BackgroundLeptospirosis is one of the most common bacterial zoonoses worldwide, with a broad spectrum of illness from mild and self-resolving to multi-organ failure and death. There have been few reports of the epidemiology, clinical features and outcomes of the disease in the United Kingdom.MethodsWe present experience of 29 patients with confirmed leptospirosis from 924 tested patients over a 10-year period at a large tertiary hospital in the UK.ResultsAll patients reported a fever and eit travel overseas in the 6 weeks prior to illness, or documented exposure to water or animals in the UK. Acute kidney injury occurred in 18/29 (62 %), 6 patients (20 %) required admission to the intensive care unit and 1 died. There were no recorded acquired UK cases during winter when water temperatures are usually below 10 °C.ConclusionsEpidemiological awareness and documented exposure history may increase the proportion of positive tests and offer potential laboratory cost savings.