Febrile Icteric Syndrome in Haiti: Surveillance Data, Diagnostic Challenges, and Implications for Health System Strengthening

Background: Febrile icteric syndrome (FIS) represents a frequent and complex clinical presentation in tropical settings, encompassing multiple infectious etiologies. In Haiti, limited diagnostic capacity complicates etiological attribution and clinical management. Methods: This narrative review integrates published literature with national laboratory surveillance data on leptospirosis (IgM) collected by the Directorate of Epidemiology, Laboratory and Research (DELR) between 2018 and 2025. Epidemiological, temporal, and geographical patterns were analyzed within a syndromic framework. Results: A total of 7,105 leptospirosis test requests were recorded, with interpretable results available for 66.3% of cases. Overall positivity was 3.6%, higher among males, adults, and during the rainy season. Significant diagnostic delays were observed, limiting clinical utility. These findings are consistent with regional patterns reported in the Caribbean. Conclusion: Leptospirosis represents a significant but under-recognized contributor to febrile icteric syndrome in Haiti. A syndromic approach integrating clinical algorithms, improved diagnostic capacity, and strengthened surveillance is essential to reduce misclassification and improve clinical outcomes.