Background The emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) with high case fatality has been reported from many countries. Understanding of clinical disease and sequel of SPHS needs larger studies with adequate numbers. The purpose of this study was to describe the characteristics and sequel by different therapeutic approaches for SPHS in Leptospirosis in Sri Lanka. Methods This study was conducted at Teaching Hospital-Karapitiya (THK), Galle, Sri Lanka from June 2015 to December 2017. THK is the main tertiary care center for the Southern Province. All confirmed-cases of leptospirosis who presented during this period and were admitted to five medical units of THK were included in this study. SPHS was defined as a patient presenting; haemoptysis, arterial hypoxemia (Acute Lung Injury Score < 2.5), haemoglobin drop (10% from the previous value), or diffused alveolar shadows in the chest radiograph, without alternative explanation other than leptospirosis. Results Of the 128 MAT confirmed cases of leptospirosis, 111 (86.7%) had acute kidney injury (AKI) whilst SPHS was seen in 80 (62.5%). Patients typically developed SPHS within the first week of illness, mostly on days 4 and 5. The case fatality rate of this study sample was 28.1% ( n = 36), while for patients with SPHS, it was 41.5%. Most of the deaths ( n = 19) were within the first 3 days of admission (on the same day 8, and within next 48 h 11). Among SPHS patients, 59 received therapeutic plasma exchange (TPE). The survival rate was higher ( n = 35, 74.5%) when the TPE was performed within the first 48 h of detecting SPHS compared to patients in whom the procedure was done after 48 h ( n = 5, 54.5%). Of the 19 leptosprosis patients with SPHS who did not receive TPE, 17 died (89.5%). However, the group of patients who received TPE was primarily the patients survived beyond day 3. Conclusions We observed that during the study period, SPHS was common and the mortality rate was higher in the study area. The treatment modalities tested need further evaluation and confirmation.

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Background Leptospirosis has gained much attention in Sri Lanka since its large outbreak in 2008. However, most of the cases were clinically diagnosed and information on Leptospira genotypes and serotypes currently prevailing in the country is lacking. Methodology/Principal findings We retrospectively analyzed 24 Leptospira strains from human patients as well as isolated and characterized three Leptospira strains from black rats using the microscopic agglutination test with antisera for 19 serovars and multilocus sequence typing. The isolates were identified as Leptospira borgpetersenii sequence types (STs) 143 and 144; L. interrogans

The virus SARS-CoV-2 emerged in December 2019 in Wuhan, China and spread rapidly worldwide. As of April 30, 2020, the virus has spread to 213 countries, infecting 3,090,445 and causing death in 217,769 1. The SARS-CoV-2 is a single stranded RNA beta-corona virus, similar to SARS and MERS 2. Therefore, drugs which were effective against SARS and MERS were repositioned for SARS-CoV-2. On behalf of the Ceylon College of Physicians' "Subcommittee for Guidance on Treatment and Prophylaxis against COVID-19", we herein summarize the current evidence as of May 2, 2020 for selected repositioned drugs which have been used in the current COVID-19 pandemic. Antiviral agents Chloroquine and hydroxychloroquine Chloroquine (CQ) has been used effectively against malaria and hydroxychloroquine (HCQ) against systemic lupus erythematous and rheumatoid arthritis for a long time. They appear to block the entry of SARS-CoV-2 virus into cells by inhibiting glycosylation of host receptors, proteolytic processing, and endosomal acidification. They also appear to have immuno-modulatory effects through attenuation of cytokine production 3,4. CQ was shown to be effective against SARS-CoV-2 in vitro with a low half maximal concentration (EC50) 5. HCQ, a less toxic derivative of CQ, has an in vitro activity with a lower EC50 for SARS-CoV-2 compared with CQ 6 and by reducing the production of cytokines, Treatment of COVID-19: A review of emerging treatment This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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