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Ahrabi SZ, Akyildiz G, Kar S, Keles AG. Detection of the Crimean-Congo Hemorrhagic Fever Virus Genome in Questing Ixodes spp. and Haemaphysalis spp. in the Periurban Forestry Areas of Istanbul: Has a New Biorisk Emerged? Vector Borne Zoonotic Dis 2023; 23:528-536. [PMID: 37527191 DOI: 10.1089/vbz.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background: Istanbul is one of the world's most densely populated metropolitan cities, with various geographical areas that possess distinct characteristics. These areas have different climates, vegetation, and host populations that can support the survival of diverse tick species. Turkey is a region with a high risk of Crimean-Congo hemorrhagic fever (CCHF) disease, making it crucial to screen for this risk, especially in densely populated regions such as Istanbul and its surrounding areas. However, the presence of potential vectors for CCHF virus (CCHFV) in these areas has not been studied in the past 12 years. Materials and Methods: In this study, a total of 676 ticks were collected from 6 centers using the flagging and dragging method. Ticks were identified as Ixodes ricinus (7.85%), Ixodes spp. immature form (73.22%), Haemaphysalis parva (0.89%), Haemaphysalis inermis (0.15%), and Haemaphysalis spp. immature form (17.89%). Pooled samples were screened for the CCHFV genome (S segment) by RT-nested PCR. Results: A total of 14.28% of the samples were found as positive. Phylogenetic analysis revealed that all the CCHFV sequences obtained from the positive samples were clustered in clade V: Europe/Turkey genogroup. Conclusion: This study suggests that ixodes spp. and Haemaphysalis spp. may have the potential to pose a biorisk for Crimean-Congo hemorrhagic fever.
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Affiliation(s)
- Salar Zarrabi Ahrabi
- Department of Basic Health Science, Health Sciences Faculty, Marmara University, Istanbul, Turkey
| | - Gurkan Akyildiz
- Department of Basic Health Science, Health Sciences Faculty, Marmara University, Istanbul, Turkey
| | - Sirri Kar
- Department of Biology, Faculty of Arts and Science, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Aysen Gargili Keles
- Department of Basic Health Science, Health Sciences Faculty, Marmara University, Istanbul, Turkey
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Messina JP, Wint GRW. The Spatial Distribution of Crimean-Congo Haemorrhagic Fever and Its Potential Vectors in Europe and Beyond. INSECTS 2023; 14:771. [PMID: 37754739 PMCID: PMC10532370 DOI: 10.3390/insects14090771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
Crimean-Congo haemorrhagic fever (CCHF) is considered to be spreading across the globe, with many countries reporting new human CCHF cases in recent decades including Georgia, Türkiye, Albania, and, most recently, Spain. We update a human CCHF distribution map produced in 2015 to include global disease occurrence records to June 2022, and we include the recent records for Europe. The predicted distributions are based on long-established spatial modelling methods and are extended to include all European countries and the surrounding areas. The map produced shows the environmental suitability for the disease, taking into account the distribution of the most important known and potential tick vectors Hyalomma marginatum and Hyalomma lusitanicum, without which the disease cannot occur. This limits the disease's predicted distribution to the Iberian Peninsula, the Mediterranean seaboard, along with Türkiye and the Caucasus, with a more patchy suitability predicted for inland Greece, the southern Balkans, and extending north to north-west France and central Europe. These updated CCHF maps can be used to identify the areas with the highest probability of disease and to therefore target areas where mitigation measures should currently be focused.
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Affiliation(s)
- Jane Paula Messina
- School of Geography and the Environment, University of Oxford, S. Parks Rd., Oxford OX1 3QY, UK
- Oxford School of Global and Area Studies, University of Oxford, 13 Bevington Rd., Oxford OX2 6LH, UK
| | - G. R. William Wint
- Environmental Research Group, Department of Biology, University of Oxford, 11a Mansfield Rd., Oxford OX1 3SZ, UK;
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3
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Batte A, Shahrin L, Claure-Del Granado R, Luyckx VA, Conroy AL. Infections and Acute Kidney Injury: A Global Perspective. Semin Nephrol 2023; 43:151466. [PMID: 38158245 DOI: 10.1016/j.semnephrol.2023.151466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Globally, there are an estimated 13.3 million cases of acute kidney injury (AKI) annually. Although infections are a common cause of AKI globally, most infection-associated AKI occurs in low- and lower-middle-income countries. There are marked differences in the etiology of infection-associated AKI across age groups, populations at risk, and geographic location. This article provides a global overview of different infections that are associated commonly with AKI, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, malaria, dengue, leptospirosis, tick-borne illnesses, and viral hemorrhagic fevers. Further discussion focuses on infectious conditions associated with AKI including sepsis, diarrheal diseases and pregnancy, peripartum and neonatal AKI. This article also discusses the future of infection-associated AKI in the framework of climate change. It explores how increased investment in achieving the sustainable development goals may contribute to the International Society of Nephrology's 0 by 25 objective to curtail avoidable AKI-related fatalities by 2025.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Global Health Uganda, Kampala, Uganda.
