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Case Reports

Indian Pediatrics 2003; 40:1081-1083 

Leptospirosis in Children

Bela Verma
S.R. Daga
D. Sawant

From the Department of Pediatrics, Cama and Albless Hospital, Mumbai 400 001, India.

Correspondence to: Bela Verma, C-17/13, Grosse Point, LIC Colony, Borivli (West), Mumbai 400 103, India.

Manuscript received: September 26, 2002; Initial review completed: October 28, 2002; Revision accepted: May 1, 2003.



Leptospirosis has a broad spectrum of clinical manifestations varying, from inapparent influenza like illness to fulminant fatal disease with hepato-renal dysfunction and hemorrhagic phenomena. Our cases had fever, puffiness, respiratory distress and bleeding diathesis as leading mainfestations. Leptospirosis was suspected in view of epidemic situation prevailing in the city. We report four cases here, three of which survived and one died.

Key words: Fever, Leptospirosis.


Leptospirosis is a grossly underdiagnosed disease in our country due to lack of awareness, protean manifestations and inadequate diagnostic facilities in many areas(1). Early diagnosis and appropriate treatment can prevent fatal outcome. We report four cases here, three of which we came across during the epidemic that Mumbai witnessed in the year 2000 and one recently in September 2002.

Case Report

Case 1

An eight-year-old boy was admitted with history of fever with chills since five days, puffiness of face and arthralgia since one day. A presumptive diagnosis of urinary tract infection was made. A day later he developed sudden onset breathlessness, hemoptysis and hematemesis (250 to 300 mL). He also had subconjunctival hemorrhage. Suspecting pulmonary edema, frusemide was given and dobutamine infusion was started. Blood was collected for leptospirosis detection [by dark ground illumination (DGI) and ELISA] and doxycycline was administered. He rapidly deteriorated with falling oxygen saturation, altered sensorium and generalized tonic-clonic seizures. He expired six hours later. Chest X-ray was not possible. Complete blood count showed: Hb 8.7 g/dL, total white cell count of 5750/cumm, N 70%, L 30%, platelets were adequate. Urine examination revealed 10-15 pus cells/hpf, few casts and bacteria. Serum creatinine was 2.4 mg/dL. Dark ground illumination (DGI) revealed leptospira in blood (report received after death of the patient). Leptospiral IgM antibodies were detected by EIA (dipstick ELISA).

Case 2

Six year old girl was admitted with fever since fifteen days and approximately 50 mL hematemesis for two days. The patient had cold extremities, feeble pulses and tachy-cardia. Patient received intravenous fluids, antibiotics (cefotaxime) and blood trans-fusion. Doxycycline was also administered and dark ground illumination and ELISA tests for leptospirosis were ordered. CBC showed total white cell count 9300/cumm, N 40%, L 53%, bands 17%, Hb 10.7 g/dL and low platelets on smear examination. DGI and ELISA for leptospira were positive, therefore crystalline penicillin was added. Patient improved clinically and was discharged.

Case 3

Seven-month-old male child was being treated for gastroenteritis with dehydration. Three days later he was found to be tachypneic, edematous and had ascites. Amikacin was started. On clinical suspicion of leptospirosis, blood was sent for DGI and ELISA tests, which came positive. Penicillin and doxycycline were administered. Other investigations revealed: CBC showed Hb of 10 g/dL total white cell count of 23,500/cumm, N 31%, L 67%, E 2%, Urine had 1-2 pus cells/hpf, serum creatinine was 0.7 mg/dL, blood urea 24 mg/dL and blood sugar 60 mg/dL. Patient improved and was discharged.

Case 4

A ten-year-old boy was admitted for fever, vomiting since 10 days, passing blood in stools and approximately 100-150 mL hematemesis since two days and myalgia. On examination, he was febrile, pale, dehydrated and had a palpable spleen. Investigations revealed Hb 12.2 g/dL, total white cell count 1140/cumm with a differential of N 67% (bands 11%), L 28% and B 5%. Smear showed trophozoites and gametocytes of Plasmodium falciparum. Serum creatinine was 1 mg /dL; Liver function tests, chest X-ray and urine examination were normal. Leptospira test by DGI was positive. Chloramphenicol was started, chloroquine and doxycycline were added in view of the positive reports of Plasmodium falciparum and leptospirosis. The patient improved and was later discharged.


