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

BackgroundIn 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 il...

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Published in:	Postgraduate medical journal Vol. 87; no. 1023; pp. 13 - 17
Main Authors:	Kularatne, Senanayake A M, Budagoda, B D Sudhara S, de Alwis, V Kapila D, Wickramasinghe, W M R Sujantha, Bandara, J M Ruwanthi P, Pathirage, L P Manoji M K, Gamlath, G Rohitha R D K, Wijethunga, Thusitha J, Jayalath, W A Thilak A, Jayasinghe, Chandrika, Pinto, Vasanthi, Somaratne, Praneetha, Kumarasiri, P V Ranjith
Format:	Journal Article
Language:	English
Published:	London The Fellowship of Postgraduate Medicine 01-01-2011 BMJ Publishing Group Oxford University Press
Subjects:	Adolescent Adult Aged Aged, 80 and over Anti-Inflammatory Agents - administration & dosage Anti-Inflammatory Agents - therapeutic use Bacterial diseases bacteriology Biological and medical sciences case death rate Comorbidity Disease Outbreaks Drug Evaluation Epidemics Female Fever General aspects Glucocorticoids - administration & dosage Glucocorticoids - therapeutic use Human bacterial diseases Humans immune mediated pathogenesis Infectious diseases Infusions, Intravenous Intensive care Leptospira Leptospirosis Leptospirosis - complications Leptospirosis - drug therapy Leptospirosis - epidemiology Male Management decisions Medical sciences methylprednisolone Methylprednisolone - administration & dosage Methylprednisolone - therapeutic use Middle Aged Miscellaneous Mortality Multiple Organ Failure - parasitology Patient Selection Peritoneal dialysis Severity of Illness Index Sri Lanka Sri Lanka - epidemiology Survival Analysis Treatment Outcome tropical medicine Young Adult Asia Sri Lanka High Leptospirosis Corticosteroid Steroid hormone Treatment efficiency Methylprednisolone Infection Medicine Bolus injection Spirochaetosis Bacteriosis Immunosuppressive agent Severe
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Summary:	BackgroundIn 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.MethodsThe 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 mg intravenously for 3 days, followed by oral 8 mg for 5 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).ResultsThere 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.ConclusionMP 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.
Bibliography:	ArticleID:postgradmedj92734 ark:/67375/NVC-N2BZ7ZXV-3 href:postgradmedj-87-13.pdf istex:8EF84C25887A7A88F2F8539E01E1D462C57D30A0 PMID:21106802 local:postgradmedj;87/1023/13 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0032-5473 1469-0756 1469-0756
DOI:	10.1136/pgmj.2009.092734