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A comparative study of leptospirosis and dengue in Thai children
Daniel H Libraty1, Khin S A Myint, Clinton K Murray
1Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. daniel.libraty@umassmed.edu
Insights
Leptospirosis is often misdiagnosed as dengue in children in tropical areas. A simple model using neutrophil count, albumin, and AST levels can help differentiate these febrile illnesses.
Area of Science:
- Pediatric infectious diseases
- Zoonotic disease epidemiology
- Tropical medicine
Background:
- Leptospirosis is an emerging zoonotic disease frequently under-recognized in children.
- It is often misdiagnosed as dengue in tropical regions, impacting resource allocation.
- Distinguishing between leptospirosis and dengue in children is crucial for effective clinical management.
Purpose of the Study:
- To develop a method for differentiating pediatric leptospirosis from dengue.
- To identify key clinical and laboratory markers for early diagnosis.
Main Methods:
- Prospective, hospital-based study of children with acute febrile illnesses in Thailand.
- Leptospirosis diagnosis confirmed by serological testing (IgM, MAT).
- Case-control comparison of clinical features and laboratory values between leptospirosis and dengue cases.
Main Results:
- Leptospirosis represented 19% of non-dengue febrile illnesses in children during the rainy season.
- A significant proportion (33%) of leptospirosis cases were misdiagnosed as dengue or scrub typhus.
- A predictive model using absolute neutrophil count, plasma albumin, and AST levels within 72 hours of illness onset was developed.
Conclusions:
- Undiagnosed leptospirosis contributes significantly to dengue-like febrile illnesses in pediatric populations.
- Enhanced diagnostic capabilities for pediatric leptospirosis are needed.
- Early discrimination between leptospirosis and dengue improves healthcare resource utilization in resource-limited settings.
Background:
Leptospirosis is an emerging zoonosis that is often under-recognized in children and commonly confused with dengue in tropical settings. An enhanced ability to distinguish leptospirosis from dengue in children would guide clinicians and public health personnel in the appropriate use of limited healthcare resources.
Methodology/Principal Findings:
We conducted a prospective, hospital-based, study of children with acute febrile illnesses and dengue in Thailand. Among the children without dengue, we identified those with leptospirosis using anti-leptospira IgM and microscopic agglutination titers in paired acute and convalescent blood samples. We then performed a case-control comparison of symptoms, signs, and clinical laboratory values between children with leptospirosis and dengue. In a semi-rural region of Thailand, leptospirosis accounted for 19% of the non-dengue acute febrile illnesses among children presenting during the rainy season. None of the children with leptospirosis were correctly diagnosed at the time of hospital discharge, and one third (33%) were erroneously diagnosed as dengue or scrub typhus. A predictive model to distinguish pediatric leptospirosis from dengue was generated using three variables: the absolute neutrophil count, plasma albumin, and aspartate aminotransferase levels in the first 72 hours of illness.
Conclusions/Significance:
Unrecognized leptospirosis can be a significant cause of "dengue-like" febrile illness in children. Increased awareness of pediatric leptospirosis, and an enhanced ability to discriminate between leptospirosis and dengue early in illness, will help guide the appropriate use of healthcare resources in often resource-limited settings.
