Role of High‐Dose Corticosteroid for the Treatment of Leptospirosis‐Induced Pulmonary Hemorrhage

Thunga, Girish; John, Jean; Sam, Kishore Gnana; Khera, Kanav; Khan, Sohil; Pandey, Sureshwar; Maharaj, Sandeep

doi:10.1177/0091270010393341

Cited by 10 publications

(10 citation statements)

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“…These treatment options are thought to have various effects on stopping excessive cytokines of the inflammatory process and reverses the disease-associated vasculitis. [11][12][13] Meaudre et al 11 described a good clinical response to high dose methylprednisolone with IVIG in the treatment of severe leptospirosis. Thunga et al 12 and Trivedi et al 13 reported a favorable outcome following glucocorticoid pulse therapy in pulmonary leptospirosis.…”

Section: Discussionmentioning

confidence: 99%

Leptospirosis in a child with acute respiratory distress syndrome

et al. 2017

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Yeşilbaş O, Şevketoğlu E, Kıhtır HS, Hatipoğlu N, Yıldırım HM, Akyol MB, Aktay-Ayaz N, Gökçe İ. Leptospirosis in a child with acute respiratory distress syndrome. Turk J Pediatr 2017; 59: 688-692. Leptospirosis is an infectious vasculitis, which can occur with different clinical features. While it is generally a subclinical and self-limited infection; kidney and liver dysfunction, pulmonary hemorrhage, thrombocytopenia, and cardiovascular collapse may occurr. A six-year-old boy presented with acute respiratory distress syndrome, shock, thrombocytopenia-associated multiple organ failure, and persistent high fever secondary to leptospirosis. Persistent high fever was resistant to intravenous immunoglobulin and pulse steroid therapy. He was successfully treated with plasmapheresis and hemofiltration with endotoxin-cytokine cleaning filter. In conclusion; leptospirosis may cause thrombocytopenia-associated multiple organ failure, persistent high fever, and acute respiratory distress syndrome. Plasmapheresis and hemofiltration should be considered in cases of severe leptospirosis with multiorgan failure.

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Section: Discussionmentioning

confidence: 99%

Leptospirosis in a child with acute respiratory distress syndrome

et al. 2017

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“…7 Leptospiral toxins also activate tumor necrosis factor alpha (TNF-α), which is an acute phase reactant produced primarily by macrophages. 8 Local effects of TNF-α triggers the cardinal signs of inflammation with systemic effects being fever and leukocytosis.…”

Section: Discussionmentioning

confidence: 99%

“…Also, methylprednisolone with its high anti-inflammatory and immunosuppressive properties plays an important role in decreasing the severity of leptospiral APS. 8 Pharmacologic doses of glucocorticoid-based therapy can reverse the effect of immune-mediated response and therefore, lessen the disease-associated vasculitis by reducing the cytokine and TNF-α production. 8 In a study by Shenoy et al, 61.53% of patients showed significant improvement when treated with intravenous methylprednisolone 1g daily for 3 days during the early course (within the first 12 hours) of pulmonary leptospirosis.…”

Section: Methylprednisolone-responsive Leptospiral Acute Pulmonary Symentioning

confidence: 99%

“…8 Pharmacologic doses of glucocorticoid-based therapy can reverse the effect of immune-mediated response and therefore, lessen the disease-associated vasculitis by reducing the cytokine and TNF-α production. 8 In a study by Shenoy et al, 61.53% of patients showed significant improvement when treated with intravenous methylprednisolone 1g daily for 3 days during the early course (within the first 12 hours) of pulmonary leptospirosis. 3 It is also beneficial in severe cases where mortality was seen to decrease from 85.71% to 33.33%.…”

Section: Methylprednisolone-responsive Leptospiral Acute Pulmonary Symentioning

confidence: 99%

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Methylprednisolone-Responsive Leptospiral Acute Pulmonary Syndrome: A Case Report

Arief

Lee

et al. 2015

Int J Med Students

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Background: Leptospirosis is an infectious disease caused by the spirochete of the genus leptospira. It is thought to be the most common zoonosis globally and has a wide range of clinical presentations with pulmonary hemorrhage being one of its most severe manifestations. This entity known as acute pulmonary syndrome carries a high fatality rate. However, it can be effectively managed with methylprednisolone therapy. Case: We report a case of leptospirosis in a 26-year-old Bangladeshi male who was otherwise healthy. He presented with a 7-day history of fever with chills and rigors, and hemoptysis for a duration of 2 days. Physical examination revealed a febrile and lethargic man. Respiratory examination exhibited bilateral generalized crepitations over the lung fields. A chest radiograph performed showed bilateral alveolar shadowing. The diagnosis of leptospirosis was made based on positive Immunoglobulin M enzyme-linked immunosorbent assay serology, which was then confirmed by the microscopic agglutination test for leptospirosis. The patient was commenced on intravenous antibiotics and methylprednisolone at this time. He responded well clinically with resolution of fever and hemoptysis and a marked decrease in crepitations upon auscultation. This correlated with radiological improvement evidence by an obvious reduction in alveolar shadowing on subsequent chest radiograph 2 days later. Conclusion: This case is highly pertinent to the medical field as leptospirosis is an ever-growing problem and acute pulmonary syndrome is an emerging manifestation of it. Therefore, early recognition and intervention is required as this can be effectively treated with methylprednisolone therapy even in resource-limited settings

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“…After the addition of prednisolone, the platelet count rise and epistaxis regressed, supporting the idea that thrombocytopenia in leptospirosis appears secondary to vasculitis and inflammation. There are limited data evaluating the use of prednisolone in Weil disease (2,5,6). These reports showed that anti-inflammatory drugs like corticosteroids can reverse vasculitis by suppressing inflammation triggered by the disease and, as a result, reduce mortality.…”

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confidence: 99%