Patients were treated according to the clinical picture and the treating physician. We followed up patients until the resolution of symptoms. Fifteen cases of travel-related leptospirosis were included in this study. Nearly all patients (14/15) were men, mean age was 34 years [interquartile range (IQR): 28–52] (Table

2). All travelers except one were tourists. The infection was contracted primarily in Asia (47%). The mean duration of travel was 18 days (IQR: 15–32). The most frequent at-risk exposure was bathing in fresh water (10/15), followed by nautical sporting activities (kayaking, rafting, canoeing) in four cases. We found a history of skin wound in 3 of the 10 patients who had fresh-water exposure. In one patient who had stayed in a rural area, exposure was not established. Four patients, including one expatriate, developed symptoms before their return to France. In the 11 remaining patients, the average lag time Doxorubicin nmr between return to country of origin and onset of symptoms

was 5 days (IQR: 2–7). Fever (temperature >38°C) was found in all patients. Other signs and symptoms selleck included were headache (80%), digestive disorders (67%) (nausea and/or vomiting, diarrhea), myalgias (53%), and arthralgias (47%). Exanthema, jaundice, and hepatosplenomegaly were observed in 20% of patients. Conjunctival suffusion, macroscopic hematuria, and hemoptysis were rarely observed (7%). Table 3 shows laboratory results. Elevation of LFTs was present in 100% of patients [average values: ASAT = 93 IU/L (3N), ALAT = 137 IU/L (4N)]. The majority

of patients had thrombocytopenia (average thrombocyte levels: 93,809/L), lymphocytopenia (average value: lymphocytes = 694/L) together with moderate renal impairment (average value: creatinine = 193 µmol/L (2N). Antibodies to specific Dynein serovars were identified in 13 cases out of 15 (87%): Leptospira sejroe serovar Hardjobovis (n = 3; 1/400, 1/1600, 1/400), Leptospira cynopteri (n = 1; 1/800), Leptospira bataviae (n = 1; 1/1,600), Leptospira grippotyphosa (n = 2; 1/400,1/6,400), Leptospira hebdo (n = 1; 1/200), Leptospira javanica (n = 1; 1/800), Leptospira icterohaemorrhagiae (n = 1; 1/200), Leptospira tarrassovi (n = 2; 1/1,600, 1/6,400), Leptospira canicola (n = 1; 1/800). Hospitalization was required for eight patients (53%). Seven patients (47%) were treated with amoxicillin (1–2 g, three to four times per day for 7–15 days), including four treated with amoxicillin alone, two with amoxicillin and ceftriaxone (because of meningitis), and one with amoxicillin plus spiramycin (because of pneumonia). The other seven treated patients were given doxycycline (n = 4), 200 mg/day for 10 days, ceftriaxone (n = 2) 1 g/day for 10 days or a combination of ceftriaxone, doxycycline, and spiramycin because of severe disease with acute renal failure and pulmonary involvement. One patient was not treated due to delayed diagnosis (6 months).