BACKGROUND: Leptospirosis 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. METHODS: We 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. RESULTS: All 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. CONCLUSIONS: Epidemiological awareness and documented exposure history may increase the proportion of positive tests and offer potential laboratory cost savings.