| | - Lubaba Shahrin
- Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2, Caja Nacional de Salud, Cochabamba, Bolivia; Instituto de Investigaciones Biomédicas e Investigación Social (IIBISMED), Facultad de Medicina, Universidad Mayor de San Simon, Cochabamba, Bolivia
| | - Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Andrea L Conroy
- Ryan White Center for Pediatric Infectious Diseases, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; Center for Global Health, Indiana University School of Medicine, Indianapolis, IN
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Ozdarendeli A. Crimean-Congo Hemorrhagic Fever Virus: Progress in Vaccine Development. Diagnostics (Basel) 2023; 13:2708. [PMID: 37627967 PMCID: PMC10453274 DOI: 10.3390/diagnostics13162708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Crimean-Congo hemorrhagic fever virus (CCHFV), a member of the Nairoviridae family and Bunyavirales order, is transmitted to humans via tick bites or contact with the blood of infected animals. It can cause severe symptoms, including hemorrhagic fever, with a mortality rate between 5 to 30%. CCHFV is classified as a high-priority pathogen by the World Health Organization (WHO) due to its high fatality rate and the absence of effective medical countermeasures. CCHFV is endemic in several regions across the world, including Africa, Europe, the Middle East, and Asia, and has the potential for global spread. The emergence of the disease in new areas, as well as the presence of the tick vector in countries without reported cases, emphasizes the need for preventive measures to be taken. In the past, the lack of a suitable animal model susceptible to CCHFV infection has been a major obstacle in the development of vaccines and treatments. However, recent advances in biotechnology and the availability of suitable animal models have significantly expedited the development of vaccines against CCHF. These advancements have not only contributed to an enhanced understanding of the pathogenesis of CCHF but have also facilitated the evaluation of potential vaccine candidates. This review outlines the immune response to CCHFV and animal models utilized for the study of CCHFV and highlights the progress made in CCHFV vaccine studies. Despite remarkable advancements in vaccine development for CCHFV, it remains crucial to prioritize continued research, collaboration, and investment in this field.
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Affiliation(s)
- Aykut Ozdarendeli
- Department of Microbiology, Faculty of Medicine, Erciyes University, 38039 Kayseri, Türkiye;
- Vaccine Research, Development and Application Centre (ERAGEM), Erciyes University, 38039 Kayseri, Türkiye
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5
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Kerget F, Kerget B. Can Fractional Exhaled Nitric Oxide (FeNO) Serve as a Clinical Indicator for Patients Hospitalized with Crimean-Congo Hemorrhagic Fever? Jpn J Infect Dis 2023; 76:226-232. [PMID: 37005275 DOI: 10.7883/yoken.jjid.2022.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Crimean-Congo hemorrhagic fever (CCHF), a zoonotic disease spread by infected viruses, can be a significant cause of morbidity and mortality in endemic areas. This prospective study aimed to establish the relationship between fractional exhaled nitric oxide (FeNO) levels and clinical prognosis of CCHF. The study included 85 participants: 55 patients followed up for CCHF from May to August 2022, and 30 healthy controls. FeNO levels were measured upon hospital admission and were 7.6 ± 3.3 parts per billion (ppb) in patients with mild/moderate CCHF, 2.5 ± 2.1 ppb in patients with severe CCHF, and 6.7 ± 1.7 ppb in the healthy control group. There was no statistically significant difference in FeNO levels between the control group and patients with mild/moderate CCHF (P = 0.09), whereas patients with severe CCHF had lower FeNO levels than those in the control group and patients with mild/moderate CCHF (P < 0.001 for both). FeNO measurement may offer a noninvasive and easily applied approach for predicting the clinical course and prognosis of CCHF in the early stages of the disease.
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Affiliation(s)
- Ferhan Kerget
- Department of Infectious Diseases and Clinical Microbiology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Turkey
| | - Buğra Kerget
- Department of Pulmonary Diseases, Faculty of Medicine, Ataturk University, Turkey
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Kaygusuz TÖ, Tartar AS, Balin ŞÖ, Akbulut A, Demirdağ K. Predictive epidemiological, clinical and laboratory parameters in the diagnosis of Crimean-Congo hemorrhagic fever. Biomark Med 2023; 17:533-540. [PMID: 37791843 DOI: 10.2217/bmm-2023-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background: The aim of this study is to determine predictive parameters that can be used in the differential diagnosis of Crimean-Congo Hemorrhagic Fever (CCHF) and other diseases with similar clinical and laboratory findings. Materials & methods: In this study, epidemiological, clinical and laboratory parameters of 107 CCHF-positive and 71 CCHF-negative patients were compared. Results: Alanine amino transferase, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, red blood cell, hemoglobin and hematocrit were significantly higher in CCHF-positive patients, whereas total and direct bilirubin, alkaline phosphatase, prothrombin time, international normalization ratio, white blood cell, C-reactive protein and procalcitonin were higher in CCHF-negative patients. In binary logistic regression analysis, an increase in activated partial thromboplastin time level was identified as an independent predictor of having CCHF, while alanine amino transferase, white blood cell and C-reactive protein elevations were identified as independent predictors of not having CCHF. Conclusion: In endemic areas where PCR and serological tests are delayed, knowing the predictive parameters may be of vital importance in the early diagnosis of CCHF.
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Affiliation(s)
- Türkkan Ö Kaygusuz
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Ayşe S Tartar
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Şafak Ö Balin
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Ayhan Akbulut
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Kutbeddin Demirdağ
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
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Touray M, Bakirci S, Ulug D, Gulsen SH, Cimen H, Yavasoglu SI, Simsek FM, Ertabaklar H, Ozbel Y, Hazir S. Arthropod vectors of disease agents: their role in public and veterinary health in Turkiye and their control measures. Acta Trop 2023; 243:106893. [PMID: 37004805 DOI: 10.1016/j.actatropica.2023.106893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023]
Abstract
Mosquitoes, sandflies, and ticks are hematophagous arthropods that pose a huge threat to public and veterinary health. They are capable of serving as vectors of disease agents that can and have caused explosive epidemics affecting millions of people and animals. Several factors like climate change, urbanization, and international travel contribute substantially to the persistence and dispersal of these vectors from their established areas to newly invaded areas. Once established in their new home, they can serve as vectors for disease transmission or increase the risk of disease emergence. Turkiye is vulnerable to climate change and has experienced upward trends in annual temperatures and rising sea levels, and greater fluctuations in precipitation rates. It is a potential hotspot for important vector species because the climate in various regions is conducive for several insect and acari species and serves as a conduit for refugees and immigrants fleeing areas troubled with armed conflicts and natural disasters, which have increased substantially in recent years. These people may serve as carriers of the vectors or be infected by disease agents that require arthropod vectors for transmission. Although it cannot be supposed that every arthropod species is a competent vector, this review aims to (1)illustrate the factors that contribute to the persistence and dispersal of arthropod vectors, (2)determine the status of the established arthropod vector species in Turkiye and their capability of serving as vectors of disease agents, and (3)assess the role of newly-introduced arthropod vectors into Turkiye and how they were introduced into the country. We also provide information on important disease incidence (if there's any) and control measures applied by public health officials from different provinces.
