Leptospirosis in Guilan, a northern province of Iran: assessment of the clinical presentation of 74 cases

This study was carried out to define the major clinical presentation and laboratory findings of leptospirosis in Guilan province, an agricultural and fishery area in the Caspian littoral. Cases with a clinically compatible illness and positive serology (immunofluorescence antibody method (IFA)), were included. Clinical information and other lab data were collected. Seventy-four cases, with a mean age of 47.3 +/- 12.4 years and of whom 52 (70.3%) were male, were recruited. All had had contact with stagnant water of a farm within the week prior to their admission. Fever and chills were the most frequent chief complaint in 47 (63.5%). Fever, headache, and myalgia were reported by 73 (98.6%), 69 (93.2%), and 57 (77%) cases, respectively. Increased serum creatinine was detected in 18 (27.3%). Only in 27% of patients did CPK rise to 3-fold or more above the Normal Upper Limit, and in 43% of patients its level was within the normal range. Thrombocytopenia was noticed in 87.3%, and 15.5% of cases had platelets less than 20,000/mm(3). Anemia was detected in 78.4%. ESR was more than 100 mm/hour in 28.3%. History of fever, headache, and myalgia in patients who have been in contact with the stagnant water of rice fields should raise the possibility of leptospirosis in Guilan province.