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VOLUME 13 , ISSUE 2 ( June, 2009 ) > List of Articles


Cyclophosphamide in pulmonary alveolar hemorrhage due to leptospirosis

Samir V. Trivedi, Ashwin H. Vasava, Tinkal C. Patel, Lovleen C. Bhatia

Keywords : Cyclophosphamide, leptospirosis, pulmonary alveolar hemorrhage

Citation Information : Trivedi SV, Vasava AH, Patel TC, Bhatia LC. Cyclophosphamide in pulmonary alveolar hemorrhage due to leptospirosis. Indian J Crit Care Med 2009; 13 (2):79-84.

DOI: 10.4103/0972-5229.56053

License: CC BY-ND 3.0

Published Online: 01-07-2012

Copyright Statement:  Copyright © 2009; The Author(s).


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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  1. Leptospiral pneumonias. Curr Opin Pulm Med 2007;13:230-5.
  2. Clinical Profile of Leptospirosis in South Gujarat. J Postgrad Med 2002;48:117-8.
  3. Epidemic of leptospirosis: An ICU experience. J Assoc Physicians India 2004;52:619-22.
  4. Pathology and pathophysiology of pulmonary manifestations in leptospirosis. Braz J Infect Dis 2007;11:142-8.
  5. Alveolar Haemorrhage Syndromes. In: Fishman, editor. Fishman′s pulmonary diseases and disorders. 3 rd edition. New York: McGraw Hill Publication;1998.
  6. Leptospirosis. In: Braunwald, Fauci, Kasper, Hauser, editors. Harrison′s principles of Internal Medicine.16 th edition New York: McGraw Hill publications.2005
  7. Diffuse alveolar haemorrhage and myositis in icterohaemorrhagic leptospirosis, rapid control by a single bolus corticosteroid. Rev Mal Respir 1994:11:601-3.
  8. The role of glucocorticoid pulse therapy in pulmonary involvement in Leptospirosis. J Assoc Physicians India 2001;49:901-3.
  9. Methylprednisolone as adjuvant in treatment of acute respiratory distress syndrome owing to leptospirosis- a pilot study. Indian J Crit Care Med 2005;9:133- 6.
  10. Multiple organ dysfunction syndromes due to tropical infections. Indian J Crit Care Med 2003;7:233-6
  11. Pulmonary leptospirosis: An excellent response to bolus methylprednisolone. Postgrad Med 2006;82:602-6.
  12. Geneva: World Health Organisation; 2003. p. 109.
  13. An expanded definition of the adult Respiratory distress syndrome. Am Rev Respir Dis 1988;138:720-3.
  14. Non invasive positive pressure ventilation: Successful outcome in patients with acute lung injury/ARDS. Chest 1999;115:173 -7.
  15. Leptospirosis. Clin Microbiol Rev 2001;14:296-326.
  16. Alveolar septal deposition of immunoglogulin and complement parallels pulmonary haemorrhage in a guinea pig model of severe pulmonary leptospirosis. Am J Pathol 2004;164:1115-27.
  17. Nitric oxide production and immunoglobulin deposition in leptospiral hemorrhagic respiratory failure. J Formos Med Assoc 2005;104:759-63.
  18. Leptospirosis severity may be associated with the intensity of humeral immune response. Rev Inst Med Trop Sao Paulo 2002;44:79-83.
  19. Successful treatment of pulmonary hemorrhage associated with leptospirosis and scrub typhus co infection by early plasma exchange. J Formos Med Assoc 2007;106, S1-6.
  20. Potential benefit of plasma exchange in treatment of severe icteric leptospirosis complicated by acute renal failure. Clin Diagn Lab Immunol 2002;9:482-4.
  21. Immunomodulation in severe leptospirosis with multiple organ failure: plasma exchange, Intravenous immunoglobulin or corticosteroids? Ann Fr Anesth Reanim 2008;27:172-6.
  22. Leptospiral lipopolysaccharide activated cells through a TLR 2 dependent mechanism. Nat Immunol 2001;2:346-52.
  23. Risk factors for death and changing patterns in leptospirosis acute renal failure. Amer J Trop Med Hyg 1999;61:630-4.
  24. Pathogenesis of dengue: Challenges to molecular biology. Science 1988;239:476-81.
  25. Antibiotics for leptospirosis. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD001306. DOI:10.1002/14651858.CD001306.
  26. Antineoplastic agents: In: Hardman, Limbird, Gilman editors. Goodman and Gilman′s The Pharmacological Basis of Therapeutics.10 th edition. New York: McGraw Hill publications; 2001.
  27. Martindale: The Extra Pharmacopia. 31 st edition. London: Royal Pharmaceutical Society; 1996.
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