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Affiliation(s)
- Mustapha Touray
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey.
| | - Serkan Bakirci
- Department of Parasitology, Faculty of Veterinary Medicine, Aydin Adnan Menderes University, Turkey
| | - Derya Ulug
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey
| | - Sebnem H Gulsen
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey
| | - Harun Cimen
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey
| | | | - Fatih M Simsek
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey
| | - Hatice Ertabaklar
- Department of Parasitology, Faculty of Medicine, Aydin Adnan Menderes University, Turkey
| | - Yusuf Ozbel
- Department of Parasitology, Faculty of Medicine, Ege University, Turkey
| | - Selcuk Hazir
- Department of Biology, Faculty of Science, Aydin Adnan Menderes University, Turkey; Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai 602105, Tamil Nadu India
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8
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Muacevic A, Adler JR, Beştepe Dursun Z, Eren E, Aslan Sırakaya H, Kuzugüden S, Celik I. The Relationship Between Cytokine Concentrations and Severity Scoring Index for Crimean-Congo Hemorrhagic Fever. Cureus 2023; 15:e34882. [PMID: 36788994 PMCID: PMC9922379 DOI: 10.7759/cureus.34882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Background This study aimed to investigate the effects of serum high mobility group box-1 (HMGB1), interleukin (IL)-6, IL-8, IL-1β, IL-10, and tumor necrosis factor alpha (TNF-α) levels on disease severity and mortality in Crimean-Congo hemorrhagic fever (CCHF) patients. Materials and methods This study was performed prospectively in the intensive care unit (ICU) and infection ward of a tertiary hospital in the Republic of Türkiye. Patients aged 18 years and older diagnosed with CCHF were included. Results Our study included 30 patients, of whom 83.3% were male, where the mean age was 51.6±14.35 years. The most common clinical findings in patients were malaise (90%) and myalgia (63.3%). In our study, IL-1β levels were found to be 1173.6 (783.0-1823.0) pg/mL, IL-6 69.9 (56.8-133.1) pg/mL, IL-8 191.2 (152.8-516.9) pg/mL, TNF-α 129.5 (104.9-270.8), HMGB1 37.01 (29.26-75.18), and IL-10 190.1 (IQR: 147.8-387.8) pg/mL. The patients' median Severity Scoring Index (SSI) score was found to be 2.5 (1.8-5.5). There was a moderate correlation between the patients' SSI score and serum IL-6 (r=0.464, p=0.010), TNF-α (r=0.420, p=0.021), and IL-10 levels (r=0.518, p=0.003), and a weak correlation between serum HMGB1 (r=0.392, p=0.032). The correlation between SSI and creatine phosphokinase (CPK) levels (r=0.499, p=0.036) was observed to be moderate. Conclusion It was seen that IL-10, IL-6, TNF-α, HMBG-1, and CPK levels evaluated at the CCHF patients' time of admission to the clinic and SSI clinical score were found to be significantly related. It is clear that more studies with patients and groups of healthy volunteers are needed on this subject.
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Oygar PD, Gürlevik SL, Sağ E, İlbay S, Aksu T, Demir OO, Coşgun Y, Eyüpoğlu SA, Karakaya J, Cangül ŞÜ, Cengiz AB, Özsürekci Y. Changing Disease Course of Crimean-Congo Hemorrhagic Fever in Children, Turkey. Emerg Infect Dis 2023; 29:268-277. [PMID: 36692327 PMCID: PMC9881758 DOI: 10.3201/eid2902.220976] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF), endemic in certain regions of the world, is listed as a priority disease with pandemic potential. Since CCHF was first identified in Turkey, children have been known to experience milder disease than adults. However, during the COVID-19 pandemic, we observed an unusually severe disease course, including hemophagocytic lymphohistiocytosis (HLH). We examined cytokine/chemokine profiles of 9/12 case-patients compared with healthy controls at 3 time intervals. Interferon pathway-related cytokines/chemokines, including interleukin (IL) 18, macrophage inflammatory protein 3α, and IL-33, were elevated, but tumor necrosis factor-α, IL-6, CXCL8 (formerly IL-8), and cytokines acting through C-C chemokine receptor 2 and CCR5 were lower among case-patients than controls. Interferon pathway activation and cytokines/chemokines acting through CCR2 and CCR5 improved health results among children with severe CCHF. Children can experience severe CCHF, including HLH, and HLH secondary to CCHF can be successfully treated with intravenous immunoglobulin and steroid therapy.
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Aslam M, Abbas RZ, Alsayeqh A. Distribution pattern of Crimean-Congo Hemorrhagic Fever in Asia and the Middle East. Front Public Health 2023; 11:1093817. [PMID: 36778537 PMCID: PMC9909290 DOI: 10.3389/fpubh.2023.1093817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023] Open
Abstract
Crimean-Congo Hemorrhagic Fever (CCHF) is one of the most important vector-borne diseases of zoonotic potential that can be acquired following the bite of the Hyalomma species of ticks. It is a highly prevalent disease in Asia and the Middle East. The risk factors of this disease are contact with infected tissue, blood, patient, or livestock in the acute viremic phase, infected tick bites, or the manual removal of ticks. The disease is clinically described as progressive hemorrhages, fever, and pain in musculature. Biochemical tests reveal elevated levels of creatinine phosphokinase, alanine transaminase, aspartate aminotransferase, and lactate dehydrogenase. Clotting time is prolonged in pro-thrombin tests, and pathogenesis is mostly related to the disruption of the epithelium during viral replication and indirectly by secreting cytotoxic molecules. These molecules cause endothelial activation and result in the loss of function. Supportive therapy is given through blood or plasma infusions to treat or manage the patients. According to the most advanced studies, CCHF can be treated by Ribavirin, which is an antiviral drug that shows excellent results in preventing the disease. Health-care staff are more prone to infection. The hemorrhagic phase represents a high risk for accidental exposures. This literature review presents a comprehensive overview of the viral epidemiology, zoonotic perspectives, and significant risk factors of CCHF in various Middle East and Asian countries. Furthermore, the pathophysiology and preventive strategies of CCHF have also been discussed as well as legislation and policies regarding public outreach programs, research, and development aimed at infection prevention and control that are required at a global level.
