P-19. Co infection of Hepatitis viruses and Leptospira in hepatic failure patients

Fulminant hepatic failure (FHF) is an acute rapidly developing fatal illness with clinical signs of hepatic encephalopathy occurring in a previously healthy individual within four weeks of occurrence of jaundice. The most common etiological agents implicated for this scenario are hepatotropic viruses. But still in 20–60% of cases etiology is not established. The hepatorenal syndrome caused by leptospira can lead to hepatic failure in the later phase of illness. So in this study we evaluated leptospira as primary or co infecting agent in hepatic failure cases. One Hundred cases of hepatic failure admitted in the Medicine and Gastroenterology department of AIIMS were evaluated. Diagnosis of leptospirosis was based on culture, IgM ELISA, MAT titre and serum/urine PCR. Hepatitis viruses were diagnosed based on standard viral markers. Microbiological proven diagnosis was established in 72 patients. Co infections were found in 16 cases. Hepatitis E virus alone was the causative agent in 26 cases. Leptospirosis alone was detected in five cases. In two cases of co infection the leptospirosis was confirmed by PCR in spite of negative serology. Hepatitis viruses are still the major etiological agent seen in hepatic failure but while investigating such cases leptospira should also be kept in mind. Co infection of leptospira with hepatitis E virus could be due to similar route of spread. Management of such cases may change in lieu of bacterial etiology where use of appropriate antibiotics may reduce the severity and mortality associated in hepatic failure.