Young children are often exposed to leptospira because of their play and sports – swimming in lakes, fishing, etc. – and from petting animals. In the developed world they are no more or less susceptible to infection than adults, as the general population has no innate immunity to the infection and there is no vaccination program. The issues when dealing with a young patient are of communication and medication.
Children and toddlers
The symptoms of leptospirosis, in the first few days at least, are very vague and look almost identical to common childhood infections such as the flu. Parents may mistake the infection and so not seek advice from their doctor, but it’s important to do that if the child has experienced a significant risk of exposure as without a blood test it will be impossible to diagnose the illness – whatever it is. Children themseves can be difficult to diagnose as a lot of the symptoms (headache, muscle pain, etc.) can be mild enough in the early stages for the child not to mention them at all.
Any illness that appears in two stages, with the child getting better after a few days but then suddenly getting worse, must be urgently seen by a doctor and would warrant direct transport to a hospital.
Sometimes the infection shows symptoms similar to menengitis – a red pinprick rash on the skin that doesn’t blanch when pressed with a glass, aversion to light and floppy, sleepy behaviour. These symptoms are always a sign of a significant infection and the child should be taken immediately to hospital – but it will help the medical staff if you mention the possible involvement of leptospirosis as it will change the blood tests they order.
Children under 8 are usually not allowed to take Doxycycline due to the potential for side effects, such as the permanent staining of their unerupted teeth, and so in cases where young patients must receive antibiotics we usually give a short course of penicillin instead. It’s just as effective.
Babies under 6 months
Young babies have a very poorly-developed immune system, and rely on their mother to fight infections on their behalf (kissing their faces collects samples of pathogens and causes antibodies to be secreted in the breast milk), but this doesn’t work for leptospirosis as the bacteria are not usually found in saliva. Babies are also unable to communicate their symptoms, so it can be difficult to detect the first stages of illness unless there is a rash. Parents of young babies that have a potential exposure to leptospirosis should always seek specific advice from their doctor.