Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles

We examined the cause of death during a 12-month period (1995/96) in all co nsecutive patients admitted to hospital with leptospiral infection in Seych elles (Indian Ocean), Where the disease is endemic. Leptospirosis was diagn osed by use of he microscopic agglutination test acid a specific polymerase chain reaction assay on serum samples. Seventy-five cases were diagnosed a nd 6 patients died, a case fatality of 8%. All 6 patients died within 9 day s of onset of symptoms and within 2 days of admission for 5 of them (5 days for the 6th). On autopsy, diffuse bilateral pulmonary haemorrhage (PH) was found in all fatalities. Renal, cardiac, digestive and cerebral haemorrhag es were also found in 5, 3, 3 and 1 case(s), respectively. Incidentally, ha emoptysis and lung infiltrate on chest radiographs, which suggest PH, were found in 8 of the 69 non-fatal cases. Dengue and hantavirus infections were ruled out. In conclusion, PH appeared to be a main cause of death in lepto spirosis in this population, although haemorrhage in other organs may also have contributed to fatal outcomes. This cause of death contrasts with the findings generally reported in endemic settings.