Its main sources are rodents, particularly rats, which excrete the spirochete (Leptospira spp) in urine. Humans are infected by direct contact with urine of infected animals or by contact with an infected environment such as surface water. The disease is increasingly reported in travelers, particularly those travelling to tropical areas, due to the development of fresh-water sports find protocol and leisure activities such as fishing, rafting, canoeing, kayaking, scrambling, etc. However, leptospirosis remains an uncommon

cause of illness in travelers. Even when focusing on the causes of fever in travelers returning from a tropical area, only 0% to 1.2% of cases were diagnosed with leptospirosis.[1-3] In these three series, 5.5% to 24% of the febrile travelers were considered as having fever of unknown origin. It is therefore possible that leptospirosis was underdiagnosed. A few sporadic click here cases of leptospirosis in returning travelers have been reported.[4, 5] Two case series were found at a national level, reporting leptospirosis in returning travelers.[6,

7] Leshem et al. reviewed 48 cases of travel-related leptospirosis seen in Israel between 2002 and 2008, while Van Crevel et al. reported 32 such cases in the Netherlands between 1987 and 1991. The goals of our study were to better evaluate the epidemiological, clinical, and laboratory characteristics of the patients diagnosed with travel-related leptospirosis. All consecutive travel-related cases Palmatine of leptospirosis that were diagnosed in the Department of Maladies Infectieuses et Tropicales, Hôpital de la Pitié-Salpêtrière, Paris between January 2008 and September 2011 were included. The diagnosis of leptospirosis relied on the

following criteria: (1) a clinical picture compatible with the disease occurring within 21 days after return, (2) the presence of a thermoresistant antigen[8] or IgM antibodies, Elisa ≥ 1/400[9], and (3) a positive microagglutination test (MAT) ≥ 1/100.[10] When possible, serogroups were confirmed by MAT. All serology testing except one (done at Biomnis) was carried out at the Pasteur Institute in Paris, National Reference Centre for Leptospirosis, using MAT (Table 1). Patient files were retrospectively analyzed to collect demographic, epidemiological, clinical, and laboratory characteristics, as well as data concerning the at-risk exposure. At-risk activities included bathing in fresh water; fresh-water sports (canoeing, rafting, kayaking, etc.); contact with animals or their urine; and activities such as gardening, hunting, and fishing. Leukocytosis was defined as white blood cells (WBCs) > 12 × 109/L, lymphocytopenia as lymphocytes < 1,500 × 109/L, and thrombocytopenia by platelet count < 150 × 109/L. Impaired liver function tests (LFTs) were defined by the rise of alanine aminotransferase (ALAT) and/or aspartate aminotransferase (ASAT) up to twice the normal values.