730. Ocular Involvement Associated with Rickettsial Infection

Abstract Background Rickettsiosis, a re-emerging disease, is characterized with a myriad clinical symptoms and various manifestations. Ocular involvement is often misdiagnosed since it’s rarely symptomatic. It especially involves the posterior segment. We aimed to study the clinical, laboratory and therapeutic features of ocular involvement associated with rickettsial infection. Methods We encountered a retrospective study including all patients hospitalized for rickettsial infection with ocular involvement in the infectious disease department between 2007 and 2020. The diagnosis was confirmed based on serology (seroconversion) and/or positive polymerase chain reaction for Rickettsia in skin biopsy. Results A total of 24 patients were included with a mean age of 40±12 years. There were 13 women (54.2%). Sixteen patients sought medical care during the warm months, from June to October (66.6%). The revealing clinical signs were febrile maculopapular skin rash (79.2%), cephalalgia (54.2%) and arthralgia (33.3%). Five patients had visual loss (20.8%). Physical examination revealed conjunctival hyperemia (37.5%) and pathognomonic eschar (29.1%). Laboratory investigations revealed elevated liver enzymes (79.1%), thrombocytopenia (75%) and cholestasis (58.3%). Ocular involvement was unilateral in 14 cases (58.3%). Retinitis was the most common manifestation (70.8%), followed by anterior uveitis (20.8%). Retinal fluorescein angiography, performed in ten cases (41.6%), confirmed retinitis in 8 cases (80%). Both retinal vasculitis and papillary hyperfluorescence were noted in two cases (20%). Patients received doxycycline in 21 cases (87.5%) and fluoroquinolones in three cases (12.5%). The median duration of treatment was 7[6-15] days. The disease evolution was favourable in all cases (100%). No ocular sequelae were noted. Complications were noted in two cases (8.2%) represented by thrombophlebitis (one case) and recurrent seizures (one case). Conclusion Systematic fundus examination should be performed in front of suspected rickettsiosis, even in the absence of ocular symptoms and signs. It provides clinical clues to promptly diagnose and treat rickettsiosis. Disclosures All Authors: No reported disclosures


Background.
Puerperal sepsis is an important cause of maternal mortality worldwide. As access to emergency obstetric services expands in resource-limited settings, rapid recognition and treatment of sepsis, and prevention of nosocomial infections that might lead to sepsis, is critical. We describe puerperal sepsis cases among women with in-facility births in the Kigoma region of Tanzania.
Methods. Demographic, obstetric history, pregnancy complication and outcome, as well as mortality data were collected for women who delivered in hospitals, health centers and dispensaries in the Kigoma region, Tanzania 2016 -2018. Up to 3 maternal complications were recorded as free text. Puerperal sepsis included women where 'sepsis' was recorded as a complication during hospitalization. We calculated rates of puerperal sepsis and completed a descriptive analysis of patients.
Results. 203,604 women delivered infants in 197 participating facilities during the data collection period. Of these, 2228 (1.1%) had sepsis recorded, for an overall rate of 10.9 sepsis cases per 1000 deliveries. Although 48% of births occurred in dispensaries, sepsis complications were reported almost exclusively in hospitals and health centers (37.7 and 10.3 per 1000 deliveries, respectively). Sepsis rates varied across individual facilities, from 15.5 to 45.2 cases per 1000 deliveries in hospitals and 0 to 38.6 cases per 1000 deliveries in health centers. Women who developed sepsis had a median age of 25 (IQR 22 -30) years and 1113 (56%) were nulliparous. 1763 (90%) of women who had sepsis delivered by caesarian delivery. Obstructed labor (827; 42%) was a common co-complication of sepsis; obstetric hemorrhage and uterine rupture were seen in 93 (5%) and 77 (4%) women with sepsis, respectively. 49 women with sepsis (3%) died prior to hospital discharge. Stillbirths and pre-discharge neonatal deaths complicated 107 (5%) and 74 (4%) deliveries to women with sepsis.
Conclusion. In the Kigoma region of Tanzania puerperal sepsis frequently occurs in women with obstructed labor and caesarian delivery. Further evaluation of both facility-level and individual factors that contribute to the incidence of sepsis in this population, particularly those related to invasive procedures, is critical for early recognition and prevention. issue Disclosures. Background. Pediatric pneumonia is the leading cause of child mortality in low-income countries. Pneumonia diagnosis is a challenge. Chest x-ray (CXR) is considered the gold standard, but it exposes children to ionizing radiation, and access to CXR is limited to hospital settings. Lung Point of Care Ultrasound (POCUS) is a portable and non-radiating alternative to CXR.
Methods. We enrolled 200 children aged 1-59 months from the University Teaching Hospital (UTH) Emergency Department (ED) in Lusaka, Zambia who met the WHO (World Health Organization) case definition for severe pneumonia. From each child, we collected demographic and clinical data, a CXR, and a set of ultrasound images using a Butterfly ultrasound probe. Images were independently interpreted by two radiologists blinded to the results of the other imaging modality. Using CXR as the gold standard, we determined the sensitivity and specificity, positive and negative predictive values, and likelihood ratios for pneumonia using lung POCUS.
Conclusion. Preliminary findings of this study demonstrated the lower diagnostic accuracy of lung POCUS versus CXR in the detection of pneumonia in children 1-59 months. The high specificity of the test will aid in ruling out severe pneumonia in children. Due to its availability, ease of interpretation, and absence of radiation exposure, lung POCUS should still be considered as an important initial imaging tool for the diagnosis of CAP in children in limited-resource settings.
Disclosures. All Authors: No reported disclosures