title: High efficacy of bolus methylprednisolone in severe leptospirosis: a descriptive study in Sri Lanka.
abstract: BACKGROUND
  In 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.
  
  
  METHODS
  The 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).
  
  
  RESULTS
  There 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.
  
  
  CONCLUSIONS
  MP 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.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. samkul@sltnet.lk
authors.forename: Senanayake A M
authors.initials: SA
authors.lastname: Kularatne
authors.forename: B D Sudhara S
authors.initials: BD
authors.lastname: Budagoda
authors.forename: V Kapila D
authors.initials: VK
authors.lastname: de Alwis
authors.forename: W M R Sujantha
authors.initials: WM
authors.lastname: Wickramasinghe
authors.forename: J M Ruwanthi P
authors.initials: JM
authors.lastname: Bandara
authors.forename: L P Manoji M K
authors.initials: LP
authors.lastname: Pathirage
authors.forename: G Rohitha R D K
authors.initials: GR
authors.lastname: Gamlath
authors.forename: Thusitha J
authors.initials: TJ
authors.lastname: Wijethunga
authors.forename: W A Thilak A
authors.initials: WA
authors.lastname: Jayalath
authors.forename: Chandrika
authors.initials: C
authors.lastname: Jayasinghe
authors.forename: Vasanthi
authors.initials: V
authors.lastname: Pinto
authors.forename: Praneetha
authors.initials: P
authors.lastname: Somaratne
authors.forename: P V Ranjith
authors.initials: PV
authors.lastname: Kumarasiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D004196:Disease Outbreaks; D004341:Drug Evaluation; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007922:Leptospirosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000469:parasitology; D018579:Patient Selection; D012720:Severity of Illness Index; D013188:Sri Lanka / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D008775:Methylprednisolone