High efficacy of bolus methylprednisolone in severe leptospirosis: a descriptive study in Sri Lanka

Kularatne, S.A.M.; Budagoda, B D Sudhara S; Alwis, V.K.D. de; Wickramasinghe, W M R Sujantha; Bandara, Jayasuriya Mudiyanselage Ruwanthi Panchali; Pathirage, Loku Pathirage Manoji Muditha Kumari; Gamlath, G Rohitha R D K; Wijethunga, Thusitha J; Jayalath, Widana Arachchilage Thilak Ananda; Jayasinghe, Chandrika; Pinto, Vasanthi; Somaratne, Praneetha; Kumarasiri, P. V. R.

doi:10.1136/pgmj.2009.092734

Cited by 42 publications

(39 citation statements)

References 14 publications

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“…Major outbreaks of leptospirosis were frequent in different parts of the island and the year 2008 showed one of the worst outbreaks in the Central Province of Sri Lanka in which many pathogenic serovars were identified [3]. In this outbreak, a single tertiary care hospital alone managed 227 cases, of them 9 patients developed severe acute kidney injury (AKI) who needed dialysis support [4]. The incidence of AKI in leptospirosis varies from 10% to 60%, depending on multiple factors such as age, severity of the disease and the causative serovars of a region [5].…”

Section: Resultsmentioning

confidence: 99%

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Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka

et al. 2014

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BackgroundLeptospirosis is an important zoonotic disease of variable severity and is a common cause of acute kidney injury (AKI) in tropics. However the knowledge on long term renal outcome in leptospirosis is scarce. This study aims to assess the long-term renal outcome of AKI caused by leptospirosis.FindingsHospital records of patients who had developed AKI following leptospirosis (Serologically confirmed) presented to two Teaching Hospitals in Kandy district over 3 years from 2007 were studied. A total of 44 patients were included and they had been followed up at least for one year in out patient clinics with regular assessment including renal status. Renal histology was studied in two patients. The primary outcome measure was normalization of renal function at one year. Of the 44 patients, 31 were in the risk and injury stage (Group 1), and the rest of them were in the failure stage (Group 2) under RIFLE criteria. Of group 2 patients, 11 had abnormal renal functions on discharge. Their mean serum creatinine and GFR values on discharge were 392 mmol/l and 20 ml/min/1.73 m2. Other two patients had full renal recovery whilst in the hospital. Nine in the group 2 required renal replacement therapy by means of peritoneal dialysis, intermittent haemodialysis or haemofiltration. Seventeen out of the total had persistently abnormal renal functions on discharge. Of them 13 recovered their renal functions to normal. Four patients (9%) who belonged to group 2, had persistently abnormal renal functions after first year compatible with stage 3 chronic kidney disease (CKD). Renal histology of two patients showed tubulointerstitial lymphocyte infiltrate, tubular atrophy and interstitial fibrosis.ConclusionThe long term renal outcome of AKI following leptospirosis is satisfactory as only 9% of patients had abnormal renal functions compatible with early stage of CKD. Even among them, advanced CKD or dialysis dependency had not been observed.

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Section: Resultsmentioning

confidence: 99%

“…In addition, haemodynamic alterations, hyperbilirubinaemia and rhabdomyolysis are also associated with the genesis of AKI in leptospirosis [6,7]. The outcome of AKI if managed properly is fair, but a significant proportion could succumb to it [4]. There are hardly any follow up data of long term renal outcome in leptospirosis in the literature.…”

Section: Resultsmentioning

confidence: 99%

Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka

et al. 2014

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“…Since EBV-reactivation could be confirmed, the use of a fourth generation cephalosporine may have been an advantage as the use of penicillins in patients with EBV infection can cause hypersensitivity syndrome with rash [22]. Given the vasculitis nature of severe leptospirosis, the use of corticosteroids has been proposed despite limited evidence [23]. We decided not to use steroids potentially supporting the clinical course [24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Severe leptospirosis complicated by Epstein–Barr Virus reactivation

et al. 2015

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Leptospirosis represents a neglected and re-emerging disease which is difficult to diagnose since Leptospira-PCR from whole blood or urine is frequently negative in the case of early empiric antibiotic treatment. EBV-reactivation might represent a severe complication in Weil's disease which potentially aggravates clinical manifestations of leptospirosis including hepatitis, nephritis, and rhabdomyolysis. Thus, there might be a need for peripheral blood EBV-PCR and EBV blotting in patients suffering from complicated Weil syndrome, also in terms of the choice of antibiotic treatment.

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“…The role of glucocorticoids is imminently significant, particularly within the first 12 hrs of respiratory involvement (Shenoy et al 2006). It reduces the need for mechanical ventilation and the mortality rate in severe leptospirosis (Shenoy et al 2006;Kularatne et al 2011). In addition, other immunomodulation approaches such as plasmapheresis and immunoglobulin may also be helpful (Meaudre et al 2008).…”

Section: Discussionmentioning

confidence: 99%

Fatal Pulmonary Haemorrhage in Co-infection with Dengue and Leptospirosis

Husain¹,

E²

2017

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High efficacy of bolus methylprednisolone in severe leptospirosis: a descriptive study in Sri Lanka

Abstract: 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.

Cited by 42 publications

References 14 publications

Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka

Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka

Severe leptospirosis complicated by Epstein–Barr Virus reactivation

Fatal Pulmonary Haemorrhage in Co-infection with Dengue and Leptospirosis

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