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Yagci-Caglayik D, Kayaaslan B, Yapar D, Kocagul-Celikbas A, Ozkaya-Parlakay A, Emek M, Baykam N, Tezer H, Korukluoglu G, Ozkul A. Monitoring Crimean-Congo haemorrhagic fever virus RNA shedding in body secretions and serological status in hospitalised patients, Turkey, 2015. ACTA ACUST UNITED AC 2020; 25. [PMID: 32183931 PMCID: PMC7078823 DOI: 10.2807/1560-7917.es.2020.25.10.1900284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
IntroductionCrimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease in Africa, Asia, the Balkan peninsula, the south-east of Europe and the Middle East, with mortality rates of 3-30%. Transmission can also occur through contact with infected animals or humans.AimThis observational, prospective case series aimed to investigate detectable viral genomic RNA in whole-body fluids and antibody dynamics in consecutive daily samples of patients diagnosed with CCHF until discharge from hospital.MethodsWe tested 18 patients and 824 swabs and sera with RT-PCR and 125 serum samples serologically.ResultsThe longest duration until clearance of viral RNA was 18 days from serum collection and 18, 15, 13, 19 and 17 days, respectively, from nasal, oral, genital (urethral or vaginal) and faecal swab, and urine. In seven patients, viral load decreased in serum at the same time as it increased in urine or persisted at the same logarithmic values. Despite clearance in serum, viral RNA was detected in faeces and genital swabs in two and three patients, respectively. Viral clearance from body fluids occurred earlier than from serum in eight patients on ribavirin treatment. The shortest seroconversion time was 3 days after symptom onset for IgM and IgG. Seroconversion of IgG occurred until Day 14 of symptoms.ConclusionWe report persistence of viral RNA in urine, faeces and genital swabs despite serum clearance. This may indicate a need for extending isolation precautions, re-evaluating discharge criteria and transmission risk after discharge, and considering oral swabs as a less invasive diagnostic alternative.
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Affiliation(s)
- Dilek Yagci-Caglayik
- Ankara University Faculty of Veterinary Medicine, Department of Virology, Ankara, Turkey.,Public Health General Directorate of Turkey, Virology Laboratory, Ankara, Turkey.,Marmara University Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Bircan Kayaaslan
- Yıldırım Beyazıt University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Derya Yapar
- Hitit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
| | - Aysel Kocagul-Celikbas
- Hitit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
| | - Aslinur Ozkaya-Parlakay
- Health Sciences University, Ankara Children's Hematology Oncology Training and Research Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Mestan Emek
- Akdeniz University Faculty of Medicine, Department of Public Health, Antalya, Turkey
| | - Nurcan Baykam
- Hitit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
| | - Hasan Tezer
- Gazi University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Gulay Korukluoglu
- Public Health General Directorate of Turkey, Virology Laboratory, Ankara, Turkey
| | - Aykut Ozkul
- Ankara University, Biotechnology Institute, Ankara, Turkey.,Ankara University Faculty of Veterinary Medicine, Department of Virology, Ankara, Turkey
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The pulmonary findings of Crimean-Congo hemorrhagic fever patients with chest X-ray assessments. Radiol Med 2019; 124:826-832. [PMID: 30911987 PMCID: PMC7102267 DOI: 10.1007/s11547-019-01024-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 03/11/2019] [Indexed: 01/01/2023]
Abstract
Background Crimean–Congo hemorrhagic fever (CCHF), characterized by fever and/or hemorrhage, is a zoonotic viral disease with high mortality. The agent causing CCHF is a Nairovirus. The virus is typically transmitted to humans through tick bites. CCHF is a life-threatening disease observed endemically over a wide geographical regions in the world, and there is limited information about pulmonary findings in CCHF patients. Purpose We aimed to investigate the pulmonary findings belonging to a large CCHF patient cohort and to determine if there is any relationship between laboratory findings and disease severity. Materials and methods A total of 165 patients who were diagnosed with CCHF and examined through chest X-ray (CXR) due to respiratory symptoms at their first examination and/or during their hospitalization were included in this study. In addition to demographical and laboratory findings of the patients, chest X-rays were also examined. Results Of the 165 patients examined, 96 were male (58.2%) and 69 were female (41.8%). The mean age was 51.64 ± 17.95 years (4–81 years). Single and/or multiple pathological findings were detected in 93 patients (56.4%) as a result of chest X-ray during their first examination. On chest X-ray, consolidation in 74 patients (44.8%), pleural effusion in 64 patients (39.8%), ground glass opacity in 49 patients (29.7%), and atelectasis in 30 patients (18.2%) were detected. Conclusion According to the results of our study, it can be suggested that radiological examination in lungs should be performed primarily with CXR and pulmonary involvement (pleural effusion and consolidation) affects survival in CCHF negatively.
