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High dose corticosteroids in severe leptospirosis: a systematic review
Chaturaka Rodrigo1, Nipun Lakshitha de Silva1, Ravindi Goonaratne2
1Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Tropical Medicine Research Unit, Faculty of Medicine, University of Colombo, Sri Lanka.
Summary
High-dose corticosteroids for severe leptospirosis lack robust evidence. While some studies suggest benefits, a randomized trial found them ineffective and potentially increasing infection risk, necessitating further research.
Area of Science:
- Infectious Diseases
- Immunology
- Critical Care Medicine
Background:
- Severe leptospirosis involves a harmful immune response leading to multi-organ dysfunction.
- Corticosteroids are hypothesized to mitigate this by providing non-specific immunosuppression.
Purpose of the Study:
- To systematically review the evidence on high-dose corticosteroid use in severe leptospirosis.
- To assess the efficacy and safety of corticosteroids in this condition.
Main Methods:
- A systematic review of MEDLINE and Scopus SciVerse databases was performed.
- Included studies assessed high-dose corticosteroids in severe leptospirosis patients.
- Five studies, including one RCT, were identified.
Main Results:
- Four studies suggested potential benefits of early corticosteroid administration for pulmonary involvement, but had methodological limitations.
- The single randomized controlled trial indicated corticosteroids were ineffective and increased nosocomial infection risk.
Conclusions:
- There is currently no robust evidence supporting the efficacy of high-dose corticosteroids in severe leptospirosis.
- A well-designed randomized clinical trial is required to definitively determine their role.
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