Leptospirosis in Travelers Returning from the Dominican Republic

Leptospirosis is probably the most widespread zoonosis in the world.1 Infection of humans occurs after indirect or direct exposure to urine of rodents, livestock, or a wide range of other mammals infected with Leptospira interrogans or other Leptospira species pathogenic to humans.2 Incidence of the disease is higher in warmer than in temperate countries,3 and in developing than in affluent countries.4,5 Leptospirosis predominates in rural areas, although urban epidemics are emerging, with larger outbreaks in various regions throughout the world.6 Human infection occurs through exposure to water and soil contaminated by infected animal urine. It is an occupational risk of farmers,veterinarians,miners, abattoir and sewer workers and has been associated with canoeing, wading,and swimming in contaminated lakes and rivers.7,8 In many tropical countries, dogs are a significant reservoir for isolated human infections and outbreaks.7 Occasional outbreaks in a recreational setting have been described among certain high-risk groups, such as whitewater rafters and athletes.8,9 In the early phase of illness when initiation of appropriate chemotherapy is most successful, it can be easily mistaken for a range of other infectious diseases, sometimes with severe consequences.6