Clinical presentation, epidemiological characteristics and complications of leptospirosis in children: A study in a Base Hospital in Sri Lanka

Introduction: Leptospirosis is a zoonotic disease, caused by a spirochaete, mainly genus leptospira. Although many studies of leptospirosis in adults have been documented, no published data are available on children with leptospirosis in Sri Lanka. It can range from mild flu like illness to a severe multi-organ dysfunction and the diagnosis can be missed unless there is a high index of suspicion
Objectives: To describe the clinical patterns, epidemiological characteristics and complications of leptospirosis in Sri Lankan children.
Method: This was a descriptive study on clinically suspected and confirmed patients with leptospirosis who were admitted to Base Hospital Panadura from 2019 to 2022.
Results: A total of 35 patients was included in this study and 25 were confirmed as leptospirosis with positive micro-agglutination testing titre >1:400, or with positive leptospira DNA, qualitative, real-time polymerase chain reaction; 19 (76%) were male and 6 (24%) were female. There were 15 (68%) children >10 years, 4 were between 5-10 years and 3 were <5 years; 100% had a history of fever. Arthralgia (56%), myalgia (64%), vomiting (60%), abdominal pain (28%) and headache (44%) were the common symptoms. Common signs were conjunctival suffusion (60%), hepatomegaly (52%) and cervical lymphadenopathy (24%). Leucocytosis was observed in 28% and 100% had neutrophil predominance. Thrombocytopenia (150,000/mL) was observed in 44%. Elevated C-reactive protein was observed in 100%. Renal functions were deranged in 16%; 2 patients developed shock following commencement of antibiotics which needed inotropic support for several hours. No deaths were reported during the study period. No patients had serious complications like acute renal failure needing renal replacement therapy, or pulmonary haemorrhage.
Conclusions: Leptospirosis was commoner in males (76%). Fever (100%), arthralgia (56%), myalgia (64%), vomiting (60%), abdominal pain (28%) and headache (44%) were the common symptoms. Common signs were conjunctival suffusion (60%), hepatomegaly (52%) and cervical lymphadenopathy (24%).  Leucocytosis was observed in 28%, neutrophilic predominance in 100% and thrombocytopenia in 44%. There were no deaths.