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Zaki SR, Shieh WJ, and the Epidemic Working Group: Leptospirosis associated with outbreak of acute febrile illness and pulmonary haemorrhage, Nicaragua, 1995. Lancet 1996, 347:535-536 This important report describes an outbreak of more than 2000 cases and at least 40 deaths from pulmonary hemorrhage during October and November 1995. Every important aspect of leptospirosis is illustrated by this outbreak: heavy rains and flooding in the tropics, difficulties with diagnosis, protean clinical presentations, and the consequences of late diagnosis and treatment.
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