Leptospirosis in children: A review for family physicians (original) (raw)

An observational study to detect leptospirosis in Mumbai, India, 2000

Archives of Disease in Childhood, 2003

Background: Leptospirosis is relatively uncommon in children. Following torrential rains and flooding an outbreak of leptospirosis was suspected in Mumbai. Aims: To investigate the possibility of an outbreak of leptospirosis and describe the clinical illness. Methods: From 24 July to 14 September 2000, children with a history of abrupt onset of high fever (.39˚C), who presented to our hospital, were admitted and tested serologically for anti-Leptospira antibodies by a quantitative enzyme linked immunosorbent assay (ELISA) test. An IgM titre of more than 20U/ml confirmed the diagnosis of leptospirosis. Clinical features in the confirmed leptospirosis and leptospirosis negative groups were analysed. Results: Of 53 children screened, 18 (34%) had leptospirosis. In all 18, the disease was anicteric and responded well to intravenous penicillin. Four clinical features present at the time of admission were significantly associated with leptospirosis: a history of contact with flood water (18/18 v 16/35), conjunctival suffusion (5/18 v 1/35), abdominal pain (9/18 v 5/35), and skin rash (5/18 v 1/35). As the number of these four features concomitantly present increased, the chances of the child having leptospirosis also increased significantly. A history of contact with flood water had a sensitivity of 100%, and the presence of conjunctival suffusion, abdominal pain, and skin rash had a specificity of 97%, 86%, and 97%, respectively, for identifying children with leptospirosis. Conclusion: Leptospirosis should be suspected in febrile children with contact with flood water.

A Review on Epidemiology, Pathogenesis and Treatment of Leptospirosis

International Journal of Advanced Research, 2021

Leptospirosis is a zoonotic disease, it arises worldwide but it is most frequent in tropical and subtropical zone. It is one of the notifiable and treatable disease. Leptospirosis is a plague caused by species of bacteria called Leptospira the bacteria shed into the nature via urine of infected animals. Rats are the most recurrent source of human sepsis. Rivers are the assumption to be a predominant risk factor for transmission of disease to humans. It possesses an extensive variation of mechanisms that allow them to avoid the host immune system and cause infection. The infection is extremely vast ranging from subclinical to multi organ infection with elevated mortality. It is frequently mild but can be terminal, it is likely to be serious and the serious alignment form known as Weils disease and can easily steer to death. The mingling of renal failure, hemorrhage and jaundice is known as Weils disease. It is the most affection pattern associated with critical leptospirosis. It is a...

Differences among children, adolescents and adults with severe leptospirosis: A comparative analysis

Indian Journal of Nephrology, 2014

Indian Journal of Nephrology suddenly with headache, high-degree fever, malaise, myalgia, conjunctival suffusion and a transient rash. The severe form is characterized by jaundice, acute kidney injury (AKI) and hemorrhage, known as Weil's disease and it is mainly caused by serovars icterohaemorrhagiae, copenhageni, lai and others. [1,2] The disease is endemic in Brazil and is associated with the rainy season and floods. [5] In a recent study conducted in the State of São Paulo a total of 576 cases of lepsotpirosis were confirmed in 2008, with 73 deaths. In Sao Paulo city, with 10,990,2449 inhabitants, 172 cases with 33 deaths were recorded. [5] There may be the difference in disease's incidence and spectrum of manifestations among pediatric and adult patients with leptospirosis and it is still not well-described. Furthermore, precise information on the frequency and types of severe manifestations in pediatric populations is limited. The aim of this study was to compare the clinical presentation, laboratory data, morbidity and mortality between children, adolescents and adults with leptospirosis, with a focus on kidney function.

Leptospirosis: an emerging global public health problem

Journal of biosciences, 2008

Leptospirosis has been recognized as an emerging global public health problem because of its increasing incidence in both developing and developed countries. A number of leptospirosis outbreaks have occurred in the past few years in various places such as Nicaragua, Brazil and India. Some of these resulted due to natural calamities such as cyclone and fl oods. It is a direct zoonotic disease caused by spirochetes belonging to different pathogenic species of the genus Leptospira. Large number of animals acts as carriers or vectors. Human infection results from accidental contact with carrier animals or environment contaminated with leptospires. The primary source of leptospires is the excretor animal, from whose renal tubules leptospires are excreted into the environment with the animal urine. Majority of leptospiral infections are either sub clinical or result in very mild illness and recover without any complications. However, a small proportion develops various complications due to involvement of multiple organ systems. In such patients, the clinical presentation depends upon the predominant organs involved and the case fatality ratio could be about 40% or more. Febrile illness with icterus, splenomegaly and nephritis (known as Weil's disease), acute febrile illness with severe muscle pain, febrile illness with pulmonary haemorrhages in the form of haemoptysis, jaundice with pulmonary haemorrhages, jaundice with heamaturea, meningitis with haemorrhages including sub conjunctival haemorrhage or febrile illness with cardiac arrhythmias with or without haemorrhages are some of the syndromes. Because of the protean manifestations of leptospirosis it is often misdiagnosed and under-reported. Although the basic principles of prevention such as source reduction, environmental sanitation, more hygienic work-related and personal practices etc., are same everywhere, there is no universal control method applicable to all epidemiological settings. Comprehensive understanding of the eco-epidemiological and cultural characteristics of a community that faces the problem of leptospirosis is an essential prerequisite for evolving an effective and acceptable control measure.

