Leptospirosis is a major zoonotic disease that has emerged worldwide, and numerous studies performed in affected countries have provided epidemiological knowledge of the disease. However, currently, there is inadequate knowledge of leptospirosis in the Middle East. Therefore, we grouped publications from various Middle Eastern countries to acquire a general knowledge of the epidemiological situation of leptospirosis and provide an initial description of the leptospiral relative risk and circulating serogroups. We conducted a detailed literature search of existing studies describing Leptospira prevalence and seroprevalence in Middle Eastern countries. The search was performed using online PubMed and ScienceDirect databases. One hundred and one articles were included in this review. Some countries, including Iran, Turkey, and Egypt, reported more publications compared to others, such as Lebanon, Kuwait, and Saudi Arabia. Frequently, the seroprevalence of leptospirosis varied considerably between and within countries. The prevalence of leptospirosis was comparable in most Middle Eastern countries; however, it varied between some countries. The methods of detection also varied among studies, with the microscopic agglutination test used most commonly. Some hosts were more recurrent compared with others. This review summarizes the epidemiological situation of Leptospira infection in the Middle East, reporting predominant serogroups—Sejroe, Grippotyphosa, Icterohaemorrhagiae, Autumnalis, and Pomona—that were identified in the most commonly tested hosts. Our findings emphasize the need to develop a deeper understanding of the epidemiology of Leptospira spp. and prioritize the disease as a public health problem in this region. To achieve this goal, increased awareness is critical, and more publications related to the topic and following a standardized approach are needed.