Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
PLoS Negl Trop Dis. 2007 Dec 26;1(3):e111. doi: 10.1371/journal.pntd.0000111.
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.
钩端螺旋体病是一种新出现的人畜共患疾病，在儿童中常被低估，在热带地区常与登革热混淆。提高区分儿童钩端螺旋体病和登革热的能力，将有助于临床医生和公共卫生人员在有限的医疗资源下正确使用。
方法/主要发现：我们在泰国进行了一项前瞻性、基于医院的儿童急性发热疾病和登革热的研究。在没有登革热的儿童中，我们使用抗钩端螺旋体 IgM 和配对的急性和恢复期血液样本的显微镜凝集滴度来确定钩端螺旋体病。然后，我们对钩端螺旋体病和登革热儿童的症状、体征和临床实验室值进行病例对照比较。在泰国的一个半农村地区，钩端螺旋体病占雨季就诊的非登革热急性发热儿童的 19%。没有一个钩端螺旋体病儿童在出院时被正确诊断，三分之一（33%）被误诊为登革热或丛林斑疹伤寒。使用三个变量（发病后 72 小时内的绝对中性粒细胞计数、血浆白蛋白和天冬氨酸氨基转移酶水平）生成了一个用于区分儿科钩端螺旋体病和登革热的预测模型。
结论/意义：未被识别的钩端螺旋体病可能是儿童“登革热样”发热疾病的一个重要原因。提高对儿科钩端螺旋体病的认识，以及提高在疾病早期区分钩端螺旋体病和登革热的能力，将有助于指导在资源往往有限的情况下正确使用医疗资源。