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Affiliation(s)
- Munazza Aslam
- Department of Pathology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Rao Zahid Abbas
- Department of Parasitology, Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan
| | - Abdullah Alsayeqh
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia,*Correspondence: Abdullah Alsayeqh ✉
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Cosgun Y, Aydemir A, Hedef H, Öz Kamiloglu A, Klemens O, Lattwein E, Klemens JM, Saschenbrecker S, Steinhagen K, Korukluoglu G. Evaluation of Nucleoprotein-Based Enzyme-Linked Immunosorbent Assay for Serodiagnosis of Acute Crimean-Congo Hemorrhagic Fever Virus Infections in a Turkish Population. Vector Borne Zoonotic Dis 2023; 23:44-53. [PMID: 36576857 DOI: 10.1089/vbz.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Crimean-Congo hemorrhagic fever virus (CCHFV) causes a highly contagious tick-borne disease with high case-fatality rates in humans. It is circulating not only in many Asian and African countries, but also spreading to and within Europe. To cope better with future outbreaks of Crimean-Congo hemorrhagic fever (CCHF), the WHO has prioritized the need for the development and validation of CCHF diagnostics, including serological assays. In this study, we evaluated the performance of the new EUROIMMUN anti-CCHFV IgM and IgG enzyme-linked immunosorbent assays (ELISAs). Materials and Methods: Both ELISAs were compared to the Vector-Best VectoCrimean-CHF-IgM and -IgG ELISAs using the EUROIMMUN CCHFV Mosaic 2 IgM and IgG indirect immunofluorescence assays (IFA) as reference. Forty-nine acute-phase serum samples from patients with CCHFV infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and/or anti-CCHFV IgM IFA positivity were used to determine assay sensitivity. The assessment of specificity was based on sera from 30 control patients, 30 healthy blood donors, and 29 patients with hantavirus or sandfly fever virus infections. All samples originated from Turkey. Results: Sensitivity of the EUROIMMUN ELISAs (IgM 98.0%, IgG 47.1%) exceeded that of the Vector-Best ELISAs (IgM 95.9%, IgG 35.3%). Specificity of the EUROIMMUN ELISA IgM (86.4%) was slightly higher compared with the Vector-Best ELISA IgM (84.7%), while specificity for IgG was 100% for both assays. Qualitative agreement between the EUROIMMUN and Vector-Best ELISAs was substantial for detecting anti-CCHFV IgM (84.1%, ĸ = 0.673) and IgG (94.9%, ĸ = 0.791), whereas the quantitative results indicated a very strong positive correlation (IgM: r = 0.868, IgG: r = 0.913). Conclusion: The new EUROIMMUN anti-CCHFV ELISAs are standardized and easy-to-use tools that reliably support the identification of acute CCHF cases, and thus suitable for laboratories involved in on-site outbreak support.
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Affiliation(s)
- Yasemin Cosgun
- National Arboviruses and Viral Zoonotic Diseases Laboratory, Microbiology Reference Laboratories Department, Public Health General Directorate of Turkey, Ankara, Turkey
| | - Ahmet Aydemir
- National Arboviruses and Viral Zoonotic Diseases Laboratory, Microbiology Reference Laboratories Department, Public Health General Directorate of Turkey, Ankara, Turkey
| | - Hakan Hedef
- National Arboviruses and Viral Zoonotic Diseases Laboratory, Microbiology Reference Laboratories Department, Public Health General Directorate of Turkey, Ankara, Turkey
| | | | - Oliver Klemens
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Erik Lattwein
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Julia Maria Klemens
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Sandra Saschenbrecker
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Katja Steinhagen
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Gulay Korukluoglu
- National Arboviruses and Viral Zoonotic Diseases Laboratory, Microbiology Reference Laboratories Department, Public Health General Directorate of Turkey, Ankara, Turkey
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12
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Vesga JF, Métras R, Clark MHA, Ayazi E, Apolloni A, Leslie T, Msimang V, Thompson PN, John Edmunds W. Vaccine efficacy trials for Crimean-Congo haemorrhagic fever: Insights from modelling different epidemiological settings. Vaccine 2022; 40:5806-5813. [PMID: 36058795 DOI: 10.1016/j.vaccine.2022.08.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Crimean-Congo haemorrhagic fever (CCHF) is a priority emerging pathogen for which a licensed vaccine is not yet available. We aim to assess the feasibility of conducting phase III vaccine efficacy trials and the role of varying transmission dynamics. METHODS We calibrate models of CCHF virus (CCHFV) transmission among livestock and spillover to humans in endemic areas in Afghanistan, Turkey and South Africa. We propose an individual randomised controlled trial targeted to high-risk population, and use the calibrated models to simulate trial cohorts to estimate the minimum necessary number of cases (trial endpoints) to analyse a vaccine with a minimum efficacy of 60%, under different conditions of sample size and follow-up time in the three selected settings. RESULTS A mean follow-up of 160,000 person-month (75,000-550,000) would be necessary to accrue the required 150 trial endpoints for a target vaccine efficacy of 60 % and clinically defined endpoint, in a setting like Herat, Afghanistan. For Turkey, the same would be achieved with a mean follow-up of 175,000 person-month (50,000-350,000). The results suggest that for South Africa the low endemic transmission levels will not permit achieving the necessary conditions for conducting this trial within a realistic follow-up time. In the scenario of CCHFV vaccine trial designed to capture infection as opposed to clinical case as a trial endpoint, the required person-months is reduced by 70 % to 80 % in Afghanistan and Turkey, and in South Africa, a trial becomes feasible for a large number of person-months of follow-up (>600,000). Increased expected vaccine efficacy > 60 % will reduce the required number of trial endpoints and thus the sample size and follow-time in phase III trials. CONCLUSIONS Underlying endemic transmission levels will play a central role in defining the feasibility of phase III vaccine efficacy trials. Endemic settings in Afghanistan and Turkey offer conditions under which such studies could feasibly be conducted.
