1434. Rickettsial Infections Complicated With Acute Renal Failure

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