Methylprednisolone Treatment in Leptospirosis

Pathophysiology and Rationale

• Leptospirosis can present with a biphasic course: an initial bacteremic phase with flu-like symptoms lasting 4-7 days, followed by an immune phase characterized by fever, myalgia, hepatorenal syndrome, and hemorrhage, according to the Infectious Diseases Society of America 1
• Severe disease is believed to be immunologically mediated, making immunomodulatory therapy a logical approach, as suggested by the European Society of Clinical Microbiology and Infectious Diseases 1, 2

Monitoring and Precautions

• The American Thoracic Society recommends monitoring for hyperglycemia, especially within 36 hours following initial bolus, in patients receiving methylprednisolone for severe leptospirosis 3, 4
• The Society of Critical Care Medicine suggests considering infection surveillance as glucocorticoid treatment can blunt febrile response, in patients with severe leptospirosis 3, 4
• The American Gastroenterological Association recommends considering proton pump inhibitor therapy for GI prophylaxis in patients receiving methylprednisolone 5