Pediatric presentations of leptospirosis
Sarala Rajajee1, Janani Shankar, Lata Dhattatri
1Kanchi Kamakoti Childs Trust Hospital, Nungambakkam, Chennai, India. saralarajaje@yahoocom
Insights
Leptospirosis in children is often missed due to non-specific symptoms. Early suspicion is crucial for diagnosis and to prevent severe outcomes like myositis and meningitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Leptospirosis in children is frequently underdiagnosed because its symptoms are non-specific, except for severe cases like Weil's disease.
- Recognizing non-icteric forms of leptospirosis is challenging without a high index of clinical suspicion.
Purpose of the Study:
- To analyze the clinical profile, laboratory findings, and outcomes of leptospirosis in pediatric patients.
- To highlight the importance of suspecting leptospirosis, particularly its myositis and meningitis presentations, in children.
Main Methods:
- Children with suggestive symptoms (fever, myalgia, jaundice, etc.) were included.
- Clinical data, laboratory parameters, treatment response, and outcomes were analyzed.
- Diagnostic confirmation involved Dark field microscopy and serological tests (MAT, ELISA IgM).
Main Results:
- Fever (96%) and headache/myalgia (24%) were the most common symptoms in 139 diagnosed cases.
- Hepatomegaly (72%) and icterus (18%) were frequent signs; meningitis (7%) and shock (9%) were also observed.
- Overlapping infections, such as with Salmonella typhi or Dengue Hemorrhagic Fever, led to complications like myocarditis, shock, and ARDS.
Conclusions:
- Non-icteric leptospirosis presents non-specifically and can be easily missed.
- Myositis and meningitis are emphasized as key presentations of leptospirosis in children.
- Delayed diagnosis significantly increases mortality and morbidity in pediatric leptospirosis cases.
Objective:
Leptospirosis in children is an often under diagnosed condition due to the non specificity of the presentations except for the classical Weil's disease.
Methods:
Children presenting with symptoms and signs suggestive of Leptospirosis were included in the study. Diagnostic criteria were fever, myalgia, conjunctival suffusion, Jaundice, headache, altered sensorium, seizures, bleeding manifestation and oliguria. Their clinical profile, lab parameters (general and specific), response to treatment and outcome were analysed.
Result:
One hundred and thirty nine cases were diagnosed during a 4-year period. The commonest symptoms were fever 133 (96%), headache and myalgia 34 (24%). Jaundice was present in only 25 (18%) of cases with renal failure in 2 cases. The frequently encountered clinical signs were hepatomegaly in 100 (72%), myalgia in 34 (24%) with icterus in 25 (18%), 12 (9%) of children presented with shock and 10 (7%) had meningitis. CPK estimated was a useful index of myositis. The diagnosis was confirmed by Dark field microscopy and paired or single high serological tests (MAT, ELISA IgM). Overlapping infections such as culture positive Salmonella typhi with leptospirosis (Serology positive) or Dengue Hemorrhagic fever with Leptospirosis presented with complications such as a myocarditis, shock and ARDS.
Conclusion:
Presentation of non-icteric forms of Leptospirosis are often non-specific and may be missed unless there is a high index of suspicion. This study emphasizes the myositis and meningitis forms of leptospirosis. Delayed diagnosis leads to increased mortality and morbidity.
Related Concept Videos
01:27Acute Pyelonephritis I: Introduction
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Rocky Mountain Spotted Fever
01:30Leishmaniasis
01:28Toxoplasmosis
01:22Bacterial Meningitis I: Introduction