Clinical features and outcomes of neuroleptospirosis in French Guiana: Insights from a retrospective study (2015–2021)

@article{delahaye2026clinical,
  title = {{Clinical features and outcomes of neuroleptospirosis in French Guiana: Insights from a retrospective study (2015–2021)}},
  author = {Audrey Delahaye and Tanguy Dequidt and Fabrice Quet and Clémentine Montagnac and Theo Blaise and Hatem Kallel and Felix Djossou and Mathieu Nacher and Kinda Schepers and Julien Coussement and Paul Le Turnier and Loïc Epelboin},
  journal = {PLOS Neglected Tropical Diseases},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pntd.0014263},
  url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014263},
  note = {CC BY},
}

TY  - JOUR
TI  - Clinical features and outcomes of neuroleptospirosis in French Guiana: Insights from a retrospective study (2015–2021)
AU  - Audrey Delahaye
AU  - Tanguy Dequidt
AU  - Fabrice Quet
AU  - Clémentine Montagnac
AU  - Theo Blaise
AU  - Hatem Kallel
AU  - Felix Djossou
AU  - Mathieu Nacher
AU  - Kinda Schepers
AU  - Julien Coussement
AU  - Paul Le Turnier
AU  - Loïc Epelboin
PY  - 2026
DA  - 2026/10/15
JO  - PLOS Neglected Tropical Diseases
DO  - 10.1371/journal.pntd.0014263
UR  - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014263
AB  - Background: Leptospirosis is a re-emerging public health threat in French Guiana with a broad clinical spectrum. Neurological involvement (neuroleptospirosis) lacks a consensus definition and may be underrecognized. This study aimed to characterize its epidemiology, clinical features, outcomes, and associated factors. Methods: A multicenter retrospective study was conducted across healthcare facilities in French Guiana from 2015 to 2021. Consecutive hospital-managed patients with laboratory-confirmed or probable leptospirosis were included. Neuroleptospirosis was defined by neurological symptoms combined with objective cerebrospinal fluid (CSF) and/or neuro-imaging abnormalities. Patients with and without neurological involvement were compared. Results: Among 146 patients, 18 (12%) met the criteria for neuroleptospirosis, corresponding to a mean annual incidence of 0.88 cases/100,000 inhabitants (95% conference interval [CI], 0.52–1.39). Presentations were meningeal (78% [14/18]), encephalitic (17% [3/18]) or meningoencephalitic (6% [1/18]). Lumbar puncture was performed in 28/146 (19%) patients; pleocytosis was observed in 18/28 (64%). The median CSF leukocyte count was 42 cells/mm3 (interquartile range [IQR], 13–240 cells/mm3), with lymphocytic predominance in 8/13 differential counts (62%). CSF protein was mildly elevated (median, 0.51 g/L; IQR, 0.32–0.88), without hypoglycorrhachia. Brain magnetic resonance imaging (MRI) revealed abnormalities in 2/8 patients with neuroleptospirosis: one cerebral infarction and one case of pachymeningitis. Age under 30 years (odds ratio [OR], 5.56; 95% CI, 1.72–18), absence of leukocytosis during hospitalization (OR, 3.29; 95% CI, 1.04–10.39), and absence of thrombocytopenia (OR, 4.46; 95% CI, 1.39–14.32) were associated with neuroleptospirosis. Under our diagnostic criteria, neuroleptospirosis cases were associated with favorable outcomes, with lower odds of sepsis (OR, 0.28; 95% CI, 0.10–0.79), no intensive care unit admissions or deaths. Conclusions: This study clarifies the clinical spectrum and outcomes of neuroleptospirosis in French Guiana, highlighting the importance of clinical awareness in tropical endemic settings. Prospective studies incorporating systematic CSF analysis and microbiological testing are needed to improve understanding of its pathophysiology and standardize diagnostic pathways. Author summary: Leptospirosis is a re-emerging public health threat in French Guiana, with diverse clinical presentations. Its neurological manifestations (neuroleptospirosis), for which no consensus definition exists, remain underrecognized. Accordingly, a multicenter retrospective study was conducted, enrolling consecutive hospital-managed patients with laboratory-supported leptospirosis to characterize the epidemiological features of neuroleptospirosis and identify factors associated with neurological involvement. We applied a standardized composite definition based on neurological symptoms combined with cerebrospinal fluid analysis and/or neuro-imaging. Neuroleptospirosis accounted for approximately one tenth (12%) of hospitalized leptospirosis cases, predominantly presenting as meningitis (78%). CSF profiles typically showed moderate lymphocytic pleocytosis, closely mimicking viral meningitis. Strikingly, according to our strict diagnostic criteria, neuroleptospirosis cases exhibited fewer severity outcomes (less frequent sepsis, no intensive care admissions, and zero mortality) compared with non-neurological forms. In an exploratory multivariate analysis, younger age (< 30 years) and the absence of both leukocytosis and thrombocytopenia during hospitalization were significantly associated with a diagnosis of neuroleptospirosis. Neuroleptospirosis accounted for a non-negligible proportion of leptospirosis cases in French Guiana, with CSF features mimicking viral meningitis and favorable outcomes under antibiotic therapy. Increasing awareness of neuroleptospirosis and improving its recognition are essential to reduce underdiagnosis and refine patient management in endemic tropical settings.
SN  - 1935-2735
SN  - 1935-2727
ER  -