To ascertain prognostic factors associated with fatal outcomes in severe leptospirosis, a retrospective case-control study was done using population-based surveillance data. Centralized death certificate reporting of leptospirosis mortality was combined with details of patients' hospitalizations, which were obtained from hospitals representing all sectors of São Paulo city. Among identified leptospirosis cases, 89 lethal cases and 281 survivor cases were analyzed. Predictors of death included age>40 years, development of oliguria, platelet count<70,000/microL, creatinine>3 mg/dL, and pulmonary involvement. The latter was the strongest risk factor with an estimated odds ratio of 6.0 (95% confidence interval: 3.0-12.0). Serologic findings with highest titer against Leptospira interrogans serovar Copenhageni did not show significant differences between survivors and non-survivors. Lung involvement was an important predictor of death in leptospirosis in São Paulo, of relevance in leptospirosis-endemic regions where this complication is common.

Rodents are involved in the transmission to human beings of several diseases, including liptospirosis, which shows high lethality rates in Sao Paulo municipality. Despite this, few studies have assessed the relationship existing between urban environmental conditions and building rodent infestation. With the purpose of clarifying this relationship, an analysis has been conducted in order to quantify the influence of environmental factors upon rodent infestation on a low-income district. Diagnosis of the environmental situation has been performed to evaluate the frequency according to which harborage, food and access sources occur, and a survey on infestation rates in 2175 dwellings in the area studied. The logistic regression analysis showed that among the environmental variables, the one that showed the closest association with rodent infestation was access; followed by harborage, and food. It was concluded that poor socioeconomic and environmental conditions in the area propitiate the occurrence of high rodent infestation rates.

Rodents are responsible for the transmission of more than 60 diseases both to human beings and to domestic animals. The increase in rodent infestation in a given area brings several health problems to the nearby population. Thus, when infestation increases, it is time to take intervention measures. Although many countries have implemented programs aimed at controlling rodent infestation, literature on studies evaluating the effectiveness of intervention measures in urban areas is scarce. Aimed at contributing to the understanding of rodents' population dynamics in urban areas, the objective of this study was to evaluate the effectiveness of the control methods proposed by "Programa de Vigilancia e Controle de Roedores do Municipio de Sao Paulo" (Program for Rodents Surveillance and Control in Sao Paulo Municipality), conducted on Jardim Comercial District. As a first step, a survey to assess infestation rates was conducted in 1529 dwellings located in the area studied. After that, a chemical control upon rodents was accomplished in every dwelling infested. One week and six months after completion of control measures, a new evaluation on infestation rates was carried out, in order to verify the effectiveness of the procedures taken and to estimate the re-infestation capacity. Initial infestation rate was 40.0%, and the final infestation rate, 14.4%. Therefore, the effectiveness of the control methods utilized was 63.8%. It can thus be concluded that the control methods applied were quite effective.

Abstract. Although leptospirosis may be fatal in childhood, the experience of many clinicians working in diseaseendemic 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 Sã o Paulo during [2004][2005][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.

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