Epidemiology, clinical and laboratory findings of leptospirosis in Southwestern Greece

Background: Leptospirosis is a zoonosis with global distribution. The aim of the present study was to determine epidemiological, clinical and laboratory characteristics of leptospirosis in Greece. Methods: We retrospectively reviewed the clinical and laboratory profile as well as the outcome of all adults with confirmed leptospirosis in our Tertiary Referral centre in Southwestern Greece from 2013 to 2017. Results: Thirty-one men and fourteen women (mean age: 55.5 +/- 13.8 years), were diagnosed with leptospirosis based on compatible clinical course and positive serology for IgM antibodies. Thirty-two (71.1%) lived in rural areas and the majority of infections (88.8%) were autochthonous, acquired in Southwestern Greece. Eighteen patients (40%) reported occupational exposure. The most prevalent clinical feature was fever (93.3%), followed by headache (66%), hematuria (31.1%), conjunctival suffusion and hepatomegaly (26.6%), dyspnoea, tachypnoea and splenomegaly (17.7%). One patient died due to pulmonary hemorrhage. Increased CRP (median 19 mg/dL) was the most common laboratory abnormality detected (93.3%), followed by thrombocytopenia (80%), increased aminotransferases (AST in 73.3% and ALT in 66.6%), anemia (66.6%) and hematuria (>100 RBC per high power field) in 66.6%. Empiric treatment with at least one active antibiotic against Leptospira was administered in 40 patients (88.8%). Conclusions: We found a higher disease incidence in our area compared to previous reports in Greece. Clinical signs of leptospirosis are diverse and generally nonspecific. Further epidemiological studies conducted ideally at a national level are required to determine the true disease incidence and better understand risk factors associated with unfavorable outcomes.