الفهرس 
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Abstract
Leptospirosis is an infectious disease that affects humans and animals, is considered the most common zoonosis in the world. It is caused by infection with bacteria of the genusLeptospirathat affects humans as well as other mammals, birds, amphibians, and reptiles. It is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, the eyes or the mucous membranes. Leptospiral infection is common among men due to their nature of work and no age or race difference present, because only occupational exposure constitutes a major risk for development of disease. Leptospirosis has a multi-organ affection that can affect nearly any organ in a classical, rare or unusual presentation and complications. This may include hepatic and renal involvements, pulmonary, meninges and cardiac affections.
Globally, leptospirosis poses an increasing public health problem. Due to its non-specific signs and symptoms, the disease is often wrongly or misdiagnosed. This leads to a lower registered number of cases than what really exists, severely neglected and hence, its global burden is largely unknown although its mortality rate in severe cases is very high (5-40%).
Diagnosis of leptospira infection is done clinically and confirmed using radiological and laboratory tools. Laboratory procedures include cultural isolation of the organism; the procedure that is time-consuming (6-8 weeks or more) and unavailable in most of the resource-limited endemic areas. Accordingly, laboratory diagnosis is done mainly using serological assays such as agglutination reactions (microscopic agglutination test (MAT) and macroscopic slide agglutination), enzyme immune assays, microscopic examination of urine, fluorescent staining, and molecular biology techniques.
Treatment of leptospirosis is a relatively complicated process comprising two main components: suppressing the causative agent and fighting possible complications using primarily the antimicrobial therapy. The process should be started as soon as possible. However, due to its non-specific signs and symptoms and also the long history of practice at the third world fever hospitals to consider any febrile case as typhoid until proven otherwise, leptospirosis cases usually misdiagnosed and consequently don’t receive the right treatment and may die before correctly diagnosed.
The aim of this work was to investigate the real picture of leptospira infections at Alexandria Fever Hospital (AFH) as one of the largest fever hospitals in Egypt among the febrile cases seeking treatment at this hospital. This included investigating the main clinical features and outcome of symptomatic leptospirosis with emphasis on the typical and atypical presentations of such condition and assesses the prognostic factors on response to management of the disease.
To achieve this goal, febrile cases admitted at AFH between 2010 till 2013 were included in this study. The work was conducted on fifty one leptospiral cases confirmed by clinical, radiological and laboratory procedures out of more than one hundred and fifty seen. Febrile cases due to other hepatic, renal, neurological diseases were excluded from the study. All the needed investigations for accurate diagnosis of leptospiroses were done. This included taking the proper history, radiological examinations and laboratory testing.