Differential profile of Leptospirosis in patients under and over 5 years of age in health centers of the Peruvian Amazon, 2023-2024

BackgroundLeptospirosis is an emerging zoonotic disease with high incidence in tropical regions such as the Peruvian Amazon. Although it affects individuals of all ages, knowledge about its clinical and epidemiological behavior in children under five years old remains limited. This population may present atypical clinical forms, nonspecific symptoms, and a milder course, increasing the risk of underdiagnosis and delayed treatment. MethodologyA descriptive and retrospective study was conducted by reviewing medical records and epidemiological forms of all MAT-confirmed patients from 2022 to 2024 in primary health centers in Belen, the district with the highest historical prevalence in Loreto. A total of 400 cases out of 1666 reported were included. Among children under five (n=28), clinical presentation was predominantly nonspecific, with malaise (78.6%) and fever (71.4%) being most frequent. Nearly half (46%) sought care within the first three days of symptoms, and 50% lived in flood-prone areas. Nutritional status showed a significant association, with a predominance of underweight (p<0.001), remaining significant in multivariate analysis (OR=0.051; 95%CI: 0.011-0.233; p<0.001). Additionally, each additional day of illness was associated with an increased likelihood of belonging to this age group (OR=1.366; 95%CI: 1.135-1.644; p=0.001). Regarding serovars, Panama showed significant association with children under five (p=0.024), whereas Hurstbridge was absent. ConclusionChildren under five with leptospirosis exhibit a distinctive clinical and epidemiological profile, characterized by nonspecific symptoms, higher frequency of underweight, and earlier healthcare-seeking behavior. Associations with malaise, poor nutritional status, and specific serovars like Panama suggest a less typical presentation, potentially hindering diagnosis at the primary care level. These findings highlight the need for tailored surveillance, diagnostic, and management strategies for this age group, particularly in endemic regions such as the Peruvian Amazon. Author summaryLeptospirosis is a disease transmitted through contact with water or soil contaminated by animal urine, especially in tropical regions like the Peruvian Amazon. While it can affect people of any age, little is known about how it presents in children under five. In our study, we analyzed 400 confirmed cases from health centers in Belen, one of the most vulnerable districts in the region. We found that children under five often had vague symptoms like general discomfort and fever, which are easy to miss or confuse with other common infections. These children were also more likely to be underweight and live in areas affected by seasonal flooding. Unlike older patients, they tended to visit health centers earlier after symptom onset, possibly because caregivers noticed changes quickly. We also found that a specific type of bacteria (the Panama serovar) was more common in this age group. These findings suggest that leptospirosis may behave differently in young children, which can make diagnosis and treatment more challenging. Recognizing these differences can help improve detection and care for young children in endemic regions.