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Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70% of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.

Leptospirosis is a worldwide disease. In this time of globalization knowledge about leptospirosis is important. Although pulmonary involvement has an incidence varying from 20% to 70% and its exteriorization may vary from mild to severe, The severe form appears to be becoming more prevalent (at least in Brazil) and may be associated with higher mortality.

As doenças pulmonares intersticiais (DPIs) são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diagnóstica das diferentes condições, além de orientar sobre o melhor tratamento nas diferentes situações. Esse artigo teve como objetivo descrever resumidamente os principais destaques dessas diretrizes. Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines. Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Curso de Pós-Graduação de Doenças Pulmonares Intersticiais Universidade Federal de Ciências da Saúde de Porto Alegre Santa Casa de Porto Alegre Ambulatório de Doenças Intersticiais SES Hospital Regional da Asa Norte Serviço de Doenças Torácicas Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho Serviço de Medicina Universidade Estadual de Campinas Faculdade de Ciências Médicas Departamento de Clínica Médica Universidade Federal do Estado do Rio de Janeiro Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Patologia Hospital do Servidor Público Estadual de São Paulo Serviço de Anatomia Patológica Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Divisão de Pneumologia Universidade Federal de Santa Catarina Departamento de Clínica Médica Universidade Federal de Santa Catarina Hospital Universitário Hospital de Messejana Ambulatório de Doenças Intersticiais Hospital do Servidor Público Estadual de São Paulo Ambulatório de Doenças Intersticiais Universidade de São Paulo Faculdade de Medicina Instituto do Coração Universidade Federal Fluminense Universidade de São Paulo Faculdade de Medicina Hospital Sírio Libanês Núcleo Avançado de Tórax Universidade Federal da Bahia Hospital do Servidor Público Estadual de São Paulo Hospital do Câncer Antônio Cândido Camargo UNIFESP, EPM, Curso de Pós-Graduação de Doenças Pulmonares Intersticiais UNIFESP, EPM, Depto. de Patologia UNIFESP, EPM SciELO

Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.

Experimental studies and few human reports demonstrate that hyperoxia increases the level of reactive oxygen-derived free radicals and that these substances can produce oxidative cellular injury. However, available data suggest that the human lung is more resistant to hyperoxic oxidative damage than previously expected and demonstrate that absorption atelectasis is the most frequently pulmonary effect of inhalation of a high inspired oxygen fraction. Practically, the therapeutic use of high inspired oxygen fractions is limited to patients with acute lung injury and severe hypoxemia. Recent studies demonstrated that ventilator-induced lung injury is a more important cause of pulmonary damage in these patients than hyperoxic toxicity. New protective ventilatory strategies are associated with increased survival.

Paracoccidioidomycosis is a systemic infection caused by the dimorphic fungus Paracoccidioides brasiliensis. It is commonly an endemic disease in Latin America, but several cases have been reported outside this area, particularly now in this time of world globalization. Primary pulmonary infection occurs commonly in the first and second decades of life and usually has a benign, self-limited respiratory infection course. The adult chronic manifestation of the disease is usually the result of reactivation of quiescent lesions with diffuse lung infiltrates, predominately of the interstitial pattern, with or without involvement of various other organs. The finding of this disease in a patient is an important step for the large differential diagnosis of the interstitial lung diseases group.

Schistosomiasis is a very important infectious disease, and pulmonary involvement is not very rare. There may be two forms of pulmonary involvement, acute and chronic. The acute form usually occurs about 6 weeks after the infection (Katayama syndrome) and seems to be due to an allergic manifestation to the presence of Schistosoma spp. worm or eggs. The chronic form is more commonly seen in endemic areas and may cause pulmonary hypertension and cor pulmonale, pulmonary granulomatous schistosomiasis, and pulmonary arteriovenous fistulas. Recurrence of pulmonary infiltrations may appear after treatment. The globalization of the world with international travel makes it necessary for clinicians around the world to be aware of some "old" diseases from endemic areas of the globe.

A sarcoidose e uma enfermidade conhecida hamais de um seculo. A classica descricao de Jona-than Hutchinson, em 1877, de um homem de 55anos com placas cutâneas nao dolorosas em maose pes, com gota, falecido com insuficiencia renal,seguramente descreve um portador de sarcoidose,pois essa enfermidade pode se exteriorizar comlesoes cutâneas, artralgias e disturbio no metabo-lismo calcico, levando a nefrocalcinose e insufici-encia renal. Desde essa epoca puderam-se anali-sar diferentes descricoes e achados clinicos e his-topatologicos "novos" que hoje em dia sao reco-nhecidos como, provavelmente, diferentes apre-sentacoes da sarcoidose. Durante esse longo tem-po muito se conheceu a respeito dessa enfermida-de, porem muito ha ainda por se descobrir.