title: Ocular and cutaneous manifestation of leptospirosis acquired in Albania: A retrospective analysis with implications for travel medicine.
abstract: Albania is an attractive tourism destination with an increasing volume of travel. As a Mediterranean country some tropical infectious diseases are present in certain areas of Albania, including leptospirosis, which is a zoonotic infectious disease prevalent around the world. The goal of this retrospective study is to describe the ocular and cutaneous manifestations of leptospirosis in Albanian patients and raise awareness to travelers travelling in and out of the country.
  
  
  METHODS
  We retrospectively studied 107 cases of leptospirosis, treated at "Mother Teresa" University Hospital Center, in Tirana, Albania between January 2009 and December 2014. All cases included in the analysis had a clinical and epidemiological presentation suggestive of leptospirosis, confirmed with ELISA (enzyme linked immunoassay) positive for IgM antibodies against Leptospira.
  
  
  RESULTS
  There were 89.7% males (n = 96) and 10.2% females (n = 11). Mean age at the time of diagnoses was 43.7 ± 17.8 years old (range 17-78). All patients were native and residents of Albania. Conjunctival suffusion was present in 81.3% of the cases, whereas subconjunctival hemorrhage was seen in 12 patients (11.2%). Uveitis was seen in 38.3% of the cases and all patients with uveitis presented a severe systemic disease. A cutaneous rash was present in 58.8% of patients. Other cutaneous manifestations include jaundice in 62.6% and intense pruritus in 5.6% of cases.
  
  
  CONCLUSIONS
  Ocular and cutaneous involvement happens more frequently in patients with Leptospirosis, than it was thought to be. Therefore the clinician should be more careful in his systemic evaluation of the disease.
authors.affiliation: Department of Infectious Diseases, University Hospital Center, Tirane, Albania. Electronic address: edmond_puca@yahoo.com.
authors.forename: Edmond
authors.initials: E
authors.lastname: Puca
authors.affiliation: Department of Infectious Diseases, University Hospital Center, Tirane, Albania.
authors.forename: Arben
authors.initials: A
authors.lastname: Pilaca
authors.affiliation: Department of Infectious Diseases, University Hospital Center, Tirane, Albania.
authors.forename: Tritan
authors.initials: T
authors.lastname: Kalo
authors.affiliation: Department of Infectious Diseases, University Hospital Center, Tirane, Albania.
authors.forename: Pellumb
authors.initials: P
authors.lastname: Pipero
authors.affiliation: Institute of Public Health, Tirane, Albania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bino
authors.affiliation: Department of Infectious Diseases, University Hospital Center, Tirane, Albania.
authors.forename: Zhenisa
authors.initials: Z
authors.lastname: Hysenaj
authors.affiliation: Institute of Public Health, Tirane, Albania.
authors.forename: Erjona
authors.initials: E
authors.lastname: Abazaj
authors.affiliation: St. Mary's Hospital, Waterbury, CT, USA.
authors.forename: Arjet
authors.initials: A
authors.lastname: Gega
authors.affiliation: Service of Statistic, University Hospital Center, Tirane, Albania.
authors.forename: Elizana
authors.initials: E
authors.lastname: Petrela
authors.affiliation: Department of Infectious Diseases, University Hospital Center, Tirane, Albania.
authors.forename: Dhimiter
authors.initials: D
authors.lastname: Kraja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000415:Albania / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005128:Eye Diseases / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007922:Leptospirosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000209:etiology* / Q000473:pathology; D057236:Travel Medicine; D055815:Young Adult
chemical_list: D007075:Immunoglobulin M
keywords: Conjunctival; Cutaneus; Leptospirosis; Ocular manifestation