Health Municipality Secretariat of São Paulo, São Paulo, Brazil.
Am J Trop Med Hyg. 2012 Feb;86(2):306-8. doi: 10.4269/ajtmh.2012.11-0308.
Although leptospirosis may be fatal in childhood, the experience of many clinicians working in disease-endemic areas is that classic Weil's disease and death are less common among pediatric patients. The aim of the study was to ascertain disease spectrum and outcome differences in severe pediatric and adult leptospirosis in a large at-risk population. Epidemiologic, clinical, and laboratory data were obtained on hospitalized cases from São Paulo during 2004-2006. A total of 42 case-patients < 18 years of age and 328 case-patients ≥ 18 years of age were tested during the study. Compared with children, adults had higher rates of jaundice (P = 0.01), elevated serum bilirubin levels (P < 0.01), oliguria (P = 0.02), and elevated creatinine levels (P = 0.01) but not for thrombocytopenia or pulmonary involvement. The overall case-fatality rate was 27% (adult) versus 5% (pediatric) (P < 0.01). Severe pediatric leptospirosis may be less likely to show all classic features of Weil's disease and may be less fatal than in adults.
虽然钩端螺旋体病在儿童中可能是致命的，但在疾病流行地区工作的许多临床医生的经验是，在儿科患者中，经典的韦尔氏病和死亡较少见。本研究的目的是在高危人群中确定严重儿科和成人钩端螺旋体病的疾病谱和结局差异。2004-2006 年期间，从圣保罗获得了住院患者的流行病学、临床和实验室数据。在研究期间，共检测了 42 名<18 岁的病例患者和 328 名≥18 岁的病例患者。与儿童相比，成人的黄疸发生率更高（P=0.01）、血清胆红素水平升高（P<0.01）、少尿（P=0.02）和肌酐水平升高（P=0.01），但血小板减少症或肺部受累发生率无差异。总的病死率为 27%（成人）与 5%（儿科）（P<0.01）。严重儿科钩端螺旋体病可能不太可能出现所有韦尔氏病的典型特征，且病死率可能低于成人。
