An open randomized controlled trial of desmopressin and pulse dexamethasone as adjunct therapy in patients with pulmonary involvement associated with severe leptospirosis

Abstract

Pulmonary involvement in leptospirosis is emerging as a common complication of severe leptospirosis. A prospective randomized controlled trial of desmopressin or high-dose (pulse) dexamethasone as adjunctive therapy in 68 patients with pulmonary involvement associated with severe leptospirosis was conducted between July 2003 and October 2006 at five hospitals in Thailand. There were 23 patients in the desmopressin group, 22 in the pulse dexamethasone group, and 23 in a control group who received standard critical care alone. The diagnosis of leptospirosis was confirmed in 52 patients (77%). There were 15 deaths (22%), of which eight patients received desmopressin, four patients received pulse dexamethasone, and three patients received critical care alone (p 0.19). Eight patients with confirmed leptospirosis died (five patients in the desmopressin group, one in the pulse dexamethasone group and two in the control group). The mortality was not significantly different in the desmopressin group or pulse dexamethasone group compared to the control group in both intention-to-treat patients, and in patients with confirmed leptospirosis. There were no serious events associated with desmopressin treatment, although pulse dexamethasone treatment was associated with a significant increase in nosocomial infection. The results of logistic regression analysis revealed that serum bilirubin level was the only significant risk factor associated with mortality (OR 0.759, 95% CI 0.598-0.965, p 0.024). The results obtained in the present study do not support the use of either pulse dexamethasone or desmopressin as adjunct therapy for pulmonary involvement associated with severe leptospirosis.

Case Series of Fatal Leptospira spp./Dengue Virus Co-Infections—Puerto Rico, 2010–2012

“…1 Similarly, controlled trial of steroids to treat leptospirosis showed no benefit to patient outcome. 38 Steroids should be reserved for patients that have a clinical condition for which they have reproducibly been shown to be beneficial.…”

Clinical spectrum of severe leptospirosis in the UK

“…A Sri Lankan study showed a significant reduction in mortality rates with methyl prednisolone in severe cases of leptospirosis (Kularatne et al ., 2011). However, a recent prospective randomized controlled trial, involving 68 patients with severe leptospirosis with pulmonary complications, showed no significant benefit from using steroids (Niwattayakul et al , 2010). In this review, three of our patients showed significant clinical improvement after the administration of steroids, as described previously.…”

Severe Pulmonary Involvement in Leptospirosis : Alternate Antibiotics and Systemic Steroids = المضاعفات الرئوية الشديدة لمرض البريميات : المضادات الحيوية و أدوية الكورتيزون بالتبادل

“…14,15 High doses or a pulse of dexamethasone or methylprednisolone have been used in patients with severe lung involvement in leptospirosis. 14,16,17 In a series of 30 patients, Shenoy et al demonstrated that corticosteroids reduce mortality and change outcomes significantly. 14 Trivedi et al found that mortality was higher in patients with pulmonary involvement who did not receive steroids and concluded that high dose glucocorticoids should be given as early as possible after the onset of dyspnoea to all the patients with pulmonary involvement.…”