First Documentation of Human Crimean-Congo Hemorrhagic Fever, Kenya

kidneys, although brain and lung cultures were negative. Another group of guinea pigs that had also been injected with Leptospira was humanely killed as soon as symptoms appeared. Necropsy showed primary lung injury. Lungs were pale with hemorrhages widely spread over the surface. Lesions were similar to those observed in one of the patients. Neither jaundice nor renal damage was found. Leptospira was isolated from kidneys, lungs, and brain. Jaundice has been reported in severe forms of human disease. Thrombocytopenia has been associated with renal failure and death in human patients. Respiratory involvement in leptospirosis could be classified as a) mild to moderate (20% to 70% of patients), with pulmonary infiltrates commonly associated with jaundice and minimal alteration of renal function; b) severe, with jaundice, nephropathy, hemorrhages (severe Weil's syndrome) (4), and occasional death due to renal failure, myocarditis, or massive hemorrhages with cardiovascular collapse; and c) pulmonary hemorrhage which is frequently fatal, without jaundice, nephropathy, or other hemorrhages. In the past two decades, an increasing number of cases of leptospiral pulmonary hemorrhages have been reported, especially from Southeast Asia (5). In a review of leptospirosis in Brazil, death was associated with renal failure in 76.2% of fatal cases, while 3.5% were related to pulmonary hemorrhages (6). In the epidemic outbreak in Nicaragua in 1995, this form was considered the cause of death in the 40 fatal cases reported (7). The two cases reported here were associated with pulmonary hemorrhage. This clinical form has not been previously reported in the Buenos Aires metropolitan area. Environmental and social factors, the prevalence of infection in reservoirs, and the virulence of the isolated strains must be considered in primary or critical-care units in the diagnosis of new cases, whether or not associated with an outbreak.