Leptospirosis in South-western Spain.
BACKGROUND
Leptospirosis is a zoonosis of worldwide distribution and tropical predominance. Its incidence could be underestimated in template regions. We describe the manifestations of leptospirosis in an area of Southwestern Spain.


METHODS
Eighty-six cases of leptospirosis (April 1997-April 2013) were retrospectively analyzed. The diagnosis was based in clinical and serological (Leptospira IgM ELISA) judgement. Epidemiological, clinical, laboratory, and prognostic dates were recorded.


RESULTS
The mean age was 43.1 ± 13.8 years (84.9% males). The mean annual incidence was 1.99/100.000. There were activities of risk in 94%: 82.5% contact with animals (57.4% pigs, 38.1% dogs, 31.7% cows, 22.2% sheeps), and 31.7% contact with pooled water. The most frequent symptoms were fever (94.1%), arthromyalgias (60.7%), and cephalalgia (53.3%). The main laboratory alterations were hypertransaminemia (48%), renal insufficiency (26.3%), and thrombocytopenia (16.9%). A lymphocytic meningitis was associated in 11 cases (12.5%) and a picture of Weil's disease was observed in 13 patients (15.1%). The patients with meningitis were younger (31.2 ± 9.2 versus 44.8 ± 15.2, p=0.004). The patients with Weil's disease were older (53.5 ± 15.8 versus 41.2 ± 14.5, p=0.007). Fifty seven patients were hospitalized (66.3%) and 6 patients died (7.0%). Factors independently associated with mortality were age >60 years (odds ratio [OR] 45.0, confidence interval 95% [CI95%] 4.7-434.6) and diagnosis of Weil's disease (OR 15.8, CI95% 2.5-98.7).


CONCLUSIONS
In our experience, leptospirosis have a not despicable incidence and tends to show fever and arthromyalgias in men with risk activities. Leptospirosis should be included in the differential diagnosis of lymphocytic meningitis. Mortality is associated with older age.
Unidad de Patología Infecciosa, Hospital Universitario de Badajoz, Badajoz, España.
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Rodríguez-Vidigal
Unidad de Patología Infecciosa, Hospital Universitario de Badajoz, Badajoz, España.
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Vera-Tomé
Unidad de Patología Infecciosa, Hospital Universitario de Badajoz, Badajoz, España.
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Nogales-Muñoz
Unidad de Patología Infecciosa, Hospital Universitario de Badajoz, Badajoz, España.
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Muñoz-García-Borruel
Unidad de Patología Infecciosa, Hospital Universitario de Badajoz, Badajoz, España. Electronic address: agus.munozsanz@gmail.com.
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Muñoz-Sanz
D000328:Adult; D000367:Age Factors; D000368:Aged; D000818:Animals; D002417:Cattle; D003937:Diagnosis, Differential; D004285:Dogs; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015994:Incidence; D007922:Leptospirosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012756:Sheep; D013030:Spain / Q000453:epidemiology; D013552:Swine; D014895:Weil Disease / Q000453:epidemiology*; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality
Leptospirosis; Lymphocytic meningitis; Meningitis linfocitaria; Zoonosis