptospirosis, Greece

of the intra-and inter-specifi c genetic variability of Plasmodium lactate dehy-drogenase. 4. den Dunnen JT, Antonarakis SE. Mutation nomenclature extensions and suggestions to describe complex mutations: a discussion. et al. Mannose-binding lectin polymor-phisms in severe sepsis: relationship to levels, incidence, and outcome. Ripoll L. Association between a genomic polymorphism within the CD14 locus and septic shock susceptibility and mortality rate. of TNF2, a TNF-alpha promoter poly-morphism, with septic shock susceptibility and mortality: a multicenter study.ant IRAK-1 haplotype is associated with increased nuclear factor-kappa B activation and worse outcomes in sepsis. The association of inter-leukin 6 haplotype clades with mortality in critically ill adults. mortality in septic shock with the 4G/4G genotype of plasminogen activator inhibi-tor 1 in patients of white descent. Inten-To the Editor: Since the lep-tospirosis outbreak associated with pulmonary hemorrhage in Nicaragua in 1995 (1), pulmonary manifestations of leptospirosis are often recognized in many countries; reported incidence has ranged from 20% to 70% (2–4). The severe pulmonary form of leptospirosis is accompanied by pulmonary hemorrhage, which directly results in high death rates (2,5). In Greece (population 11 million), leptospirosis cases in humans occur every year, usually from June to November (summer and autumn), with a peak in August. The annual incidence rate of the disease is 3 cases per 1 million population (6). Clinical presentation varies from a fl u-like syndrome to Weil disease, which includes jaundice, renal failure, and hemorrhagic complications. Studies on leptospirosis in Greece have been limited, and no reports have focused on pulmonary involvement. During 1998–2007, we tested samples from 650 patients with suspected leptospirosis or hemorrhagic fever with renal syndrome (i.e., han-tavirus infection). Various hospitals of northern Greece sent these samples to our laboratory (a World Health Organization Collaborating Center for Reference and Research on Arboviruses and Hemorrhagic Fever) for analysis. Because both diseases are endemic to Greece and have similar clinical, epi-demiologic, and seasonal characteristics (7), all samples sent to our laboratory for testing either for leptospirosis or for hantavirus infection are always tested for both (8). Leptospirosis was confi rmed for 123 patients, 10 (8.1%) of whom died (Table). For 72 case-patients, paired samples were available. A commercial ELISA (Leptospira IgG/IgM, Institute Virion/Serion GmbH, Würzburg, Germany) was used to detect immu-noglobulin (Ig) G and IgM against Leptospira spp.. A nested PCR, which amplifi es a 289-bp fragment of the 16S rDNA gene, was used to detect bacterial DNA (9). IgM concentrations …