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Pulmonary leptospirosis: an excellent response to bolus methylprednisolone

Medical Intensive Care Unit and Department of Internal Medicine, Grant Medical College and Sir J J Group of Hospitals, Byculla, Mumbai, India

Correspondence to:
Correspondence to:
Dr V S Nagar
4/29, Swastik, J J Hospital Campus, Byculla 400008, India; vidyaic{at}vsnl.net

Background: This case series analyses the beneficial effect of methylprednisolone in pulmonary leptospirosis, which usually has an aggressive course and grave outcome.

Methods: 30 patients of pulmonary leptospirosis were evaluated. The initial 13 patients did not receive corticosteroids while the remaining 17 all received bolus methylprednisolone one gram intravenously for three days followed by oral prednisolone 1 mg/kg for seven days, on the basis of occasional case reports of benefit in pulmonary leptospirosis. APACHE III and lung injury scores of similar severity were considered while comparing outcomes in those who received methylprednisolone with those who did not.

Results: Dyspnoea and haemoptysis were the commonest symptoms in those with pulmonary manifestations. Overall mortality was 18% (3 of 17) in patients who received methylprednisolone, as compared with 62% (8 of 13 patients) in those who did not (p<0.02). In patients with established acute lung injury (ALI score >2.5), five of eight patients survived in the subgroup with corticosteroids (37% mortality) while only one of nine patients survived in the group that did not receive corticosteroids (89% mortality). Corticosteroids affected outcome only if given within the first 12 hours after the onset of pulmonary manifestations. Mortality seemed to correlate with the APACHE scores, and number of quadrants affected on chest radiographs, more than with blood gas pressures.

Conclusions: Corticosteroids reduce mortality and change outcome significantly when used early in the management of pulmonary leptospirosis.

Keywords: pulmonary leptospirosis; acute lung injury; corticosteroids; methylprednisolone