1434. Rickettsial Infections Complicated With Acute Renal Failure

Abstract Background Rickettsiosis, an acute febrile illness, is generally considered as a benign disease. However, severe cases were reported, among which acute renal failure (ARF) represented 13 to 18% of the cases. We aimed to study the clinical and evolutionary features of rickettsiosis complicated with ARF, when compared with all rickettsial infections. Methods We conducted a retrospective study including all patients hospitalized for rickettsiosis in the infectious diseases department between 1995 and 2018. The diagnosis was confirmed by serologies (seroconversion). Results Overall, we encountered 28 patients (6.4%) with ARF among 440 patients with rickettsiosis. There were 19 males (67.9%). Patients with ARF were significantly older (53±16 vs 38±17 years; p< 0.001). They consulted for eruptive fever (78.6%), febrile cephalalgia (10.7%) or isolated fever (10.7%). Arthralgia and vomiting were noted in 75% and 35.7% of the cases, respectively. There were 4 cases (14.3%) of meningitis and 2 cases (7.1%) of meningoencephalitis. The mean creatinine levels were 158 µmol/L [120-444 µmol/L]. In comparison with all rickettsial infections, eschars were more frequently noted among patients with ARF (46.4% vs 23.8%; p=0.008). They were more frequently diagnosed with septic shock (14.3% vs 0.5%; p< 0.001) and retinitis (10.7% vs 1.5%; p=0.015). Comparison of the disease evolution showed that death was significantly more frequent among cases with ARF (7.1% vs 0.2%; p=0.011). The mean length of hospital stay was significantly longer among patients with ARF (8.7±4.7 vs 5.3±3.5 days; p=0.001). As to gender and the revealing symptoms, no significant difference was noted. Conclusion Rickettsial infections complicated with ARF had a poor prognosis, especially among the elderly. Prompt empiric antibiotic therapy might improve the prognosis. Disclosures All Authors: No reported disclosures