Successful Treatment of Pulmonary Hemorrhage Associated with Leptospirosis and Scrub Typhus Coinfection by Early Plasma Exchange

Chen, Yun-Sung; Cheng, Shih-Lung; Wang, Hao-Chien; Yang, Pan‐Chyr

doi:10.1016/s0929-6646(09)60344-2

Cited by 21 publications

(6 citation statements)

References 17 publications

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“…Plasma exchange has been found to be useful in leptospirosis. [ 19 20 ] Plasma exchange is useful mainly in conditions where immune mechanisms play an important role.…”

Section: Discussionmentioning

confidence: 99%

Cyclophosphamide in pulmonary alveolar hemorrhage due to leptospirosis

Trivedi

Vasava

Patel

et al. 2009

Indian Journal of Critical Care Medicine

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Background and Aims:Severe pulmonary involvement in leptospirosis carries high mortality rates. It is the most common cause of death due to leptospirosis in many parts of India and the world. Exacerbated immune response of the host plays an important role in its pathogenesis. Hence, immunosuppressive drugs could be useful in its treatment. Glucocorticosteroids have been found to be useful in several studies. Cyclophosphamide, an immunosuppressive agent, has been found to be useful in a majority of pulmonary alveolar hemorrhages due to non leptospiral causes. This study was carried out to study the effects of cyclophosphamide in patients with leptospiral pulmonary alveolar hemorrhage.Method:A total of 65 patients with confirmed leptospirosis with severe pulmonary involvement admitted to a tertiary care center in south Gujarat were included in the study. All of the patients were treated with injection crystalline penicillin, methyl prednisolone pulse therapy, and non invasive mechanical ventilation. A total of 33 patients were given parenteral cyclophosphamide 60 mg/kg body weight stat on diagnosis. Their outcomes were compared with the remaining 32 patients who had not been given this drug. Survival was considered the main outcome indicator.Results:Out of the 33 patients treated with cyclophosphamide, 22 (66.7%) survived, while in the control group out of 32 patients, three (9.4%) survived. On statistical analysis, the odds ratio was 19.33 (4.22–102.13) and the P-value was <0.001. Leucopenia (78.78%) and alopecia (18.75%) were the main side effects noted. No mortality was noted due to these side effects.Conclusion:Cyclophosphamide improves survival in cases of severe pulmonary alveolar hemorrhage due to leptospirosis. Statistically, the improvement is highly significant.

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“…Plasma exchange has been found to be useful in leptospirosis. [ 19 20 ] Plasma exchange is useful mainly in conditions where immune mechanisms play an important role.…”

Section: Discussionmentioning

confidence: 99%

Cyclophosphamide in pulmonary alveolar hemorrhage due to leptospirosis

Trivedi

Vasava

Patel

et al. 2009

Indian Journal of Critical Care Medicine

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“…Co-infection with O. tsutsugamushi and Leptospira spp. tends to be associated with severe illness and death ( 8 – 12 ), and cases are mainly reported in Southeast Asia, particularly in Thailand ( 8 ) and Taiwan ( 9 – 12 ). However, we did not routinely test for leptospirosis in this study.…”

Section: Discussionmentioning

confidence: 99%

Acute Q Fever and Scrub Typhus, Southern Taiwan

Lai¹,

Chen²,

Lin³

et al. 2009

Emerg. Infect. Dis.

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“…We found two case reports [15, 16] and one clinical trial [17], where benefits of plasmapheresis in severe leptospirosis with pulmonary hemorrhages have been described. Chen et al [15] described a patient with leptospirosis and coinfection with typhus presenting with diffuse alveolar hemorrhage and acute kidney injury (AKI) and recovered after 8 cycles of plasma exchange and high-dose steroids. Despite recovery from pulmonary hemorrhage, this patient had a complicated course of illness with active gastrointestinal bleeding and necessitated 6 weeks of hospitalization.…”

Section: Resultsmentioning

confidence: 99%

Role of Plasmapheresis and Extracorporeal Membrane Oxygenation in the Treatment of Leptospirosis Complicated with Pulmonary Hemorrhages

Fonseka

Lekamwasam

2018

Journal of Tropical Medicine

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Introduction Leptospirosis is an emerging infectious disease associated with multiorgan involvement and significant morbidity and mortality. Although pulmonary hemorrhage due to leptospirosis has a high fatality, specific treatment options are limited and their efficacy is not adequately proven. We opted to find out the current evidence on plasmapheresis and extracorporeal membrane oxygenation (ECMO) in pulmonary hemorrhages due to leptospirosis. Methods The first search was conducted in PubMed, OVID, Google Scholar, and Cochrane clinical trial registry using keywords “leptospirosis” OR “Leptospira” OR “Weil's disease” AND “plasmapheresis” OR “plasma exchange” AND “pulmonary hemorrhage” OR “alveolar hemorrhage” OR “lung hemorrhage” and the second search was done using keyword “leptospirosis” OR “Leptospira” OR “Weil's disease” AND “ECMO” OR “Extracorporeal membrane oxygenation.” The searches were not limited by study design or the date of publication. Only articles written in English were reviewed. Although we intended to include only clinical trials, it was decided later to include other information such as case reports and case series which addressed these treatment modalities. Two authors selected articles independently in a blinded manner using a set of inclusion and exclusion criteria and discrepancies were solved after discussions. Results The information found was very limited. This included one clinical trial which showed a significant survival benefit with plasmapheresis but the study design had many limitations. Two case reports described the benefit of plasmapheresis in severe leptospirosis with pulmonary hemorrhages. There were eight case reports where ECMO was performed and out of all only one patient has died. One retrospective study on patients with severe leptospirosis mentioned that four out of five patients with pulmonary hemorrhages survived after being treated with ECMO. Conclusions Current evidence is insufficient to recommend the routine use of plasmapheresis or ECMO for patients presenting with pulmonary hemorrhages due to leptospirosis. ECMO may be a promising mode of treatment in acute respiratory failure in leptospirosis related pulmonary hemorrhages. These treatment modalities, however, can be applied based on the availability of resources and expertise at the discretion of the clinician in charge, considering patient related factors such as cardiovascular stability and derangement of coagulation profile. Clinical trials conducted adhering to standard procedures are urgently required to establish the efficacy of these treatment modalities.

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Successful Treatment of Pulmonary Hemorrhage Associated with Leptospirosis and Scrub Typhus Coinfection by Early Plasma Exchange

Cited by 21 publications

References 17 publications

Cyclophosphamide in pulmonary alveolar hemorrhage due to leptospirosis

Cyclophosphamide in pulmonary alveolar hemorrhage due to leptospirosis

Acute Q Fever and Scrub Typhus, Southern Taiwan

Role of Plasmapheresis and Extracorporeal Membrane Oxygenation in the Treatment of Leptospirosis Complicated with Pulmonary Hemorrhages

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