title: A comparative study of leptospirosis and dengue in Thai children.
abstract: BACKGROUND
  Leptospirosis 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.
  
  
  RESULTS
  We 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
  Unrecognized 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.
authors.affiliation: Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA. daniel.libraty@umassmed.edu
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Libraty
authors.forename: Khin S A
authors.initials: KS
authors.lastname: Myint
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: Robert V
authors.initials: RV
authors.lastname: Gibbons
authors.forename: Mammen P
authors.initials: MP
authors.lastname: Mammen
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Endy
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.forename: David W
authors.initials: DW
authors.lastname: Vaughn
authors.forename: Ananda
authors.initials: A
authors.lastname: Nisalak
authors.forename: Siripen
authors.initials: S
authors.lastname: Kalayanarooj
authors.forename: Duane R
authors.initials: DR
authors.lastname: Hospenthal
authors.forename: Sharone
authors.initials: S
authors.lastname: Green
authors.forename: Alan L
authors.initials: AL
authors.lastname: Rothman
authors.forename: Francis A
authors.initials: FA
authors.lastname: Ennis
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D018709:Statistics, Nonparametric; D013785:Thailand / Q000453:epidemiology