Clinical profile and outcome of leptospirosis at tertiary care centre in western Maharashtra

Journal of Academy of Medical Sciences, 2012

Background: Leptospirosis is an emerging spirochetal zoonosis world wide. Leptospirosis is common zoonosis that is under reported and under diagnosed in India. The aim of this study was to study the clinical profile outcome and prognostic factors in human leptospirosis at tertiary care centre. settings and design: This was a retrospective study of leptospira positive patients who were admitted in tertiary care centre. The study was conducted in 2010, over a period of 6 month from July to December. Materials and Methods: All patients who presented with clinical features and tested IgM positive for leptospirosis were taken into the study and analyzed based on modified Faine's criteria. results: Out of total 23 patients there were 21 males and 2 females, with mean age was 32 years. Maximum incidence of cases was found in month of July and August. Out of total 23 patients, 18 (78.26%) were farmers and 5 (21.73%) were laborers. Predominant complaints were fever, jaundice, myalgia, and headache. All 23 had positive results for IgM against leptospira. Liver function tests were deranged in 16 (69.56%) and renal functions were deranged in 12 (52.17%). Total 7 (30.43%) patients had Weil's syndrome and 7 (30.43%) had acute respiratory distress syndrome (ARDS). Total 7 (30.43%) patients had neuroleptospirosis, out of which 5 (21.73%) had aseptic meningitis, one had paraparesis secondary to lumbar radiculopathy and one had meningoencephalitis. Hyperkalemia was present in 6 (26.08%) patients, 7 (30.43%) patients had hypokalemia. Total 11 (47.82%) patients had metabolic acidosis (pH<7.3) on arterial blood gas analysis. Two (8.69%) patients had disseminated intravascular coagulation and 3 (13.04%) patients had thrombocytopenia. There was one death due to meningoencephalitis with multiorgan failure with overall case fatality rate of 4.34%. Total nine patients with oliguric renal failure were treated with daily dialysis and seven patients with ARDS were on artificial ventilator. Applying modified Faine's criteria, all 23 were positive for leptospirosis. All patients responded ceftriaxone. conclusions: Leptospirosis was unexpectedly found to be positive in many of our patients who were having pyrexia with multiorgan dysfunction during the monsoons. Hepatic dysfunction, acute renal failure, ARDS, and neuroleptospirosis in decreasing frequency were the commonest complication. Daily dialysis, ventilatory support and intensive care management has definitely reduced morbidity and mortality associated with leptospirosis with multi-organ failure.

Fatal Leptospirosis Case in Pediatric Patient: Clinical Case

Open Journal of Medical Microbiology, 2013

Introduction: Leptospirosis is a worldwide zoonosis. It is transmitted through the urine of infected animals. Currently, there is an increase of reports in many countries. In humans, it presents an ample clinical spectrum, which goes from an asymptomatic infection up to Weil syndrome, which is generally fatal. Clinical Case: A male, 6 years of age, who started with onset fever and jaundice, handled in private means, diagnosed as viral hepatitis "A" and was referred to an institutional hospital where hepatomegaly and splenomegaly were detected. His evolution was towards graveness and, therefore, he was referred to a third level hospital with reactive Hepatitis diagnosis and to rule out lymphoma. On admission, he presented liver and kidney failure, as well as metabolic acidosis and pulmonary haemorrhage that led to death 6 hours later. Confirmatory tests for hepatitis were negative; biopsies were taken post-mortem for Leptospira diagnosis, which were positive in liver and kidney. Conclusions: Leptospirosis is a disease that may be manifested in multiple ways. It is important the understanding of this disease by the physician to improve the diagnosis and, for general population, to avoid exposure. The examination of the epidemiological history of the patient is essential.

REVIEW LEPTOSPIROSIS, A CLINICAL UPDATE REGARDING A NEGLECTED INFECTIOUS DISEASE

2021

Leptospirosis is one of the neglected infectious diseases locally widespread and extremely significant in tropical areas due to its great epidemic potential. It is a worldwide public health problem in view of the emergence and reemergence of the disease due to lack of sanitation and negligence, among other factors. In fact, leptospirosis infects more than 1 million people per year, resulting in almost 60,000 deaths. Human infection generally takes place after skin exposure to soil and/or water contaminated with urine of chronically infected mammals. The clinical presentations of the disease vary from a slight fever, goosebumps and flu-like symptoms to the acute forms of the disease. Understanding the main aspects of the disease is paramount due to the many unspecific signs and symptoms as well as frequently mistaken diagnosis. In this article, we discuss the epidemiological, immunopathogenic, clinical and prophylactic aspects of this condition with the purpose of clarifying an up to date panorama of the subject.

RESEARCH Leptospirosis as Frequent Cause of Acute Febrile Illness in Southern Sri Lanka

2013

To determine the proportion of fevers caused by leptospirosis, we obtained serum specimens and epidemiologic and clinical data from patients in Galle, Sri Lanka, March–October 2007. Immunoglobulin M ELISA was performed on paired serum specimens to diagnose acute (seroconversion or 4-fold titer rise) or past (titer without rise) leptospirosis and seroprevalence (acute). We compared (individually) the diagnostic yield of acute-phase specimens and clinical impression with paired specimens for acute leptospirosis. Of 889 patients with paired specimens, 120 had acute leptosoirosis and 241 had past leptospirosis. The sensitivity and specificity of acute-phase serum specimens were 17.5 % (95 % confi dence interval [CI] 11.2%–25.5%) and 69.2 % (95 % CI 65.5%–72.7%), respectively, and of clinical impression 22.9 % (95 % CI 15.4%–32.0%) and 91.7 % (95 % CI 89.2%–93.8%), respectively. For identifying acute leptospirosis, clinical impression is insensitive, and immunoglobulin M results are more...