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High efficacy of bolus methylprednisolone in severe leptospirosis: a descriptive study in Sri Lanka.
MedLine Citation:
PMID:  21106802     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background In 2008, an outbreak of leptospirosis caused high mortality in Sri Lanka. The General Hospital, Peradeniya recorded nine deaths in May, which prompted the medical staff to change the treatment protocol. Addition of intravenous methylprednisolone (MP) to the treatment regimen of severely ill patients was implemented on the basis of immune mediated pathogenesis of the disease to reduce mortality. Methods The day MP commenced (25 May 2008), the study period was divided into a 'pre-MP period' and an 'MP period'. A clinical score ranging from 0-6 was applied to assess the severity of the infection. A score ≥2 was considered severe. Thus, 62 patients received bolus MP 500&emsp14;mg intravenously for 3 days, followed by oral 8&emsp14;mg for 5&emsp14;days (MP given). Ten patients to whom MP was withheld were included in the MP period severe group (n=72). The same score was applied to pre-MP periods and 60 cases were identified as the historical control group (pre-MP period severe). Results There were 78 and 149 cases of leptospirosis in the pre-MP period and MP period, respectively. Of these cases, 17 and 16 patients died, with case death rates of 21.8% and 10.7%, respectively; the difference was significant (p=0.025). The survival rate at score 4 in the MP period severe group was 100% (16 of 16), compared to 38% (5 of 13) in pre-MP period severe group; this difference was highly significant (p<0.001). Six patients who died despite MP therapy had a clinical score of 5 or 6; four were alcohol consumers, and two had heart disease and hypertension. Conclusion MP may reduce mortality in patients with severe leptospirosis, except in cases with established multiple organ dysfunction and comorbidities. Therefore, early administration of MP seems advisable.
Authors:
Senanayake A M Kularatne; B D Sudhara S Budagoda; V Kapila D de Alwis; W M R Sujantha Wickramasinghe; J M Ruwanthi P Bandara; L P Manoji M K Pathirage; G Rohitha R D K Gamlath; Thusitha J Wijethunga; W A Thilak A Jayalath; Chandrika Jayasinghe; Vasanthi Pinto; Praneetha Somaratne; P V Ranjith Kumarasiri
Publication Detail:
Type:  Journal Article     Date:  2010-11-24
Journal Detail:
Title:  Postgraduate medical journal     Volume:  87     ISSN:  1469-0756     ISO Abbreviation:  Postgrad Med J     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0234135     Medline TA:  Postgrad Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  13-7     Citation Subset:  IM    
Affiliation:
Department of Medicine, Faculty of Medicine,University of Peradeniya, Peradeniya, Sri Lanka. samkul@sltnet.lk.
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