title: Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil.
abstract: BACKGROUND
  leptospirosis is a zoonosis of worldwide importance. The disease is endemic in Brazil. This study was conducted to describe the clinical and laboratory presentation of leptospirosis in a metropolitan city of Brazil.
  
  
  METHODS
  this is a retrospective study including 201 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil, between 1985 and 2006. All patients had clinical and epidemiological data suggestive of leptospirosis, and positive laboratorial test for leptospirosis (microscopic agglutination test, MAT, higher than 1:800).
  
  
  RESULTS
  a total of 201 patients were included, with mean age of 38.9 + or - 15.7 years; 79.1% were male. The mean length from onset of symptoms to admission was 7 + or - 3 days. The main clinical signs and symptoms at admission were fever (96.5%), jaundice (94.5%), myalgia (92.5%), headache (74.6%), vomiting (71.6%) and dehydration (63.5%). Hemorrhagic manifestations were present in 35.8%. Acute kidney injury was found in 87% of the patients. Platelet count was less than 100,000/mm(3) in 74.3%. Hematuria was found in 42.9%. Death occurred in 31 cases (15.4%).
  
  
  CONCLUSIONS
  leptospirosis is a globally relevant disease with potential fatal outcome. Signs and symptoms suggestive of leptospirosis must be known by any physician in order to institute early adequate treatment to improve outcome. Early indication and daily hemodialysis seems to be beneficial in this group of patients.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, School of Medicine, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará - UFC. Fortaleza, Ceará, Brazil. ef.daher@uol.com.br
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Daher
authors.forename: Rafael Sa
authors.initials: RS
authors.lastname: Lima
authors.forename: Geraldo B
authors.initials: GB
authors.lastname: Silva Júnior
authors.forename: Eveline C
authors.initials: EC
authors.lastname: Silva
authors.forename: Nahme Nn
authors.initials: NN
authors.lastname: Karbage
authors.forename: Raquel S
authors.initials: RS
authors.lastname: Kataoka
authors.forename: Paulo C
authors.initials: PC
authors.lastname: Carvalho Júnior
authors.forename: Max M
authors.initials: MM
authors.lastname: Magalhães
authors.forename: Rosa Ms
authors.initials: RM
authors.lastname: Mota
authors.forename: Alexandre B
authors.initials: AB
authors.lastname: Libório
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014505:Urban Population; D055815:Young Adult