Abstract:
Abstract
Background: The emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) with
high case fatality has been reported from many countries. Understanding of clinical disease and sequel of SPHS
needs larger studies with adequate numbers. The purpose of this study was to describe the characteristics and
sequel by different therapeutic approaches for SPHS in Leptospirosis in Sri Lanka.
Methods: This study was conducted at Teaching Hospital-Karapitiya (THK), Galle, Sri Lanka from June 2015 to
December 2017. THK is the main tertiary care center for the Southern Province. All confirmed-cases of leptospirosis
who presented during this period and were admitted to five medical units of THK were included in this study.
SPHS was defined as a patient presenting; haemoptysis, arterial hypoxemia (Acute Lung Injury Score < 2.5),
haemoglobin drop (10% from the previous value), or diffused alveolar shadows in the chest radiograph, without
alternative explanation other than leptospirosis.
Results: Of the 128 MAT confirmed cases of leptospirosis, 111 (86.7%) had acute kidney injury (AKI) whilst SPHS was
seen in 80 (62.5%). Patients typically developed SPHS within the first week of illness, mostly on days 4 and 5. The
case fatality rate of this study sample was 28.1% (n = 36), while for patients with SPHS, it was 41.5%. Most of the
deaths (n = 19) were within the first 3 days of admission (on the same day 8, and within next 48 h 11). Among
SPHS patients, 59 received therapeutic plasma exchange (TPE). The survival rate was higher (n = 35, 74.5%) when
the TPE was performed within the first 48 h of detecting SPHS compared to patients in whom the procedure was
done after 48 h (n = 5, 54.5%). Of the 19 leptosprosis patients with SPHS who did not receive TPE, 17 died (89.5%).
However, the group of patients who received TPE was primarily the patients survived beyond day 3.
Conclusions: We observed that during the study period, SPHS was common and the mortality rate was higher in
the study area. The treatment modalities tested need further evaluation and confirmation.