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Laboratory features of 160 CCHF confirmed cases in Zabol of Iran: A 10-year study. J Infect 2017; 74:418-420. [DOI: 10.1016/j.jinf.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/03/2016] [Accepted: 12/10/2016] [Indexed: 11/15/2022]
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Leblebicioglu H, Sunbul M, Barut S, Buyuktuna SA, Ozkurt Z, Yapar D, Yilmaz G, Guner R, But A, Cicek Senturk G, Murat N, Ozaras R. Multi-center prospective evaluation of discharge criteria for hospitalized patients with Crimean-Congo Hemorrhagic Fever. Antiviral Res 2016; 133:9-13. [PMID: 27424492 DOI: 10.1016/j.antiviral.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The information of discharge criteria in patients with Crimean-Congo Hemorrhagic Fever (CCHF) is limited. In this study, we aimed to determine the clinical and laboratory parameters used in discharging the patients by the experienced centers. MATERIALS AND METHODS The study was done in 9 reference centers of CCHF from May 1, 2015 to December 1, 2015 and included laboratory-confirmed patients with CCHF. The study was prospective, observational and non-interventional. RESULTS The study included 260 patients. Mean age was 51.3 ± 16.3 years; 158 (60.8%) were male. Mean hospital stay was 7 ± 2.6 days. The decision of discharging was taken considering clinical and laboratory findings. On discharge, no patients had fever or hemorrhage. The patients were followed-up clinically and a repeat CCHF PCR was not studied. All centers considered the following criteria for discharge: no fever and hemorrhage, improvement in clinical findings and laboratory studies. For all patients except one, platelet count was >50,000/mm(3) and had a tendency to increase. Prothrombin time and international normalized ratio (INR) were normal in 258 (99.6%) and 254 (98.1%) patients respectively. Alanine aminotransferase (ALT) was either normal or not higher than 10-fold and had a tendency to decrease in 259 (99.6%) patients. ALT and aspartate aminotransferase (AST) levels were not taken as discharge criteria with priority. During 30 days following the discharge, complication, relapse, or secondary transmission were not reported. CONCLUSIONS The discharging practice of the centers based on clinical and laboratory parameters seems safe considering no complications, relapses, or secondary infection thereafter. Current discharge practice of the centers composed of no fever and hemorrhage, improvement in clinical findings, platelet count of either >100,000/mm(3) or >50,000/mm(3) with a tendency to increase, and normal bleeding tests can be used as the criteria of discharge.
