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A problem seems to be that few in the medical communtiy are familiar with lepto and it can take some convincing to get the disease treated properly. That said it seems to be a pretty wimpy bug in the face of a good anti-biotic regimen.
This is a copy and paste with attribution from a local paddler who is an MD:
"Below is a copy of the article that Dr. Bob (Shaw) of Willow Springs, MO, wrote for the April 1997 River Log. He also wrote an article titled "Kayaking as a Risk Factor for Leptospirosis" for a Missouri medical journal in June 1992. I've included the abstract below this article but the full length article has to be ordered.
LEPTOSPIROSIS: ANOTHER WHITEWATER HAZARD
An unexpected day off, water two feet over the highway D bridge and the Missouri Whitewater Championships, what could be better. We played the river all morning, chatted with many boaters that we hadn't seen since last April, and watched another well run race on the rain swollen river. Heading home that evening I thought it had been a great day. Little did I realize that I was bringing home an unexpected souvenir from the St. Francis.
Twelve days later while anticipating an upcoming three day canoe trip on the Buffalo River, I suddenly developed chills, fever and diffuse muscle aches. Arriving home I felt worse and noted my temperature of 103. But never one to let reality interfere with an outdoor activity, I went to bed and set my alarm to allow me enough time to pack before leaving in the morning.
The next three days on the Buffalo River were bright sunny days with good water and all the glories of early spring in the Ozarks. The food was superb and the companionship was excellent. Or at least that is what I was told. I spent the three day trip trying desperately to sit upright in the canoe. I ate nothing and forced myself to drink water. As soon as a campsite was reached I climbed into my sleeping bag (or simply lay on the ground) and slept. There's nothing like zipping up in a winter bag in 70 degree weather to stop the chills. The headaches were worse.
The next six days in the hospital were a blur.
Finally with lots of broad spectrum antibiotics and intravenous fluids my fever broke and for the first time in a week I was able to eat. Despite the hepatitis and meningitis, no blood tests were positive as to the cause of this illness. But in the midst of my fever I recalled an incident near Columbia, Missouri that occurred in 1985 to a group of kayakers.
Their complaints were very similar to mine and they were eventually found to have the rare illness, leptospirosis.
Now in medicine when you begin to suggest rare diagnoses when more common ones have not been excluded you are frequently labeled a "zebra hunter" (when you hear hoof beats it is much more likely to be a horse than a zebra). And while my medical partners gave me the courtesy not to laugh at me, they attributed my "zebra hunting" to a little brain damage from the meningitis. So when I left the hospital my official diagnosis was "fever of unknown origin."
For many individuals with this affliction, this is the end of the investigation (especially the 10% who will die from it). But leptospirosis as with many other illnesses produces an antibody response and by doing blood tests every week you can confirm the diagnosis. So after another week at home, I returned to work and began the weekly blood tests (we were also looking for other causes as well). Six weeks after my run on the St. Francis, the tests confirmed a recent infection with leptospirosis (this also helped stopped the stories that began with "doctor with 'unknown' fever, weight loss and been hanging around the river with people dressed in rubber -- we know what he's got!")
So what is leptospirosis and how can you avoid it on your next kayak trip? A bacteria found in cattle, skunks, raccoons, dogs and rats is the cause. Most farmers vaccinate their cattle for this and previously it was considered an occupational disease of farmers. The bacteria is excreted in the urine of an infected animal and any exposure to a cut, abraded skin or even mucous membranes can result in the illness. Flood waters seem to be more often polluted with this germ and the previous cases near Columbia had this as a common factor. Following an incubation period of about 10 days, the hapless boater will develop sudden onset of fever, muscle aches, gastrointestinal symptoms and severe weakness. Blood tests will frequently reveal liver and kidney abnormalities. Headaches will be severe and secondary to the meningitis that develops. The headache will usually become worse just as it seems the illness is improving. Fortunately in 90% of cases there will be spontaneous resolution of the illness with no residual damage. Antibiotics do speed the recovery. The other 10% will develop both liver and renal failure and die.
Now before you rush out and sell your boat, consider a few facts. Most cases are mild and are frequently not even diagnosed. There are an average of only three cases per year in Missouri (mostly due to animal exposure). Even when conditions are right (flooding river, lots of "play" with head under water frequently) the incidence is still very low. An informal survey after the races showed that despite a couple of cases of gastroenteritis, I was the only reported serious illness out of the hundred or so boaters on the river.
But on the rare chance that you should develop typical "flu" symptoms about 10 days after a kayak trip, you might mention to your doctor that you did have water exposure and you are concerned about the possibility of "lepto." While he may label you a zebra hunter, he will at least be aware of this possibility.
There are a couple of other consequences of which boaters should be aware. First, my wife counted the two weeks of my illness as "kayak time" thus effectively ending my spring boating this year. I would advise that if you should contract this ailment after a boating trip, you tell your spouse that it is from cleaning up after the family dog. Secondly, this disease was previously quite common from exposure to rats. So if you do any research on this affliction, do not be surprised to find that its nickname is "sewer workers' disease."
Bob Shaw MD
Abstract from Medline referencing a Missouri medical journal:
Unique Identifier
1620089
Authors
Shaw RD.
Institution
Family Practice Department, Ozarks Medical Center, West Plains, MO.
Title
Kayaking as a risk factor for leptospirosis.
Source
Missouri Medicine. 89(6):354-7, 1992 Jun.
Local Messages
Owned by MU HSL in print
Abstract
Leptospirosis is a common zoonosis present throughout Missouri. Previously regarded as an occupational illness of farmers and sewer workers, it is now primarily acquired from exposure to water polluted with the bacteria Leptospira. We present a case report of leptospirosis acquired through kayaking and review both the disease and the risk factor associated with kayaking."
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Ironically this is a current topic on our local board as well New 
BoaterTalk 
