779. Prevalence and Outcomes of Leptospirosis Infection in HIV Infected Patients in South India
Session: Oral Abstract Session: Travel/Tropical Medicine and Parasitology
Friday, October 21, 2011: 2:45 PM
Room: 204AB
Background: 

Leptospirosis is a zoonotic disease that can cause significant morbidity and mortality. In India little is known about leptospirosis in HIV infected patients who may be at increased risk for disease due to underlying immunesuppression.  Greater understanding of sociodemographics, prevalence, and outcomes in patients with HIV-leptospirosis co-infection may help guide future management and public health control.

Methods:

We performed a retrospective study from March 1, 2007 to March 1, 2011 of all HIV-infected patients (1,677) admitted to YRG CARE, a tertiary HIV care center in Chennai to determine prevalence of leptospirosis in our HIV infected population. Diagnosis was made by serum Dark Field Microscopy (DFM) and Microscopic Agglutination Test (MAT).  Data was analyzed using SPSS 17.0.

Results: 

1,677 patients accounted for 3,585 admissions (1-17 per patient) with an avg. LOS 5.26 days (1-71). Most were 26-35 yrs (36.3%), male (66.2%), acquired HIV by heterosexual intercourse (91%), and had a median CD4=329 cells/µl at hospitalization.

The top 5 infectious diseases causes of admission were: pulmonary TB (n=699), extra-pulmonary TB (n= 152), PCP (n= 142), cryptococcal meningitis (n=112), and leptospirosis (n=105).

The 97 HIV patients with leptospirosis (5.8% of sample), had 105 admissions (1-2 per patient) for a total of 810 hospital days, and avg. LOS 8.4 days (1-39). Most patients were male (77%) and between 36-45 yrs (28.9%). CD4 count at hospitalization was available for 55 of 97 patients, with a median CD4=232 cells/µl (IQR=114,391). Of the 55 patients with available CD4, 73% had a CD4 <350 cells/µl.

HIV-leptospirosis co-infection caused significant mortality with 20.6% dying from disease related complications: respiratory arrest (70%), hepatic failure (30%), renal failure (30%), and hematologic abnormalities (15%).

Conclusion: 

Leptospirosis is the 5th most common infectious diseases cause of hospitalization in our HIV infected population, uses limited medical resources, and causes significant mortality.  Given the high mortality rate in patients with HIV-leptospirosis co-infection, in the appropriate clinical context leptospirosis should be considered, tested for, and promptly treated to prevent unnecessary mortality.


Subject Category: T. Travel/tropical medicine and parasitology

Krutika Kuppalli, MD1, Ezhilarasi Chandrasekaran, MSc2, Carlos del Rio, MD1,3, Kenneth Mayer, MD4 and N. Kumarasamy, M.B.B.S., PhD2, (1)Infectious Diseases, Emory Univ. Sch. of Med., Atlanta, GA, (2)YRG Center for AIDS Research and Education, Chennai, India, (3)Global Health, Emory Univ. Rollins Sch. of Publ. Health, Atlanta, GA, (4)Infectious Diseases, Brown Univ. Sch. of Med., Providence, RI

Disclosures:

K. Kuppalli, NIH/FIC: , Educational grant

E. Chandrasekaran, None

C. del Rio, None

K. Mayer, None

N. Kumarasamy, None

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