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Affiliation(s)
- Juan F Vesga
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Raphaelle Métras
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (Unité Mixte de Recherche en Santé 1136), Paris, France
| | - Madeleine H A Clark
- Integrated Understanding of Health, Research Strategy and Programmes, Biotechnology and Biosciences Research Council, Swindon, UK
| | - Edris Ayazi
- Ministry of Public Health, Massoud Square, Kabul, Afghanistan
| | - Andrea Apolloni
- CIRAD, UMR ASTRE, Montpellier, France; ASTRE, Univ Montpellier, CIRAD, INRA, Montpellier, France
| | | | - Veerle Msimang
- Epidemiology Section, Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa; Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, South Africa
| | - Peter N Thompson
- Epidemiology Section, Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - W John Edmunds
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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13
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Nurettin C, Engin B, Sukru T, Munir A, Zati V, Aykut O. The Seroprevalence of Crimean-Congo Hemorrhagic Fever in Wild and Domestic Animals: An Epidemiological Update for Domestic Animals and First Seroevidence in Wild Animals from Turkiye. Vet Sci 2022; 9:vetsci9090462. [PMID: 36136678 PMCID: PMC9501697 DOI: 10.3390/vetsci9090462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Crimean-Congo hemorrhagic fever is a tick-borne and zoonotic emerging viral disease that is characterized by the sudden development of high fever and vascular bleeding in humans. The seroevidence among livestock has been reported, but it is less known in wild animals. Due to the importance and emerging state of the disease, we conducted a serosurvey on both domestic and wild animals in different areas of Turkiye. Serological investigations conducted on cattle, goats, and sheep revealed 10.81%, 15.15%, and 19.23% seropositivity, respectively, in the collected serum samples. We also found seropositivity rates in hare (23.81%) and wild boars (2.5%) indicating the substantial role of wild animals in virus epidemiology in Turkiye. This study provides first seroevidence of Crimean Congo hemorrhagic fever in wild animals in Turkiye. Abstract Crimean-Congo hemorrhagic fever virus (CCHFV) is a zoonotic, tick-borne pathogen that is endemic to some parts of Europe, Africa, and Asia. The disease causes fever and hemorrhagic manifestations in humans but not in animals. Domestic and wild animals are asymptomatic hosts of CCHFV and are critical in the transmission cycle. Hyalomma marginatum spp. has been identified as the natural reservoir and vector of the virus in Turkiye. A few studies have been conducted on domesticated animals showing the seroprevalence of CCHFV in them, but seroevidence in wild animals is absent. For contributing this antrum to the understanding of virus transmission in Turkiye, we performed a seroprevalence investigation of CCHFV in both wild and domesticated animals in various geographical areas of Turkiye. In-house IgG iELISA was performed for the screening of sera IgG in a total of 582 animal samples collected from boar (n = 40), cattle (n = 259), goat (n = 132), hare (n = 21), and sheep (n = 130). Results from ELISA performed on domestic animals revealed 10.81%, 15.15%, and 19.23% anti-CCHF virus seropositivity in cattle, goats, and sheep, respectively, in collected serum samples. ELISA tests performed in wild animals showed 23.81% and 2.5% positivity in hare and wild boars, respectively, suggesting the importance of wild animals in CCHF virus epidemiology in Turkiye. This study performed the first serological investigation of CCHFV in wild animals and provided the first seroevidence of CCHFV in wild boars and hare in Turkiye.
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Affiliation(s)
- Canakoglu Nurettin
- Department of Virology, Milas Faculty of Veterinary Science, Muğla Sıtkı Koçman University, Muğla 48200, Türkiye
- Correspondence: (C.N.); (B.E.)
| | - Berber Engin
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
- Correspondence: (C.N.); (B.E.)
| | - Tonbak Sukru
- Department of Virology, Faculty of Veterinary Medicine, Firat University, Elazığ 23119, Türkiye
| | - Aktas Munir
- Department of Parasitology, Faculty of Veterinary Medicine, Firat University, Elazığ 23119, Türkiye
| | - Vatansever Zati
- Department of Parasitology, Faculty of Veterinary Medicine, Kafkas University, Kars 36100, Türkiye
| | - Ozdarendeli Aykut
- Vaccine Research, Development, and Application Center, Erciyes University, Kayseri 38280, Türkiye
- Department of Microbiology, Medical Faculty, Erciyes University, Kayseri 38280, Türkiye
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Imran MA, Islam MR, Saha A, Ferdousee S, Mishu MA, Ghosh A. Development of Multi-epitope Based Subunit Vaccine Against Crimean-Congo Hemorrhagic Fever Virus Using Reverse Vaccinology Approach. Int J Pept Res Ther 2022; 28:124. [PMID: 35789799 PMCID: PMC9244561 DOI: 10.1007/s10989-022-10430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Md. Ashik Imran
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Md. Rubiath Islam
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Akash Saha
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Shahida Ferdousee
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Moshiul Alam Mishu
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Ajit Ghosh
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
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15
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Do we need to take extra care of Military Personnel with Tick Bites: A follow-up study. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1064396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Shahhosseini N, Wong G, Babuadze G, Camp JV, Ergonul O, Kobinger GP, Chinikar S, Nowotny N. Crimean-Congo Hemorrhagic Fever Virus in Asia, Africa and Europe. Microorganisms 2021; 9:microorganisms9091907. [PMID: 34576803 PMCID: PMC8471816 DOI: 10.3390/microorganisms9091907] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
The global spread of ticks and various tick-borne viruses (TBVs) suggests the possibility of new tick-borne diseases emerging. Crimean-Congo hemorrhagic fever virus (CCHFV) is an emerging TBV of the Nairoviridae family that causes serious disease that can be fatal in humans. CCHFV endemic foci can be found in Africa, Asia, the Middle East, and South-Eastern Europe, and has spread to previously unaffected regions and nations, such as Spain, over the last two decades. In this review, we discuss the current situation of CCHFV in Asia, Africa and Europe based on existing knowledge, and we discuss driving factors in the distribution and transmission of the virus, such as the spread of tick vector species and host reservoirs.
