Association between Age and Severity to Leptospirosis in Children

<div><p>Background</p><p>In endemic areas, leptospirosis is more common and more severe in adults compared with children. Reasons to explain this discrepancy remain unclear and limited data focusing on adolescents are available. The objective of the study was to describe disease spectrum and outcome differences in children and adolescents admitted for leptospirosis in a large at-risk population.</p><p>Methods</p><p>Clinical and laboratory data were obtained on hospitalized cases in New Caledonia from 2006 to 2012.</p><p>Results</p><p>Data of 60 patients <18 years of age (25 children under 14 and 35 adolescents aged 14 to 17) with confirmed leptospirosis were analyzed. Compared with children, adolescents presented more often with classic features of Weil disease (p = 0.02), combining hepatic and renal involvement with or without pulmonary participation. Jarisch-Herxheimer reactions were observed more often among adolescents (p<0.01). The overall case fatality rate was low (1 adolescent versus 0 children).</p><p>Conclusion</p><p>Severe leptospirosis in adolescents may be more likely to show adults' characteristics compared with children. Further studies are required to explore age-dependant host factors, including puberty-related physiological changes.</p></div

Demographic characteristics and medical histories of 60 paediatric leptospirosis in New Caledonia, 2006.

<p>Demographic characteristics and medical histories of 60 paediatric leptospirosis in New Caledonia, 2006.</p

Initial laboratory findings among 60 leptospirosis children in New Caledonia, 2006–2012.

*<p>mean [95%CI].</p

Clinical symptoms in 60 leptospirosis children in New Caledonia, 2006–2012.

<p>Clinical symptoms in 60 leptospirosis children in New Caledonia, 2006–2012.</p

Multivariate model of independent factors associated with severe leptospirosis (N = 156) in New Caledonia, 2008–2011.

<p>Abbreviations: OR, odds ratio; CI, confidence interval.</p>a<p>Significant association was classified as P<.05.</p

Clinical symptoms in 176 leptospirosis patients in New Caledonia 2008–2011.

*<p>1 patient had an already known chronic pancytopenia.</p

Multivariate model of independent biological factors associated with severe leptospirosis (N = 176) in New Caledonia, 2008–2011.

<p>Abbreviations: OR, odds ratio; CI, confidence interval; MI, multiple imputation.</p

Initial laboratory findings among 176 leptospirosis patients in New Caledonia, 2008–2011.

<p>Abbreviations: OR, odds ratio; CI, confidence interval; MI, multiple imputation.</p

High incidence of leptospirosis in an observational study of hospital outpatients in Vanuatu highlights the need for improved awareness and diagnostic capacities

<div><p>Background</p><p>Estimates of leptospirosis morbidity identified Oceania as the region with highest burden. Besides Australia and New Zealand, Oceania is home of Pacific Island Countries and Territories, most of which are developing countries facing a number of challenges. Their archipelago geography notably affects health infrastructure and access to healthcare. Although human leptospirosis was formerly identified in Vanuatu, there is a lack of knowledge of this disease in the country. We aimed to identify leptospirosis in outpatients visiting the hospital.</p><p>Methodology/Principal findings</p><p>We conducted a clinical study to investigate leptospirosis as a cause of non-malarial acute febrile illness in Vanuatu. A total 161 outpatients visiting the outpatient clinics at Port Vila Central Hospital for internal medicine were recruited over 20 month. We showed that leptospirosis significantly affects humans in Vanuatu: 12 cases were confirmed by real-time PCR on acute blood samples (n = 5) or by high serology titers evidencing a recent infection (MAT titer ≥800 or ELISA≥18 Units, n = 7). A high rate of positive serology was also evidenced, by MAT (100</p><p>Conclusions/Significance</p><p>The high numbers of both seropositive patients and acute leptospirosis cases observed in outpatients visiting Port Vila Central Hospital suggest a high exposure to pathogenic <i>Leptospira</i> in the population studied. The MAT serology pointing to serogroup Australis as well as exposure history suggest that livestock animals largely contribute to the burden of human leptospirosis in Vanuatu. The analysis of residential and travel data suggests that the risk might even be higher in other islands of the Vanuatu archipelago. Altogether, our study emphasizes the need to increase awareness and build laboratory capacity to improve the medical care of leptospirosis in Vanuatu.</p></div

Map showing the Vanuatu archipelago and the capital Port Vila.

<p>Map showing the Vanuatu archipelago and the capital Port Vila.</p