Abstract
Objective: To investigate the effectiveness of high-dose corticosteroids in patients with severe leptospirosis, especially in reducing morbidity and mortality rates.
 Methods: Literature searches were conducted using PubMed® and SCOPUS®. One systematic review and one systematic review with meta-analysis were selected from three chosen studies.
 Results: The systematic review from Rodrigo et al. only included qualitative synthesis from four interventional studies. Early administration of methylprednisolone can be beneficial; however, low number and poor methodological quality of the studies question the validity of this review. Duggal et al. stated that there was no significant difference in the therapeutic effects of early high-dose corticosteroids (P ³ 0.05; 95% CI: 0.81–1.37), early low-dose corticosteroids (P ³ 0.05; 95% CI: 0.3–1.03), and late low-dose corticosteroids (P ³ 0.05; 95% CI: 0.11–2.52). Limited number of studies and high statistical heterogeneity, however, are major drawbacks for this review.
 Conclusion: Evidence about the role of high-dose corticosteroids in severe leptospirosis patients with pulmonary complications, especially their benefits, is still limited. Additional randomized, controlled trials with adequate statistical power still need to be conducted.
Highlights
Leptospirosis is an acute infection caused by Leptospira spp
According to the World Health Organization (WHO), the number of severe leptospirosis cases worldwide is more than approximately 500,000 cases per year (10 cases per 100,000 people living in tropical regions per year, and 0.1– 10 cases per 100,000 people living in temperate regions)
The systematic review by Rodrigo et al consists of four interventional studies with brief descriptions of 10 case reports with a similar topic
Summary
Leptospirosis is an acute infection caused by Leptospira spp. A history of previous hospitalization, similar clinical manifestation in the past, spontaneous bleeding, nausea and vomiting, decreased level of consciousness, seizures, cardiac disease, hematological problems, lung diseases, allergy, and previous trauma were denied. The patient was a farmer and often did not wear slippers when he worked. His neighborhood suffered from damage due to recurrent floods during the rainy season. Leptospirosis is an acute infection, which can occur in humans and animals, and is caused by Leptospira spp. This disease was first discovered by Weil in 1886; leading to the name Weil’s disease for severe leptospirosis. Clinical manifestations usually vary from unspecific acute fever to severe manifestations such as kidney failure, icterus, spontaneous bleeding, respiratory failure, and vascular collapse [1]
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