Pediatric leptospirosis is an underrecognized yet important cause of acute febrile illness in India, particularly during monsoon seasons. Overlapping clinical features with dengue, malaria, enteric fever, and scrub typhus, coupled with limited access to early diagnostics, contribute to delayed diagnosis and increased morbidity in children. This narrative review synthesizes current Indian evidence on pediatric leptospirosis, focusing on epidemiology, regional prevalence, clinical spectrum, diagnostic strategies, management approaches, complications, mortality, and emerging clinical perspectives. A narrative review approach was adopted to integrate data from Indian pediatric studies, outbreak reports, hospital-based cohorts, and case series, including recent literature highlighting diagnostic and clinical advancements. This approach was justified due to heterogeneity of study designs, regional variability, and limited pediatric-specific randomized trials. Pediatric leptospirosis in India demonstrates marked regional and seasonal variation, with highest burden in southern and coastal states. Clinical presentation ranges from mild febrile illness to severe multisystem disease with renal, hepatic, pulmonary, cardiac, and neurological involvement. Advances in molecular diagnostics, particularly PCR, have improved early detection, while prompt antimicrobial therapy and intensive supportive care have reduced mortality in tertiary centers. Early clinical suspicion, improved diagnostic access, and timely multidisciplinary management are crucial to improving outcomes in pediatric leptospirosis. Strengthening surveillance and pediatric-focused research is essential to address this neglected tropical disease in India.

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