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Affiliation(s)
- Nariman Shahhosseini
- Centre for Vector-Borne Diseases, Canadian Food Inspection Agency, Lethbridge, AB T1H 6P7, Canada;
| | - Gary Wong
- Département de Microbiologie-Infectiologie et d’Immunologie, Université Laval, Québec City, QC G1V 0A6, Canada; (G.W.); (G.P.K.)
- Institut Pasteur of Shanghai, Shanghai 200031, China
| | - George Babuadze
- Department of Biological Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Jeremy V. Camp
- Center for Virology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Onder Ergonul
- Koç University, School of Medicine and Koç University Iş Bank Center for Infectious Diseases, Istanbul 34450, Turkey;
| | - Gary P. Kobinger
- Département de Microbiologie-Infectiologie et d’Immunologie, Université Laval, Québec City, QC G1V 0A6, Canada; (G.W.); (G.P.K.)
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Department of Immunology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sadegh Chinikar
- Pasteur Institute of Tehran, Tehran 1316943551, Iran
- Institute of Virology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
- Correspondence: (S.C.); (N.N.)
| | - Norbert Nowotny
- Institute of Virology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
- Department of Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
- Correspondence: (S.C.); (N.N.)
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Berber I, Korkmaz S, Sarici A, Erkurt MA, Kuku I, Kaya E, Bicim S, Ozgul M. Therapeutic plasma exchange for envenomation: Is it reasonable? Transfus Apher Sci 2021; 60:103241. [PMID: 34429240 DOI: 10.1016/j.transci.2021.103241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of poisoning due to snakebite and Crimean Congo Hemorrhagic Fever (CCHF), referred to as 'envenomation', varies according to the region, and many deaths occur every year. Therapeutic plasma exchange (TPE) is a method of extracorporeal blood purification that clears toxins and virus load from the circulation. Therefore, its use has been increasing recently in envenomation cases. However, there are a limited number of studies on poisoning due to snakebite and CCHF. In the present study, we share our TPE experience retrospectively in patients diagnosed with poisoning due to snakebite and CCHF between 2010 and 2019. MATERIALS AND METHODS A total of 26 patiens, including 20 patients with poisoning due to snakebite and 6 CCHF patients were treated with TPE. Demographic data, clinical status, and outcomes of patients were recorded. Routine biochemical and hematologic laboratory parameters were analyzed before and after TPE. TPE was performed by using centrifugation technology via a central venous catheter. Fresh frozen plasma was used as replacement fluid. RESULTS An average of 3.95 (1-11) apheresis sessions were applied to patients poisoned due to snakebite, and 19 patients (95 %) were discharged in an average of 8.3 (1-17) days without any complications. None of the patients enrolled in the study lost their limbs. Only one patient died due to disseminated intravascular coagulopathy. Six patients with CCHF who received 5 sessions of TPE on average were discharged successfully after an average of 6.5 days. No adverse events or complications were observed in any patient after TPE. CONCLUSIONS TPE is a good alternative and a reliable method in treating envenomation cases who are refractory to supportive measures. TPE should be performed without delay in cases of poisoning due to snakebite and CCHF.
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Affiliation(s)
- Ilhami Berber
- Inonu University, Department of Hematology, Malatya, Turkey
| | - Serdal Korkmaz
- University of Health Sciences, Kayseri City Training and Research Hospital, Department of Hematology & Apheresis Unit, Kayseri, Turkey
| | - Ahmet Sarici
- Inonu University, Department of Hematology, Malatya, Turkey
| | | | - Irfan Kuku
- Inonu University, Department of Hematology, Malatya, Turkey
| | - Emin Kaya
- Inonu University, Department of Hematology, Malatya, Turkey
| | - Soykan Bicim
- Inonu University, Department of Hematology, Malatya, Turkey
| | - Mustafa Ozgul
- Inonu University, Department of Hematology, Malatya, Turkey
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18
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Crimean-Congo hemorrhagic fever outbreak in Turkey amid the coronavirus disease 2019 (COVID-19) pandemic; a debacle for the healthcare system of Turkey. Infect Control Hosp Epidemiol 2021; 43:1726-1727. [PMID: 34308813 PMCID: PMC8365041 DOI: 10.1017/ice.2021.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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19
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Shyma KP, Gupta JP, Parsani HR, Ankuya KJ, Singh V. Ivermectin resistance in the multi-host tick Hyalomma anatolicum (Acari: Ixodidae) in India. Ticks Tick Borne Dis 2021; 12:101791. [PMID: 34329928 DOI: 10.1016/j.ttbdis.2021.101791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022]
Abstract
The multi-host tick, Hyalomma anatolicum is a widely distributed vector of many pathogens of veterinary and public health importance. Ivermectin (IVM), as an alternative to control pyrethroid-resistant ticks, has been used extensively for the past 4-6 years in tropical and sub-tropical countries including India resulting in declining tick control efficacy. The present study used adult immersion test (AIT) to examine the resistance status of H. anatolicum collected from three districts in the Indian state of Gujarat against ivermectin. Probit analysis was used for calculation of concentration-mortality regressions; concentrations required for 50% mortality (LC50) and 95% mortality (LC95), along with confidence intervals; slope of mortality; % inhibition of oviposition; and discriminating concentration (DC). The calculated LC50 and LC95 estimates were utilized to determine resistance ratios (RR50, RR95) and the resistance levels (RL) of the field ticks compared to the susceptible population. The DC (2 x LC95) for IVM was calculated as 84.48 ppm, using susceptible H. anatolicum ticks (KHD). Lower estimates of the coefficient of non-determination (1-R2) for AIT ranged from 0.06 to 0.27, and the range of RR50 and RR95 values against IVM was estimated to be from 1.43 to 52.06 and 1.14 to 71.99, respectively, which indicated a varying degree of resistance among the field tick populations. Based on RR50 values, tick populations from Danta and Palanpur showed resistance level IV and II, respectively. Another four populations (Vadgam, Kankrej, Saraswati and Sidhpur) were classified as having level I resistance status against IVM. To our knowledge, this is the first report of ivermectin resistance in H. anatolicum from Gujarat, India.
