A Comparative Study of Leptospirosis and Dengue in Thai Children

Abstract

BackgroundLeptospirosis 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 FindingsWe 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/SignificanceUnrecognized 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.

Leptospirosis and malaria as causes of febrile illness during a dengue epidemic in Jamaica

“…A study of dengue and leptospirosis among children during an epidemic of the former during in Thailand showed that dengue accounted for 61% of the cases while leptospirosis accounted for 6.0%. 37 While leptospirosis showed two epidemic peaks at ages 6 and 11 years, dengue had a single peak at age 9 years. There was a male predominance in cases of leptospirosis.…”

Effect of temperature, relative humidity and rainfall on dengue fever and leptospirosis infections in Manila, the Philippines

“…Moreover, leptospirosis is associated with floodwaters following monsoons [11][12][13]. It has also been suggested that temperature and rainfall considerably increase the incidence of DF infections [14,15].…”

Fatal Pulmonary Haemorrhage in Co-infection with Dengue and Leptospirosis

“…Only 31% of confirmed leptospirosis cases were diagnosed as leptospirosis at the time of hospital discharge while another 38% were wrongly diagnosed as dengue fever or dengue hemorrhagic fever (Rafizah et al 2012). A study in Thailand by Libraty et al (2007) also reported that 19% of the children with confirmed leptospirosis were not diagnosed correctly on discharge from hospital. Because the specific treatment differs for both infectious diseases, the availability of antigen-based rapid diagnostic tests is essential to aid the clinicians to make timely and accurate diagnosis as well as to start appropriate treatment regimes, which is even more important in co-infection cases.…”

“…Libraty et al (2007) reported that the presence of petechial rash was significantly higher in dengue patients compared to those with leptospirosis. Another study conducted in Brazil by Flannery et al (2001) showed that a greater proportion of patients develop jaundice in leptospirosis infection compared to those with dengue.…”

“…The clinical manifestation of both infectious diseases at early stages of illness consists of an ample array of non-specific signs and symptoms such as high-grade fever, anorexia, generalised body ache, arthralgia, myalgia, nausea, and vomiting (Libraty et al 2007;Flannery et al 2001). Libraty et al (2007) reported that the presence of petechial rash was significantly higher in dengue patients compared to those with leptospirosis.…”