Leptospirosis is a zooanthroponosis caused by a pathogenic spirochete of genus Leptospira, the species Leptospira interrogans(2,3). It is characterized by a broad spectrum of clinical manifestations varying from inapparent infection to fulminant fatal disease. In the mild form it may present as an influenza like illness with headache and myalgia. Severe form characterized by jaundice, renal dysfunction and hemorrhagic diathesis is referred to as Weil’s syndrome(2). The first case of leptospirosis from India was reported in 1929 by Taylor and Goyal from Andaman and Nicobar Islands(3). It is known to occur in sporadic as well as epidemic form in mainland India. There has been a significant increase in the reported cases of leptospirosis from India since 1980s. Epidemics have been increasingly reported from Orissa, Maharashtra, Karnataka, Tamil Nadu and Kerala(4,5). The primary lesion caused by leptospires is damage to the endothelial lining of small blood vessels with resultant ischemic damage to liver, kidneys, meninges and muscles. A low index of suspicion of this disease coupled with the diversity and non-specificity of the presentation accounts for the significant number of cases that go unrecognized(6).

Leptospirosis should be considered in the differential diagnosis of any acute febrile illness(7). As there is an overlap of the clinical features of leptospirosis with other infections like influenza, dengue hemorrhagic fever, enteric fever and viral hepatitis A, a high index of suspicion is required to diagnose leptospirosis in a child, especially in endemic areas.

Definitive diagnosis is based on demonstration of the infecting organism from clinical specimens of blood (first seven days), cerebrospinal fluid (day four to ten) and from urine (after tenth day) by phase contract or dark field microscopy. However, the skill required and the high frequency of artifacts limit their use(7). Serologic tests like microscopic slide-agglutination test (MAT), indirect hemagglutination test, dipstick ELISA and dot ELISA for IgM antibodies, in the presence of clinical symptoms compatible with leptospires establish the diagnosis(7).

Although this is a multisystem disease with varying presentation, in our cases, prolonged fever, gastroenteritis, bleeding tendency, renal symptoms and signs were conspicuous. The patients did not come from the same locality. The first patient (case 1) who expired, the respiratory distress appeared to be due to acute respiratory distress syndrome (ARDS) with severe hemorrhagic disease. This first case alerted us to keep leptospirosis in mind and suspect it in the other two cases which presented a month later. In the fourth case, there was co-existence of two infections (malaria and leptospirosis).

These case reports emphasize the importance of a high index of suspicion about this disease in view of the recent emergence and difficult diagnosis, to institute prompt treatment and reduce fatal outcome.

Contributors: BV prepared the script and reviewed the literature. SRD co-drafted and reviewed the final script.

Funding: None.

Competing interests: None stated.




1. Gulati S, Menon S, Kabra M, Chaudhry R, Kalra V. Leptospirosis: A case report. Pediatr Today, 2002; 7: 428-433.

2. Andre VL, Diamen D, Jaime RT. Leptospirosis in Latin America. Infect Dis Clin North Am 2000; 14 : 23-29.

3. Faines S. Guidelines for control of leptospirosis. Geneva, World Health Organisation offset Publication 1982; 67.

4. John T J. Emerging and re-emerging bacterial pathogens in India. Indian J Med Res 1996; 103: 4-18.

5. Leptospirosis. India. Report of the investigation of a post-cyclone outbreak in Orissa. November, 1999. Wkly Epidemiol Rec 2000; 75: 217-223.

6. Feigin R, Anderson D. Leptospirosis. In: Feigin R, Cherry J. editors. Textbook of Pediatric Inectious diseases, 3rd Edn. Philadelphia: W.B. Saunders; 1992, p 1167-1183.

7. Azimi P: Spirochetal Infections. In: Nelson WE, Behrman RE, Kliegman RM, Arvin AM, editors. Nelson Textbook of Pediatrics, 16th edn. Philadelphia: W.B. Saunders Company; 2000; p 908-909.


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