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Affiliation(s)
- K P Shyma
- Department of Veterinary Parasitology, College of Veterinary Science & AH, Kamdhenu University (Erstwhile SDAU), Sardarkrushinagar, 385506 Gujarat (India).
| | - Jay Prakash Gupta
- Department of Animal Genetics & Breeding, College of Veterinary Science & AH, Kamdhenu University (Erstwhile SDAU), Sardarkrushinagar, 385506 Gujarat (India).
| | - H R Parsani
- Department of Veterinary Parasitology, College of Veterinary Science & AH, Kamdhenu University (Erstwhile SDAU), Sardarkrushinagar, 385506 Gujarat (India).
| | - K J Ankuya
- Department of Livestock Production & Management, College of Veterinary Science & AH, Kamdhenu University (Erstwhile SDAU), Sardarkrushinagar, 385506 Gujarat (India).
| | - Veer Singh
- Department of Veterinary Parasitology, College of Veterinary Science & AH, Kamdhenu University (Erstwhile SDAU), Sardarkrushinagar, 385506 Gujarat (India); Director Resident Instruction-cum-Dean, Post Graduate Studies, BASU, Patna, 800 014, Bihar (India).
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20
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Katta M, Sandanalakshmi R. Simultaneous tropical disease identification with PZT-5H piezoelectric material including molecular mass biosensor microcantilever collection. SENSING AND BIO-SENSING RESEARCH 2021. [DOI: 10.1016/j.sbsr.2021.100413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Sporadic outbreaks of crimean-congo haemorrhagic fever in Uganda, July 2018-January 2019. PLoS Negl Trop Dis 2021; 15:e0009213. [PMID: 33684124 PMCID: PMC7971858 DOI: 10.1371/journal.pntd.0009213] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 03/18/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne, zoonotic viral disease that causes haemorrhagic symptoms. Despite having eight confirmed outbreaks between 2013 and 2017, all within Uganda’s ‘cattle corridor’, no targeted tick control programs exist in Uganda to prevent disease. During a seven-month-period from July 2018-January 2019, the Ministry of Health confirmed multiple independent CCHF outbreaks. We investigated to identify risk factors and recommend interventions to prevent future outbreaks. Methods We defined a confirmed case as sudden onset of fever (≥37.5°C) with ≥4 of the following signs and symptoms: anorexia, vomiting, diarrhoea, headache, abdominal pain, joint pain, or sudden unexplained bleeding in a resident of the affected districts who tested positive for Crimean-Congo haemorrhagic fever virus (CCHFv) by RT-PCR from 1 July 2018–30 January 2019. We reviewed medical records and performed active case-finding. We conducted a case-control study and compared exposures of case-patients with age-, sex-, and sub-county-matched control-persons (1:4). Results We identified 14 confirmed cases (64% males) with five deaths (case-fatality rate: 36%) from 11 districts in western and central region. Of these, eight (73%) case-patients resided in Uganda’s ‘cattle corridor’. One outbreak involved two case-patients and the remainder involved one. All case-patients had fever and 93% had unexplained bleeding. Case-patients were aged 6–36 years, with persons aged 20–44 years more affected (AR: 7.2/1,000,000) than persons ≤19 years (2.0/1,000,000), p = 0.015. Most (93%) case-patients had contact with livestock ≤2 weeks before symptom onset. Twelve (86%) lived <1 km from grazing fields compared with 27 (48%) controls (ORM-H = 18, 95% CI = 3.2-∞) and 10 (71%) of 14 case-patients found ticks attached to their bodies ≤2 weeks before symptom onset, compared to 15 (27%) of 56 control-persons (ORM-H = 9.3, 95%CI = 1.9–46). Conclusions CCHF outbreaks occurred sporadically during 2018–2019, both within and outside ‘cattle corridor’ districts of Uganda. Most cases were associated with tick exposure. The Ministry of Health should partner with the Ministry of Agriculture, Animal Industry and Fisheries to develop joint nationwide tick control programs and strategies with shared responsibilities through a One Health approach. Uganda has had multiple Crimean-Congo haemorrhagic fever outbreaks since 2013 when the first outbreak was confirmed. Tick exposure has been identified as the major risk factor by our study and this finding was similar with other studies done during outbreaks in Uganda. However, Uganda still lacks national tick control guidelines and indiscriminate use of acaricides (pesticides specially for ticks) has been observed widely. This has been cited to influence increased tick resistance to acaricides. Our study might not indicate whether tick resistance to acaricides has increased tick populations in Uganda however it is imperative that tick control is considered in efforts of prevention and control of CCHF outbreaks. We therefore recommend improved tick control in Uganda through national regulations on acaricide distribution and use, development of strategies to reduce tick resistance to acaricides in the country, and more community-based engagement of tick control in livestock management.
