Blood Exchange in Severe Leptospirosis at Mahasarakham Hospital

Leptospirosis is a disease being the important problem of Thailand because the patient may die when has complication such as acute renal failure, pulmonary complication and hyperbilirubinemia. The aim of this study was to review the benefit of blood exchange in severe leptospirosis.During an outbeark of leptospirosis in northeastern Thailand, 39 patient with severe leptospirosis diagnosed by WHO criteria were hospitalized at Mahasarakham Hospital. The clinical features were consistent with those described for the classic manifestation of the disease However, of these patients with severe leptospirosis, 35(89%) had acute renal failure; 17 (43%) had hyperbilirubin above 15 mg% and 6(15%) had pulmonary complications, including pulmonary edema,hemorrhage and acute respiratory distress syndrome. Blood exchange was performed in 15 patient with hyperbilirubinemia, acute renal failure and pulmonary complications, Result of the treatment with blood exchange, 13 (86.66%) survived and 2 (13.33%) died.Conclusion: Blood exchange, in addition to conventional treatment was beneficial in severe leptospirosis with complication and hyperbilirubinemia.