{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:39:53Z","timestamp":1792510793747,"version":"4.5.0"},"reference-count":30,"publisher":"American Society of Tropical Medicine and Hygiene","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Leptospirosis is a zoonosis prevalent on R\u00e9union Island. Severe forms with acute respiratory failure can lead to refractory hypoxemia, requiring the use of extracorporeal membrane oxygenation (ECMO). The aim for the present study was to describe all cases of leptospirosis complicated by refractory acute respiratory distress syndrome (ARDS) requiring veno-venous ECMO on R\u00e9union Island and to conduct a literature review. This retrospective observational study was conducted in a multidisciplinary intensive care unit of the University Hospital of R\u00e9union Island. The aim was to describe the clinical, biological, and prognostic characteristics of patients who developed leptospirosis complicated by refractory ARDS requiring ECMO between January 2011 and December 2024. A total of 14 patients with a median age of 38 years and few comorbidities were included. The organ failure most commonly associated with respiratory involvement was acute kidney injury (93%). The median delay between mechanical ventilation and ECMO support was 0 (0\u20131) days. The median duration of ECMO support was short (7 [4\u201312] days). The mortality rate in this population was 29%. A systematic literature review revealed 50 cases of patients with leptospirosis requiring ECMO, with a median age of 34 years and a mortality rate of 20%. The favorable prognosis of patients with refractory ARDS due to leptospirosis justifies the use of ECMO. Early referral to a center equipped with ECMO is essential, given the rapid decline in respiratory function.<\/jats:p>","DOI":"10.4269\/ajtmh.26-0044","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:50:56Z","timestamp":1792507856000},"source":"Crossref","is-referenced-by-count":0,"title":["Refractory Acute Respiratory Distress Syndrome Supported by Extracorporeal Membrane Oxygenation due to Leptospirosis at R\u00e9union Island and a Literature Review"],"prefix":"10.4269","author":[{"given":"Elora","family":"Bordier","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, Felix Guyon University Hospital, Saint-Denis, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Vidal","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Felix Guyon University Hospital, Saint-Denis, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Delmas","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Felix Guyon University Hospital, Saint-Denis, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Jabot","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Felix Guyon University Hospital, Saint-Denis, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Traversier","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Felix Guyon University Hospital, Saint-Denis, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Miltgen","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Felix Guyon University Hospital, Saint-Denis, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Belmonte","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Felix Guyon University Hospital, Saint-Denis, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Allyn","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Felix Guyon University Hospital, Saint-Denis, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Allou","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Felix Guyon University Hospital, Saint-Denis, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"5","key":"b1","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"835","article-title":"Leptospirosis: A neglected tropical zoonotic infection of public health importance \u2013 An updated review","volume":"39","author":"Karpagam","year":"2020"},{"issue":"9","key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0003898","article-title":"Global morbidity and mortality of leptospirosis: A systematic review","volume":"9","author":"Costa","year":"2015"},{"issue":"4","key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0012084","article-title":"Severe leptospirosis in tropical and non-tropical areas: A comparison of two French, multicentre, retrospective cohorts","volume":"18","author":"Allyn","year":"2024"},{"issue":"3","key":"b4","series-title":"Emerg Infect Dis","first-page":"505","article-title":"Leptospirosis-associated severe pulmonary hemorrhagic syndrome, Salvador, Brazil","volume":"14","author":"Gouveia","year":"2008"},{"issue":"11","key":"b5","series-title":"Intensive Care Med","first-page":"1959","article-title":"Leptospirosis in Reunion Island (Indian Ocean): Analysis of factors associated with severity in 147 confirmed cases","volume":"33","author":"Paganin","year":"2007"},{"issue":"1","key":"b6","series-title":"J Med Case Rep","first-page":"493","article-title":"A 16-year-old man with leptospirosis and atypical disseminated intravascular coagulation: A case report","volume":"17","author":"Conreur","year":"2023"},{"issue":"5","key":"b7","series-title":"BMJ Case Rep","first-page":"e229582","article-title":"A case of leptospirosis with acute respiratory failure and acute kidney injury treated with simultaneous extracorporeal membrane oxygenation and haemoperfusion","volume":"12","author":"Chavez","year":"2019"},{"issue":"22","key":"b8","series-title":"Intern Med","first-page":"2943","article-title":"Acute respiratory distress syndrome manifested by leptospirosis successfully teated by extracorporeal membrane oxygenation (ECMO)","volume":"54","author":"Liao","year":"2015"},{"issue":"3","key":"b9","series-title":"Am J Trop Med Hyg","first-page":"507","article-title":"Case report: An imported case