Marotto P C, Marotto M S, Santos D L, Souza T N, Seguro A C
Instituto de Infectologia Emilio Ribas, Sao Paulo, Brazil.
Am J Trop Med Hyg. 1997 Mar;56(3):307-10. doi: 10.4269/ajtmh.1997.56.307.
We conducted a retrospective analysis of 43 consecutive children (35 boys and 8 girls), 4-14 years of age and living in an urban area, who were hospitalized at the Instituto de Infectologia Emilio Ribas (Sao Paulo, Brazil) from January 1989 to December 1995 with an acute illness subsequently diagnosed as leptospirosis. Epidemiologic data indicated contact with contaminated water in most cases (88%). The patient sera reacted most strongly with Leptospira interrogans serovars copenhageni (45%) and icterohaemorrhagiae (32.7%). Jaundice was present in 70% of the patients, elevated transaminase levels in 56%, renal failure in 79%, meningitis in 23%, thrombocytopenia in 65%, and hemorrhagic manifestations in 11.6%. Three children had pulmonary hemorrhage with respiratory failure and one death occurred as a consequence of respiratory failure. We also observed that antimicrobial therapy reduced the extent of renal failure and thrombocytopenia. These data indicate that antibiotics benefit children with late, severe leptospirosis and that severe disease also occurs in children and should be considered in the differential diagnosis.
我们对43名连续的儿童进行了回顾性分析，这些儿童年龄在4至14岁之间，居住在城市地区，于1989年1月至1995年12月在巴西圣保罗的埃米利奥·里巴斯传染病研究所住院，患有随后被诊断为钩端螺旋体病的急性疾病。流行病学数据表明，大多数病例（88%）与受污染水有接触。患者血清与问号钩端螺旋体哥本哈根血清型（45%）和出血性黄疸血清型（32.7%）反应最强。70%的患者出现黄疸，56%的患者转氨酶水平升高，79%的患者出现肾衰竭，23%的患者出现脑膜炎，65%的患者出现血小板减少，11.6%的患者出现出血表现。三名儿童发生肺出血伴呼吸衰竭，一名患者因呼吸衰竭死亡。我们还观察到抗菌治疗减少了肾衰竭和血小板减少的程度。这些数据表明，抗生素对晚期重症钩端螺旋体病患儿有益，重症疾病也发生在儿童中，在鉴别诊断时应予以考虑。
