1. Manajemen leptospirosis berat
Gangguan ginjal akut
Perdarahan paru
M. Hussein Gasem

2. Manajemen pasien Leptospirosis (3)
Pasien dengan disfungsi multi-organ
Terapi suportif
Keseimbangan cairan dan elektrolit
Diuretika pada keadaan oliguri
Transfusi darah (trombosit atau PRC)
Ventilator utk pasien ARDS, perdarahan paru
Dialisis (hemodialisis atau peritoneal dialisis)

3. Tatalaksana AKI pada Leptospirosis
OVERHIDRASI
DEHIDRASI
ATN
STADIUM
OLIGOURI
rehidrasi
diuretika
forced
diuresis
STADIUM
DIURESIS
(POLIURI)
STADIUM
OLIGOURI
DIALISIS
Dwi Lestari 2007

4. Mortality according to treatment group
Door-to-dialysis time (from ICU admission
to the initiation to dialysis)
Mortality according to treatment group
Delayed, alternate day dialysis
Prompt and daily dialysis
Andrade et al. Clin J Am Soc Nephrol2:739-44, 2007

5. Disfungsi organ/komplikasi pada Leptospirosis berat (n: 87) #
Ginjal (AKI , oligurik or non-oligurik)
87 (100)
Hepar (hiperbilirubinemia / icterus)
Hematologi (trombositopenia, dg/ tanpa ganguan koagulasi , DIC¥)
85 (98)
Kardiovaskuler (kelainan EKG, gagal jantung, syok dll)
74 (87)
Gastrointestinal (“pankreatitis” , hematemesis, melena)
16 (19)
Pulmo (perdarahan paru, ARDS dll)
5 (6)
Mata (perdarahan retina, uveitis)
4 (5)
Serebral (gangguang kesadaran, perdarahan otak)
Note: Semua dikonfirmasi dg MAT; 18 pasian dg Lepto DriDot saja.
MH Gasem dkk (2008)

6. Pulmonary involvement
Pulmonary hemorrhage has been increasingly reported
Lepto patients with PH highest mortality rates (50-70%)
Clinical signs vary : sudden increase of RR to impending RF
ARDS, chest pain, low Hb/Ht, hemoptysis not always found
Clinical manifestation as CAP  caused by Leptospira sp
Pulmonary involvement
Histopathology (autopsy):
diffuse intra-alveolar hemorrhage
with or without alveolar damage
Pathogenesis is not well understood
Leptospirosis pulmonary hemorrhage syndrome (LPHS)
Severe pulmonary haemorrhage syndrome (SPHS)

7. Corticosteroid in pulmonary leptospirosis
including pulmonary hemorrhage
methylprednisolone 1000 mg/hari selama 3 hari, iv bolus
dilanjutkan dengan 1 mg/kgBB/hari oral
Shenoy et al. Postgrad Med J 2006;82:602–606