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Community child health, public health, and epidemiology
An observational study to detect leptospirosis in Mumbai, India, 2000
  1. S Karande,
  2. M Bhatt,
  3. A Kelkar,
  4. M Kulkarni,
  5. A De,
  6. A Varaiya
  1. Departments of Paediatrics and Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai (Bombay) 400 022, India
  1. Correspondence to:
    Dr S Karande
    Department of Paediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai (Bombay) 400 022, India; karandesunilyahoo.com

Abstract

Background: Leptospirosis is relatively uncommon in children. Following torrential rains and flooding an outbreak of leptospirosis was suspected in Mumbai.

Aims: To investigate the possibility of an outbreak of leptospirosis and describe the clinical illness.

Methods: From 24 July to 14 September 2000, children with a history of abrupt onset of high fever (>39°C), who presented to our hospital, were admitted and tested serologically for anti-Leptospira antibodies by a quantitative enzyme linked immunosorbent assay (ELISA) test. An IgM titre of more than 20U/ml confirmed the diagnosis of leptospirosis. Clinical features in the confirmed leptospirosis and leptospirosis negative groups were analysed.

Results: Of 53 children screened, 18 (34%) had leptospirosis. In all 18, the disease was anicteric and responded well to intravenous penicillin. Four clinical features present at the time of admission were significantly associated with leptospirosis: a history of contact with flood water (18/18 v 16/35), conjunctival suffusion (5/18 v 1/35), abdominal pain (9/18 v 5/35), and skin rash (5/18 v 1/35). As the number of these four features concomitantly present increased, the chances of the child having leptospirosis also increased significantly. A history of contact with flood water had a sensitivity of 100%, and the presence of conjunctival suffusion, abdominal pain, and skin rash had a specificity of 97%, 86%, and 97%, respectively, for identifying children with leptospirosis.

Conclusion: Leptospirosis should be suspected in febrile children with contact with flood water.

  • developing countries
  • ELISA
  • leptospirosis
  • natural disasters
  • poverty areas
  • CI, confidence interval
  • ELISA, enzyme linked immunosorbent assay
  • IgM, immunoglobulin M
  • MAT, microscopic agglutination test
  • OR, odds ratio

https://doi.org/10.1136/adc.88.12.1070

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    Footnotes

    • SK initiated and designed the study, directed the data analysis, and wrote the manuscript; he will act as guarantor for the paper. MB and AK monitored patients, collected the data, performed the literature review, and helped in drafting the manuscript. MK helped in designing the study, discussed the core ideas and analysis, and edited the manuscript. AD and AV helped design the study, performed the IgM-ELISA, tests and edited the manuscript.

    • The Municipal Corporation of Greater Mumbai paid for the IgM-ELISA kits used in the study.