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Outcome of leptospirosis in children
P C Marotto1, M S Marotto, D L Santos
1Instituto de Infectologia Emilio Ribas, Sao Paulo, Brazil.
Insights
Leptospirosis in children, often caused by contaminated water, presents with severe symptoms like jaundice and renal failure. Early antibiotic treatment can improve outcomes in pediatric leptospirosis cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Leptospirosis is a zoonotic disease with significant morbidity in children.
- Understanding the clinical spectrum and risk factors in pediatric populations is crucial for timely diagnosis and management.
Purpose of the Study:
- To analyze the clinical and epidemiological features of leptospirosis in hospitalized children.
- To evaluate the impact of antimicrobial therapy on severe pediatric leptospirosis.
Main Methods:
- Retrospective analysis of 43 children (4-14 years) hospitalized with acute leptospirosis.
- Epidemiological data collection, including exposure to contaminated water.
- Serological testing for Leptospira serovars.
- Clinical data review, including symptoms, laboratory findings, and treatment outcomes.
Main Results:
- Most cases (88%) involved contact with contaminated water.
- Commonly identified serovars were Leptospira interrogans serovars copenhageni (45%) and icterohaemorrhagiae (32.7%).
- High prevalence of jaundice (70%), renal failure (79%), and thrombocytopenia (65%).
- Antimicrobial therapy was associated with reduced renal failure and thrombocytopenia.
Conclusions:
- Leptospirosis is a severe illness in children, presenting with significant organ involvement.
- Early antibiotic intervention appears beneficial for children with severe leptospirosis.
- Leptospirosis should be considered in the differential diagnosis of febrile illnesses in children, especially in endemic areas.
Abstract:
We conducted a retrospective analysis of 43 consecutive children (35 boys and 8 girls), 4-14 years of age and living in an urban area, who were hospitalized at the Instituto de Infectologia Emilio Ribas (Sao Paulo, Brazil) from January 1989 to December 1995 with an acute illness subsequently diagnosed as leptospirosis. Epidemiologic data indicated contact with contaminated water in most cases (88%). The patient sera reacted most strongly with Leptospira interrogans serovars copenhageni (45%) and icterohaemorrhagiae (32.7%). Jaundice was present in 70% of the patients, elevated transaminase levels in 56%, renal failure in 79%, meningitis in 23%, thrombocytopenia in 65%, and hemorrhagic manifestations in 11.6%. Three children had pulmonary hemorrhage with respiratory failure and one death occurred as a consequence of respiratory failure. We also observed that antimicrobial therapy reduced the extent of renal failure and thrombocytopenia. These data indicate that antibiotics benefit children with late, severe leptospirosis and that severe disease also occurs in children and should be considered in the differential diagnosis.