De Thomasis Sarah, Flodrops Hugues, Llanas Brigitte, Martinez Casado Édouard, Cloarec Sylvie, Pietrement Christine, Zaloszyc Ariane
Service de pédiatrie 1, CHU Hautepierre, 1, avenue Molière, 67200 Strasbourg, France.
Service de pédiatrie générale, Groupe hospitalier Sud Réunion, CHU La Réunion, avenue François Mitterrand, 97410 Saint-Pierre, France.
Nephrol Ther. 2022 Jun;18(3):189-194. doi: 10.1016/j.nephro.2021.11.006. Epub 2022 Mar 7.
Leptospirosis is an anthropozoonosis with polymorphic clinical symptoms and a high variability of severity, ranging from flu-like syndrome to severe acute kidney injury. This disease is highly incident in tropical regions but there is a trend towards increasing incidence in metropolitan France and in Reunion Island. The objective of this study was to describe the epidemiological, clinical, laboratory and therapeutic characteristics of the pediatric leptospirosis in metropolitan France and in Reunion Island.
We performed a retrospective analysis of leptospirosis cases hospitalized in University hospitals where members of the Paediatric Nephrology Society work in France between January 2008 and December 2020, 6 centers reported leptospirosis cases, one center had one patient in consultation but lack of available data and 10 centers did not find any case.
A total of 21 cases were reported (mean age 13.4±3.4years), mostly boys (ratio 6:1). Out of 21 patients, 95% had fever, 71% were presenting with myalgia, 81% with thrombocytopenia, and 76% with gastrointestinal symptoms. Regarding kidney impairment, 18 patients (86%) had acute kidney injury, including 4 (19%) with oligoanuria, but none of them required acute dialysis. About 30% of patients had biological signs of tubulopathy including hypophosphatemia, hypokalemia, or tubular proteinuria. No death due to the disease occurred. The therapeutic management followed the current guidelines with the use of antibiotic therapy by amoxicillin or 3rd generation cephalosporins with symptomatic treatment. When there was biological control after exit, creatinine decreased.
In this multicenter retrospective study, we report 21 children with leptospirosis with a significant proportion of acute kidney injury, the outcome was favorable. Children do not seem to be at high risk of chronic kidney disease progression but nephrology follow-up has not been systematically carried out. Compared to studies performed in adults, the prognosis was better and hepatic impairment was rare. Compared to other pediatric studies, conjunctivitis was not a common symptom but kidney injury and survival appeared to be similar. Children were presenting with anicteric renal presentation. The casebook wasn't exhaustive and didn't include the other overseas territories, which account for the highest proportion of leptospirosis infection.
Leptospirosis is an infection which may lead to multivisceral failure with kidney involvement conditioning the outcome. Despite a better prognosis in children, it remains important to quickly diagnose this infection in order to start appropriate antibiotic therapy and perform a kidney function monitoring.
钩端螺旋体病是一种人畜共患病，临床症状多样，严重程度差异很大，从流感样综合征到严重急性肾损伤不等。这种疾病在热带地区高发，但在法国本土和留尼汪岛有发病率上升的趋势。本研究的目的是描述法国本土和留尼汪岛小儿钩端螺旋体病的流行病学、临床、实验室和治疗特征。
我们对2008年1月至2020年12月期间法国儿科肾脏病学会成员所在大学医院收治的钩端螺旋体病病例进行了回顾性分析。6个中心报告了钩端螺旋体病病例，1个中心有1例会诊患者但缺乏可用数据，10个中心未发现任何病例。
共报告21例（平均年龄13.4±3.4岁），以男孩居多（比例为6:1）。21例患者中，95%有发热，71%有肌痛，81%有血小板减少，76%有胃肠道症状。关于肾脏损害，18例（86%）有急性肾损伤，其中4例（19%）为少尿无尿，但均无需进行急性透析。约30%的患者有肾小管病的生物学指标，包括低磷血症、低钾血症或肾小管蛋白尿。无因该病死亡病例。治疗管理遵循现行指南，使用阿莫西林或第三代头孢菌素进行抗生素治疗并对症治疗。出院后进行生物学监测时，肌酐水平下降。
在这项多中心回顾性研究中，我们报告了21例钩端螺旋体病患儿，其中相当一部分有急性肾损伤，预后良好。儿童似乎没有慢性肾脏病进展的高风险，但尚未系统地进行肾脏病随访。与成人研究相比，预后较好，肝损害罕见。与其他儿科研究相比，结膜炎不是常见症状，但肾损伤和生存率似乎相似。儿童表现为无黄疸型肾脏表现。该病例记录并不详尽，未包括其他海外领地，而这些地区钩端螺旋体病感染比例最高。
钩端螺旋体病是一种可能导致多脏器功能衰竭且肾脏受累影响预后的感染。尽管儿童预后较好，但快速诊断这种感染以便开始适当的抗生素治疗并进行肾功能监测仍然很重要。
