[An Endemic Disease in the Black Sea Region: Leptospirosis]

Leptospirosis is a zoonotic infectious disease that affects humans and animals, is found in all continents except for Antarctica and is caused by spirochetes of the genus Leptospira. It is an important disease in terms of public health because it can cause epidemics. In this study, we aimed to retrospectively evaluate 11 cases followed up in our clinic with the diagnosis of leptospirosis in terms of epidemiological features, detected agents, clinical and laboratory findings.The patients were diagnosed with microscopic agglutination test (MAT) and/or ELISA IgM methods. Nine (81.8%) of the cases were male, two (18.1%) were female and the average age was determined as 54.18 (26-68) years. Two of the cases applied in the summer and nine in the autumn-winter months. All patients came from rural areas (collecting hazelnuts, owning vineyards and dealing with animal husbandry) and one of our cases had a history of fishing in the lake. All the 11 cases had fatigue, nine (81.8%) had fever, six (54.5%) had nausea-vomiting, three (27.2%) had headache, four (36.3%) had diffuse muscle-joint pain, five (45.4%) had diarrhea, three (27.2%) had jaundice, one (9. 09%) had shortness of breath, three (27.2%) were unable to urinate, two (18.1%) had rash (one was defined as vasculitis and the other as drug eruption), two (18.1%) had abdominal pain and one (9.09%) had bilateral conjunctival redness. At the time of admission to the hospital, one patient had acute respiratory distress syndrome, one patient had vasculitis and one patient had truncal ataxia. As a result of MAT sent for diagnostic purposes: Leptospira interrogans serovar icterohemorrhagiae strain Wijnberg was detected in seven cases, L.interrogans serovar Bratislava strain Jez Bratislava in two cases, L.interrogans serovar Hepdomadis strain Hebdomadis in one case, L.interrogans serovar Copenhageni strain Winjberg in one case. L.interrogans was detected in all cases and the most common serovar was icterohemorrhagiae. The most common symptoms of leptospirosis are fatigue, fever, chills, nausea and vomiting. While these symptoms may mimic many diseases, the presence of conjunctival hyperemia may be helpful in the diagnosis. Leptospirosis may present in different clinics due to multisystemic involvement (vasculitis, truncal ataxia, etc.). In laboratory tests, thrombocytopenia is frequently associated and total bilirubin, creatinine, creatinine phosphokinase may be elevated. In our study, procalcitonin was also found to be elevated in most patients. The most common causative agent was L.interrogans serovar icterohemorrhagiae and rodents were thought to be the most common source. The detection of other serovars suggested that farm animals and domestic animals other than rodents may have played a role as possible reservoirs. The causative agents and identifying possible sources is important for the formulation of health policies. Outbreaks can be prevented in disasters such as floods by continuing educational activities on transmission routes and taking environmental health measures. Leptospirosis should be kept in mind in the differential diagnosis in regions with high rainfall, such as the Black Sea region, due to climatic conditions and Leptospira reservoir potential and further studies should be done to increase awareness.