title: High dose corticosteroids in severe leptospirosis: a systematic review.
abstract: The role of corticosteroids in the treatment of severe leptospirosis is unclear. The rationale for their use is that, in severe leptospirosis, there is a severe immunological response that is harmful to the host resulting in multi-organ dysfunction, which is potentially offset by the nonspecific immunosuppression of high dose steroids. We conducted a systematic review of studies that have assessed the use of high dose corticosteroids in patients with severe leptospirosis by searching MEDLINE and Scopus SciVerse without any language or time restrictions. We identified five studies, including one open randomized clinical trial, which had assessed the use of high dose steroids in severe leptospirosis. Four studies demonstrated a benefit of corticosteroids in treating severe disease with pulmonary involvement when administered early in the course of the disease, but these studies had several methodological constraints as highlighted in the text. Only the randomized controlled trial study showed that corticosteroids are ineffective and may increase the risk of nosocomial infections. There is no robust evidence to suggest that high dose corticosteroids are effective in severe leptospirosis, and a well-designed randomized clinical trial is needed to resolve this.
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Tropical Medicine Research Unit, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: Chaturaka
authors.initials: C
authors.lastname: Rodrigo
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Tropical Medicine Research Unit, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: Nipun
authors.initials: N
authors.lastname: Lakshitha de Silva
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: Ravindi
authors.initials: R
authors.lastname: Goonaratne
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: Keshinie
authors.initials: K
authors.lastname: Samarasekara
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: Indika
authors.initials: I
authors.lastname: Wijesinghe
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: B
authors.initials: B
authors.lastname: Parththipan
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Tropical Medicine Research Unit, Faculty of Medicine, University of Colombo, Sri Lanka senaka.ucfm@gmail.com.
authors.forename: Senaka
authors.initials: S
authors.lastname: Rajapakse
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007922:Leptospirosis / Q000188:drug therapy*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones
keywords: ARDS; Adult respiratory distress syndrome; Corticosteroids; Leptospirosis; Steroids