Leptospirose em crianças no Rio de Janeiro

Cruz, Maria Letícia Santos; Andrade, Juliana da Silva Ribeiro de; Pereira, Martha María

doi:10.1590/s0037-86821994000100002

Cited by 16 publications

(9 citation statements)

References 10 publications

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“…Since most studies performed in children did not discriminate age groups, our findings are uneasy to compare with other series. However, some characteristics of small children in our study were similar to what has been previously reported in Thailand [13] and Brazil [7]. In contrast, our results differ from a previous report of 43 children, 4–14 years of age [14] showing more severe manifestations of leptospirosis than the present study, including renal failure and thrombocytopenia.…”

Section: Discussionsupporting

confidence: 55%

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Association between Age and Severity to Leptospirosis in Children

et al. 2013

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BackgroundIn endemic areas, leptospirosis is more common and more severe in adults compared with children. Reasons to explain this discrepancy remain unclear and limited data focusing on adolescents are available. The objective of the study was to describe disease spectrum and outcome differences in children and adolescents admitted for leptospirosis in a large at-risk population.MethodsClinical and laboratory data were obtained on hospitalized cases in New Caledonia from 2006 to 2012.ResultsData of 60 patients <18 years of age (25 children under 14 and 35 adolescents aged 14 to 17) with confirmed leptospirosis were analyzed. Compared with children, adolescents presented more often with classic features of Weil disease (p = 0.02), combining hepatic and renal involvement with or without pulmonary participation. Jarisch-Herxheimer reactions were observed more often among adolescents (p<0.01). The overall case fatality rate was low (1 adolescent versus 0 children).ConclusionSevere leptospirosis in adolescents may be more likely to show adults' characteristics compared with children. Further studies are required to explore age-dependant host factors, including puberty-related physiological changes.

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Section: Discussionsupporting

confidence: 55%

“…Along with experienced clinicians' beliefs, several studies suggest leptospirosis to produce more severe presentation in adults compared with children [3], [4], [5], [6], [7]. Pathogen as well as host-related factors are believed to play a role in the development of severe leptospirosis in adults [1], [8].…”

Section: Introductionmentioning

confidence: 99%

Association between Age and Severity to Leptospirosis in Children

et al. 2013

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“…We identified three retrospective studies ( Table 2). These studies showed similar results concerning higher prevalence in male subjects (>4:1), age range (4 to ∼15 years), and high frequency of jaundice (43-70%), thrombocytopenia (56-61%), and meningitis (∼25%) [29][30][31]. However, in the first study, the prevalence of ARF was 17% and in the two others >50%.…”

Section: Introductionmentioning

confidence: 56%

The kidney in leptospirosis

Abdulkader

Silva

2008

Pediatr Nephrol

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Leptospirosis is a worldwide zoonosis. Typically, patients are young men, although children can be affected. In children, this disease causes mainly alterations of sensorium. Acute renal failure and jaundice (Weil's syndrome) are less common in children than in adults. The main renal histological findings are acute interstitial nephritis and acute tubular necrosis. Acute renal failure is characterized by hypokalemia and nonoliguria. Many factors are involved in its physiopathology: hypotension, hypovolemia, rhabdomyolysis, hyperbilirubinemia, and, primarily, the direct action of leptospiral proteins. Antibiotic administration (especially early administration) reduces length of hospitalization and leptospiruria. For children, even late antibiotic treatment has been shown to reduce the extent of acute renal failure and thrombocytopenia. Although the best method of dialysis is not yet established, early and intensive dialysis can decrease mortality. Mortality in patients with acute renal failure is approximately 15-20% in association with the presence of oliguria, higher levels of creatinine, and older age. Functional recovery is fast and complete; however, abnormal urinary concentration can persist.

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“…[910] There are several reports presenting lower rates of classic signs and symptoms of Weil's disease in children. [111213] Spichler et al ,[11] in a recent study with 370 patients with severe leptospirosis, found that adults exhibited a higher frequency of jaundice and oliguria than in pediatric group. In the present study, most signs and symptoms where similar between the two groups, with the exception of arrhythmia, which was more commonly reported in adults and vomiting, which was more frequent in children.…”

Section: Discussionmentioning

confidence: 99%

Differences among children, adolescents and adults with severe leptospirosis: A comparative analysis

et al. 2014

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Leptospirosis is a zoonosis of global importance caused by Leptospira interrogans. The aim of this study was to compare the data between children, adolescents and adults with leptospirosis. This is a retrospective study including a total of 373 consecutive patients with leptospirosis, admitted to tertiary hospitals in Northeast of Brazil, from May 1985 to August 2010. The patients were divided into two groups (age ≤21 years and >21 years). The adults were 304 (81.5%) of the population, with a mean ge of 41 ± 13 (range 22-84) years. The pediatric group was 16 ± 3 (range 9-21) years. Signs and symptoms where similar between the groups, excepting arrhythmia, which was more frequent in adults and vomiting, more common in children (16% vs. 0%, P = 0.04 and 65% vs. 79%, P = 0.02), respectively. Adult group presented with higher serum urea (137 vs. 97 mg/dl, P = 0.002) and creatinine (4.3 vs. 3.0 mg/dl, P = 0.007). Acute kidney injury (AKI) was observed in 80%, mainly in adults (83% vs. 70% P < 0.005). Adults required renal replacement therapy more frequently than children (38% vs. 11%, P < 0.0001). Mortality was higher in adults (14.8% vs. 2.8%, P = 0.005) and in adults with AKI (93% vs. 7%, P < 0.05). There are important differences between the adults and children with leptospirosis. AKI was more frequent in adults and it was associated with increased mortality.

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Leptospirose em crianças no Rio de Janeiro

Cited by 16 publications

References 10 publications

Association between Age and Severity to Leptospirosis in Children

Association between Age and Severity to Leptospirosis in Children

The kidney in leptospirosis

Differences among children, adolescents and adults with severe leptospirosis: A comparative analysis

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