{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:37:32Z","timestamp":1790800652697,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","license":[{"start":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T00:00:00Z","timestamp":1543708800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Tropical Medicine"],"published-print":{"date-parts":[[2018,12,2]]},"abstract":"<jats:p><jats:italic>Introduction<\/jats:italic>. Leptospirosis is an emerging infectious disease associated with multiorgan involvement and significant morbidity and mortality. Although pulmonary hemorrhage due to leptospirosis has a high fatality, specific treatment options are limited and their efficacy is not adequately proven. We opted to find out the current evidence on plasmapheresis and extracorporeal membrane oxygenation (ECMO) in pulmonary hemorrhages due to leptospirosis.<jats:italic> Methods<\/jats:italic>. The first search was conducted in PubMed, OVID, Google Scholar, and Cochrane clinical trial registry using keywords \u201cleptospirosis\u201d OR \u201cLeptospira\u201d OR \u201cWeil\u2019s disease\u201d AND \u201cplasmapheresis\u201d OR \u201cplasma exchange\u201d AND \u201cpulmonary hemorrhage\u201d OR \u201calveolar hemorrhage\u201d OR \u201clung hemorrhage\u201d and the second search was done using keyword \u201cleptospirosis\u201d OR \u201cLeptospira\u201d OR \u201cWeil\u2019s disease\u201d AND \u201cECMO\u201d OR \u201cExtracorporeal membrane oxygenation.\u201d The searches were not limited by study design or the date of publication. Only articles written in English were reviewed. Although we intended to include only clinical trials, it was decided later to include other information such as case reports and case series which addressed these treatment modalities. Two authors selected articles independently in a blinded manner using a set of inclusion and exclusion criteria and discrepancies were solved after discussions.<jats:italic> Results<\/jats:italic>. The information found was very limited. This included one clinical trial which showed a significant survival benefit with plasmapheresis but the study design had many limitations. Two case reports described the benefit of plasmapheresis in severe leptospirosis with pulmonary hemorrhages. There were eight case reports where ECMO was performed and out of all only one patient has died. One retrospective study on patients with severe leptospirosis mentioned that four out of five patients with pulmonary hemorrhages survived after being treated with ECMO.<jats:italic> Conclusions<\/jats:italic>. Current evidence is insufficient to recommend the routine use of plasmapheresis or ECMO for patients presenting with pulmonary hemorrhages due to leptospirosis. ECMO may be a promising mode of treatment in acute respiratory failure in leptospirosis related pulmonary hemorrhages. These treatment modalities, however, can be applied based on the availability of resources and expertise at the discretion of the clinician in charge, considering patient related factors such as cardiovascular stability and derangement of coagulation profile. Clinical trials conducted adhering to standard procedures are urgently required to establish the efficacy of these treatment modalities.<\/jats:p>","DOI":"10.1155\/2018\/4520185","type":"journal-article","created":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T18:32:29Z","timestamp":1543775549000},"page":"1-8","source":"Crossref","is-referenced-by-count":24,"title":["Role of Plasmapheresis and Extracorporeal Membrane Oxygenation in the Treatment of Leptospirosis Complicated with Pulmonary Hemorrhages"],"prefix":"10.1155","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3364-6257","authenticated-orcid":true,"given":"C. L.","family":"Fonseka","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3541-9982","authenticated-orcid":true,"given":"S.","family":"Lekamwasam","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1007\/s12038-008-0074-z"},{"issue":"2","key":"2","first-page":"281","volume":"36","year":"2005","journal-title":"Southeast Asian Journal of Tropical Medicine and Public Health"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003898"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1086\/313501"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1997.56.181"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1016\/s1201-9712(02)90137-2"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-9203(00)90445-0"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1590\/S0037-86822002000400017"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.3201\/eid1403.071064"},{"issue":"5","key":"10","first-page":"501","volume":"4","year":"2013","journal-title":"International Journal of Preventive Medicine"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1093\/trstmh\/tru148"},{"key":"12","volume":"11","year":"2011","journal-title":"BMC Infectious Diseases"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2009.03037.x"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.56053"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1016\/S0929-6646(09)60344-2"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2006.00638.x"},{"issue":"3","key":"17","first-page":"429","volume":"131","year":"2010","journal-title":"Indian Journal of Medical Research"},{"key":"27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(81)91329-5"},{"key":"28","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/817414"},{"key":"29","volume":"7","year":"2013","journal-title":"Journal of Medical Case Reports"},{"key":"30","doi-asserted-by":"publisher","DOI":"10.1128\/CDLI.9.2.482-484.2002"},{"key":"31","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2011.07.012"},{"key":"32","doi-asserted-by":"publisher","DOI":"10.5152\/balkanmedj.2016.151240"},{"key":"33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1797.2005.00332.x"},{"key":"18","volume":"11","year":"2017","journal-title":"Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.54.4528"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/5369267"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2004.09.010"},{"key":"22","doi-asserted-by":"publisher","DOI":"10.1007\/s10047-017-0998-x"},{"key":"23","doi-asserted-by":"publisher","DOI":"10.1111\/jtm.12189"},{"issue":"5","key":"24","first-page":"1597","volume":"102","year":"2006","journal-title":"Anesthesia & Analgesia"},{"key":"25","doi-asserted-by":"publisher","DOI":"10.1016\/j.idcr.2017.04.016"},{"key":"26","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002825"},{"key":"34a","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.1.305"},{"key":"34b","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.1.305"},{"key":"35","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-4453(99)90029-4"},{"key":"36","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200205-450CR"},{"key":"38","doi-asserted-by":"publisher","DOI":"10.12816\/0003241"},{"key":"39","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.91"},{"key":"40","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.152765"},{"key":"41","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2005.044255"},{"issue":"5","key":"42","first-page":"215","volume":"70","year":"2012","journal-title":"The Netherlands Journal of Medicine"},{"issue":"1","key":"45","volume":"13","year":"2013","journal-title":"BMC Infectious Diseases"},{"key":"46","doi-asserted-by":"publisher","DOI":"10.12980\/APJTB.4.2014D126"},{"issue":"10","key":"47","first-page":"291","volume":"75","year":"2016","journal-title":"Hawai'i Journal of Medicine & Public Health"},{"key":"48","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.092203"},{"issue":"1","key":"49","first-page":"50","volume":"104","year":"2005","journal-title":"Journal of the Formosan Medical Association"}],"container-title":["Journal of Tropical Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/jtm\/2018\/4520185.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/jtm\/2018\/4520185.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/jtm\/2018\/4520185.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T18:32:32Z","timestamp":1543775552000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/jtm\/2018\/4520185\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,2]]},"references-count":47,"alternative-id":["4520185","4520185"],"URL":"https:\/\/doi.org\/10.1155\/2018\/4520185","relation":{},"ISSN":["1687-9686","1687-9694"],"issn-type":[{"value":"1687-9686","type":"print"},{"value":"1687-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,2]]}}}