of severe leptospirosis with septic cardiomyopathy requiring venoarterial extracorporeal membrane oxygenation in Japan","volume":"108","author":"Goto","year":"2023"},{"issue":"3","key":"b10","series-title":"Am J Trop Med Hyg","first-page":"866","article-title":"Case report: Refractory acute respiratory distress syndrome supported by extracorporeal membrane oxygenation due to coinfection with Chlamydia pneumoniae and leptospirosis in Reunion Island","volume":"104","author":"Lecadieu","year":"2021"},{"issue":"3","key":"b11","series-title":"Rev Bras Ter Intensiva","first-page":"317","article-title":"Characterization of patients transported with extracorporeal respiratory and\/or cardiovascular support in the State of S\u00e3o Paulo, Brazil","volume":"30","author":"Li","year":"2018"},{"issue":"1","key":"b12","series-title":"BMC Infect Dis","first-page":"788","article-title":"Diagnosis of leptospira by metagenomics next-generation sequencing with extracorporeal membrane oxygenation support: A case report","volume":"23","author":"Ji","year":"2023"},{"issue":"1","key":"b13","series-title":"BMJ Open Gastroenterol","first-page":"e001094","article-title":"Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): A descriptive study","volume":"10","author":"Madrigal","year":"2023"},{"issue":"1","key":"b14","series-title":"BMJ Case Rep","first-page":"e230075","article-title":"Leptospirosis manifested with severe pulmonary haemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation","volume":"13","author":"Chaikajornwat","year":"2020"},{"issue":"2","key":"b15","series-title":"J Infect","first-page":"158","article-title":"Leptospirosis: A case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation","volume":"50","author":"Arokianathan","year":"2005"},{"issue":"5","key":"b16","series-title":"Anesth Analg","first-page":"1597","article-title":"Veno-arterial extracorporeal membrane oxygenation in acute respiratory distress syndrome caused by leptospire sepsis","volume":"102","author":"Kahn","year":"2006"},{"issue":"1","key":"b17","series-title":"BMC Infect Dis","first-page":"794","article-title":"Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by leptospirosis","volume":"20","author":"Wang","year":"2020"},{"key":"b18","series-title":"Case Rep Crit Care","first-page":"5369267","article-title":"A case of leptospirosis-associated severe pulmonary hemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation","volume":"2017","author":"Umei","year":"2017"},{"key":"b19","series-title":"IDCases","first-page":"84","article-title":"Lethal pulmonary hemorrhage syndrome due to Leptospira infection transmitted by pet rat","volume":"8","author":"Ludwig","year":"2017"},{"issue":"4","key":"b20","series-title":"J Artif Organs","first-page":"371","article-title":"Leptospirosis-associated catastrophic respiratory failure supported by extracorporeal membrane oxygenation","volume":"20","author":"Cantwell","year":"2017"},{"issue":"10","key":"b21","series-title":"PLoS Negl Trop Dis","first-page":"e0011352","article-title":"Pulmonary haemorrhage as a frequent cause of death among patients with severe complicated Leptospirosis in Southern Sri Lanka","volume":"17","author":"Fonseka","year":"2023"},{"key":"b22","series-title":"J Intensive Care","first-page":"31","article-title":"Leptospirosis as an important differential of pulmonary haemorrhage on the intensive care unit: A case managed with VV-ECMO","volume":"8","author":"Barnacle","year":"2020"},{"issue":"12","key":"b23","series-title":"Intensive Care Med","first-page":"1763","article-title":"Severe leptospirosis in non-tropical areas: A nationwide, multicentre, retrospective study in French ICUs","volume":"45","author":"Miailhe","year":"2019"},{"key":"b24","series-title":"J Crit Care","first-page":"165","article-title":"Acute respiratory distress syndrome in leptospirosis","volume":"51","author":"Vandroux","year":"2019"},{"issue":"1","key":"b25","series-title":"Crit Care Med","first-page":"93","article-title":"Leptospirosis in ICU: A retrospective study of 134 consecutive admissions","volume":"46","author":"Delmas","year":"2018"},{"issue":"21","key":"b26","series-title":"N Engl J Med","first-page":"1965","article-title":"Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome","volume":"378","author":"Combes","year":"2018"},{"issue":"8","key":"b27","series-title":"N Engl J Med","first-page":"747","article-title":"Driving pressure and survival in the acute respiratory distress syndrome","volume":"372","author":"Amato","year":"2015"},{"issue":"6","key":"b28","series-title":"Am J Trop Med Hyg","first-page":"1970","article-title":"Pathogenesis of pulmonary hemorrhagic syndrome in human leptospirosis","volume":"104","author":"Nicodemo","year":"2021"},{"issue":"3","key":"b29","series-title":"Cochrane Database Syst Rev","first-page":"CD014959","article-title":"Antibiotic prophylaxis for leptospirosis","volume":"3","author":"Win","year":"2024"},{"issue":"2","key":"b30","series-title":"ASAIO J","first-page":"180","article-title":"Cannula-related infection in patients supported by peripheral ECMO: Clinical and microbiological characteristics","volume":"65","author":"Allou","year":"2019"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/aop\/article-10.4269-ajtmh.26-0044\/article-10.4269-ajtmh.26-0044.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/aop\/article-10.4269-ajtmh.26-0044\/article-10.4269-ajtmh.26-0044.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:50:56Z","timestamp":1792507856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/aop\/article-10.4269-ajtmh.26-0044\/article-10.4269-ajtmh.26-0044.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":30,"URL":"https:\/\/doi.org\/10.4269\/ajtmh.26-0044","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]}}}