BACKGROUND: This case series analyses the beneficial effect of methylprednisolone in pulmonary leptospirosis, which usually has an aggressive course and grave outcome. METHODS: 30 patients of pulmonary leptospirosis were evaluated. The initial 13 patients did not receive corticosteroids while the remaining 17 all received bolus methylprednisolone one gram intravenously for three days followed by oral prednisolone 1 mg/kg for seven days, on the basis of occasional case reports of benefit in pulmonary leptospirosis. APACHE III and lung injury scores of similar severity were considered while comparing outcomes in those who received methylprednisolone with those who did not. RESULTS: Dyspnoea and haemoptysis were the commonest symptoms in those with pulmonary manifestations. Overall mortality was 18% (3 of 17) in patients who received methylprednisolone, as compared with 62% (8 of 13 patients) in those who did not (p<0.02). In patients with established acute lung injury (ALI score >2.5), five of eight patients survived in the subgroup with corticosteroids (37% mortality) while only one of nine patients survived in the group that did not receive corticosteroids (89% mortality). Corticosteroids affected outcome only if given within the first 12 hours after the onset of pulmonary manifestations. Mortality seemed to correlate with the APACHE scores, and number of quadrants affected on chest radiographs, more than with blood gas pressures. CONCLUSIONS: Corticosteroids reduce mortality and change outcome significantly when used early in the management of pulmonary leptospirosis.
BACKGROUND: This case series analyses the beneficial effect of methylprednisolone in pulmonary leptospirosis, which usually has an aggressive course and grave outcome. METHODS: 30 patients of pulmonary leptospirosis were evaluated. The initial 13 patients did not receive corticosteroids while the remaining 17 all received bolus methylprednisolone one gram intravenously for three days followed by oral prednisolone 1 mg/kg for seven days, on the basis of occasional case reports of benefit in pulmonary leptospirosis. APACHE III and lung injury scores of similar severity were considered while comparing outcomes in those who received methylprednisolone with those who did not. RESULTS:Dyspnoea and haemoptysis were the commonest symptoms in those with pulmonary manifestations. Overall mortality was 18% (3 of 17) in patients who received methylprednisolone, as compared with 62% (8 of 13 patients) in those who did not (p<0.02). In patients with established acute lung injury (ALI score >2.5), five of eight patients survived in the subgroup with corticosteroids (37% mortality) while only one of nine patients survived in the group that did not receive corticosteroids (89% mortality). Corticosteroids affected outcome only if given within the first 12 hours after the onset of pulmonary manifestations. Mortality seemed to correlate with the APACHE scores, and number of quadrants affected on chest radiographs, more than with blood gas pressures. CONCLUSIONS: Corticosteroids reduce mortality and change outcome significantly when used early in the management of pulmonary leptospirosis.
Authors: J P Courtin; P Carré; P Poubeau; M Di Francia; E Jarlet; A Michault; C Amat; C A Arvin-Bérod Journal: Rev Mal Respir Date: 1994 Impact factor: 0.622
Authors: Marc Clavel; Gwenaelle Lhéritier; Nicolas Weinbreck; Antoine Guerlin; Anthony Dugard; Eric Denes; Philippe Vignon Journal: Crit Care Res Pract Date: 2010-05-26
Authors: B Jayakrishnan; Fatma Ben Abid; Abdullah Balkhair; Juma K Alkaabi; Omar A Al-Rawas; Jojy George; Khalfan Al-Zeedy Journal: Sultan Qaboos Univ Med J Date: 2013-05-09
Authors: Ana Flávia C Azevedo; Demócrito de B Miranda-Filho; Gustavo T Henriques-Filho; Alfredo Leite; Ricardo A A Ximenes Journal: BMC Infect Dis Date: 2011-06-30 Impact factor: 3.090