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Affiliation(s)
- Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - Mustafa Sunbul
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey
| | - Sener Barut
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpasa University Medical School, Tokat, Turkey
| | - Seyit Ali Buyuktuna
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University Medical School, Sivas, Turkey
| | - Zulal Ozkurt
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University Medical School, Erzurum, Turkey
| | - Derya Yapar
- Department of Infectious Diseases and Clinical Microbiology, Hitit University Medical School, Corum, Turkey
| | - Gurdal Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical School, Samsun, Turkey
| | - Rahmet Guner
- Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University Medical School, Ankara, Turkey
| | - Ayse But
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Gonul Cicek Senturk
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Naci Murat
- Department of Industrial Engineering, Ondokuz Mayis University, Faculty of Engineering, Samsun, Turkey
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
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Akinci E, Bodur H, Sunbul M, Leblebicioglu H. Prognostic factors, pathophysiology and novel biomarkers in Crimean-Congo hemorrhagic fever. Antiviral Res 2016; 132:233-43. [PMID: 27378224 DOI: 10.1016/j.antiviral.2016.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/28/2016] [Indexed: 12/16/2022]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a geographically widespread tick-borne zoonosis. The clinical spectrum of the illness varies from mild infection to severe disease and death. In severe cases, hemorrhagic manifestations develop, with fatality rates of 4-20%, depending on the geographic region and quality of the health care. Although vast majority of the CCHF cases were reported from Turkey, mortality rate is lower than the other regions, which is 5% on average. Prediction of the clinical course of the disease enables appropriate management planning by the physician and prompt transportation, if needed, of the patient to a tertiary care hospital for an intensive therapy. Thus, predicting the outcome of the disease may avert potential mortality. There are numerous studies investigating the prognostic factors of CCHF in the literature. Majority of them were reported from Turkey and included investigations on clinical and biochemical parameters, severity scoring systems and some novel biomarkers. Somnolence, bleeding, thrombocytopenia, elevated liver enzymes and prolonged bleeding times are the most frequently reported prognostic factors to predict the clinical course of the disease earlier. High viral load seems to be the strongest predictor to make a clinical decision about the patient outcome. The severity scoring systems based on clinically important mortality-related parameters are especially useful for clinicians working in the field to predict the course of the disease and to decide which patient should be referred to a tertiary care hospital for intensive care. In the light of the pathophysiological characteristics of CCHF, some new biomarkers of prognosis including cytokines, soluble adhesion molecules, genetic polymorphisms and coagulopathy parameters were also investigated. However most of these tests are not available to clinicians and they were obtained mostly for research purposes. In spite of the various studies about prognostic factors, they have several inherent limitations, including large variability in the results and confusing data that are not useful for clinicians in routine practice. In this paper, the results of diverse studies of the prediction of the prognosis in CCHF based on epidemiological, clinical and laboratory findings of the disease were summarized and suggestions for future studies are provided.
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Affiliation(s)
- Esragul Akinci
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Hurrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Mustafa Sunbul
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey
| | - Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
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Aktaş T, Aktaş F, Özmen Z, Kaya T. Does Crimean-Congo Hemorrhagic Fever Cause a Vasculitic Reaction with Pulmonary Artery Enlargement and Acute Pulmonary Hypertension? Lung 2016; 194:807-12. [PMID: 27344326 PMCID: PMC7101793 DOI: 10.1007/s00408-016-9913-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/14/2016] [Indexed: 12/02/2022]
Abstract
Purpose Crimean-Congo hemorrhagic fever (CCHF) is a viral tick-borne illness. Although its etiopathogenesis is not clearly understood, it is known to be a Nairovirus. We aimed to examine the viral effects of intense systemic inflammation and vascular damage on the pulmonary vascular beds and lung tissues. Methods A total of 45 patients who were diagnosed with CCHF were considered for this retrospective study. In this patient group, those whose lungs had been visualized via thoracic computer tomography (CT) were entered into the study. Diameters of the pulmonary trunk, main pulmonary arteries, atria, and ventricles were measured. Study group measurements were compared with the control group, which included patients with normal thoracic CT. Results Overall, 90 patients were enrolled in the study, with 45 patients in the study group and 45 in the control group. In the study group, the man-to-woman balance was 3/2. The average age in the study group was 54.07 ± 17.91 years. In comparing the average diameters of pulmonary arteries in the study and control groups, the study group’s average pulmonary artery diameter was significantly larger than the control group (p < 0.001). Conclusions The increase in diameters of the pulmonary trunks and main pulmonary arteries due to CCHF was first shown in this current study. Moreover, due to our findings, it should be noted that with the rise in pulmonary artery diameter in CCHF, pulmonary hypertension can appear acutely, and this condition can be significantly alter clinical course and follow-up of the viral illness.
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Affiliation(s)
- Turan Aktaş
- Pulmonar Medicine Department, Gaziosmanpaşa University School of Medicine, Tokat, Turkey.
| | - Fatma Aktaş
- Radiology Department, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Zafer Özmen
- Radiology Department, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Turan Kaya
- Infections and Clinical Microbiology Department, Tokat State Hospital, Tokat, Turkey
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