Abstract
Objectives: To determine the efficacy of three day methylprednisolone plus single dose intravenous cyclophosphamide on the survival of patients with leptospirosis, renal failure and pulmonary hemorrhage. Methods: A retrospective review of 138 patients diagnosed with leptospirosis at the National Kidney and Transplant Institute (NKTI) from August 1, 2009 to August 31, 2013 were included in the study. Patients were grouped according to those who received standard therapy with a 3-day course of Hydrocortisone (HC group) compared to a 3-day course of Methylprednisolone-Cyclophosphamide (MP-C). Patient survival, length of hospital stay and time to becoming dialysis independent were compared. Results: There were 65 patients in the HC group and 73 patients in the MP-C group. Mean age was 35.9 years, with male predominance. The most common clinical manifestation was fever. Thrombocytopenia was the major indication to steroid therapy. Survival of patients given MP-C was significantly higher than those given HC (88% and 74% respectively; p=0.035). The post treatment activated Plasma Thromboplastin Time (aPTT) was significantly lower in the MP-C group. There was no significant difference in the length of hospital stay and time to becoming dialysis independent. Conclusion: Three day MP-C pulsing significantly improves survival of patients with leptospirosis, renal failure and pulmonary hemorrhage.
Highlights
Leptospirosis is frequently encountered in the tropical region
This study aims to determine the effect of the 3-day Methylprednisolone-Cyclophosphamide in the survival of patients with severe leptospirosis, renal failure and pulmonary hemorrhage compared to those given a 3-day course of hydrocortisone
A total of 138 patients were included in the study, 65 patients for the HC group and 73 patients for the MP-C group
Summary
Leptospirosis is frequently encountered in the tropical region. It is caused by the pathogenic species of leptospira, commonly L. Interrogans, with L. icterohemorrhagica causing the severe form [1]. They shed urine into water and soil and infect humans via skin or gastrointestinal routes. The risk of infection is increased through exposure from work, household surroundings and flooding. Clinical manifestations range from subclinical infection, self limited febrile illness to severe and fatal disease with hemodynamic collapse and multi-organ involvement, including renal and pulmonary failure [2]
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