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22
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High prevalence and different genotypes of Crimean-Congo hemorrhagic fever virus genome in questing unfed adult Hyalomma marginatum in Thrace, Turkey. Ticks Tick Borne Dis 2020; 12:101622. [PMID: 33388553 DOI: 10.1016/j.ttbdis.2020.101622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease in the old continents, in many countries south of the 50 °North Parallel. The agent is known to be the most prevalent and major cause of severe and fatal human hemorrhagic diseases among the tick-borne viruses, and is the second most widespread of all medically critical arboviruses following dengue. Members of the Hyalomma genus are mainly involved in the natural transmission of the CCHF virus (CCHFV); of those, H. marginatum is known to be the primary vector of the disease in the Western Palaearctic. In general, epidemiological studies have been based on serological detections in the hosts and/or virus screening of ticks collected from the hosts. To the best of our knowledge, only a few studies have been carried out to screen the virus in unfed, questing field ticks. Nevertheless, detection of the virus in questing ticks is known to be a crucial parameter to determine the possible vector roles of the ticks and to understand the ecological dynamics of related diseases. In this study, 200 (75 males,125 females) questing H. marginatum adults collected from the field in nine villages in Thrace, located in the European part of Turkey, were screened individually for CCHFV using nested PCR. As a result, 103 (51.5 %) ticks were determined as positive with various strains of CCHFV. High positivity in questing vectors in a region where a significantly lower number of human cases have been encountered suggests that there should be some region-specific drivers that are effective in the natural dynamics of the disease. Detailed etiological and epidemiological studies are needed to reveal the possible reason for this unexpected discrepancy.
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Arab-Bafrani Z, Jabbari A, Mostakhdem Hashemi M, Arabzadeh AM, Gilanipour A, Mousavi E. Identification of the crucial parameters regarding the efficacy of ribavirin therapy in Crimean-Congo haemorrhagic fever (CCHF) patients: a systematic review and meta-analysis. J Antimicrob Chemother 2020; 74:3432-3439. [PMID: 31369086 DOI: 10.1093/jac/dkz328] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Recently, ribavirin has been suggested as a therapeutic approach in Crimean-Congo haemorrhagic fever (CCHF) patients; however, there are controversial findings about its efficacy. In the current study, a meta-analysis was systematically performed to assess the effectiveness of ribavirin administration regarding CCHF patient survival and to explore the most important influential parameters for its efficacy. METHODS All of the outcomes of the clinically studied CCHF patients who were treated with ribavirin were included in the meta-analysis. RESULTS Overall, 24 studies met our criteria. Although the studies did not have high quality there was no heterogeneity and publication bias across studies. The results indicated that the administration of ribavirin to CCHF patients significantly decreased the mortality rate (by 1.7-fold) compared with those who did not receive this medication. Furthermore, it was found that the prescription of ribavirin in the initial phase of disease was more effective, and a delay in the start of treatment resulted in a 1.6-fold increase in mortality rate. In addition, interventional therapy resulted in an ∼2.3-fold reduction in the mortality rate of those who received ribavirin along with corticosteroids compared with those who were treated with ribavirin monotherapy. CONCLUSIONS This meta-analysis reveals that ribavirin should be considered as a crucial antiviral drug in the therapeutic approach used for CCHF patients, especially in early phases of the disease. Additionally, it seems that the administration of corticosteroids alongside ribavirin can play an effective role in alleviation of the disease status, particularly in haemorrhagic phases.
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Affiliation(s)
- Zahra Arab-Bafrani
- Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran.,Department of Biochemistry and Biophysics, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ali Jabbari
- Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran.,Department of Anesthesiology and Critical Care Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Ali Mohammad Arabzadeh
- Department of Medical Microbiology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Atena Gilanipour
- Department of Medical Microbiology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Mousavi
- Department of Medical Microbiology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Noreen N, Saima D, Irum N, Asghar RJ, Faiz AU, Mohiuddin N, Ali Khan M, Ullah Khan N, Khudaidad F, Khalid Khan F. ‘Characterisation of suspected Crimean-Congo Haemorrhagic Fever (CCHF) cases in a public sector hospital Islamabad’. GLOBAL SECURITY: HEALTH, SCIENCE AND POLICY 2020. [DOI: 10.1080/23779497.2020.1823869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Nadia Noreen
- Directorate of Central Health Establishments, IIAP (Airport Health Establishment), Islamabad, Pakistan
| | - Dil Saima
- Livestock & Diary Department, FELTP Pakistan, Rawalpindi, Punjab, Pakistan
| | - Naveed Irum
- Administration, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Rana Jawad Asghar
- Public Health Department, CEO Global Health Strategists & Implementers (GHSI), Islamabad, Pakistan
| | - Asad Ullah Faiz
- Regulations, Services & Coordinations, Ministry of National Health, Islamabad, Pakistan
| | - Naseer Mohiuddin
- Regulations, Services & Coordinations, Ministry of National Health, Islamabad, Pakistan
| | - Mumtaz Ali Khan
- Federal Disease Surveillance Division, NIH, Islamabad, Pakistan
| | - Naveed Ullah Khan
- Department of Surgery, Federal Government Polyclinic Hospital, Islamabad, Pakistan
| | - Farida Khudaidad
- Department Bolan University of Medical & Health Sciences, FELTP alumnus, Quetta, Pakistan
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Ergünay K, Polat C, Özkul A. Vector-borne viruses in Turkey: A systematic review and bibliography. Antiviral Res 2020; 183:104934. [PMID: 32949637 DOI: 10.1016/j.antiviral.2020.104934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
Turkey serves as a natural hub for the dissemination of vector-borne viruses and provides many suitable habitats with diverse ecologies for introduction and establishment of new pathogens. This manuscript provides an updated systematic review and meta-analysis of the vector-borne viruses documented in Turkey. Following web-based identification, screening and eligibility evaluation, 291 published reports were reviewed. The publications were categorized and listed as a supplementary bibliography accompanying the manuscript. In brief, Crimean-Congo hemorrhagic fever virus (CCHFV) and West Nile virus (WNV) are currently documented as prominent tick and mosquito-borne viral pathogens in Turkey. CCHFV produces a significant number of infections annually, with severe outcome or death in a portion of cases. WNV gained attention following the clustering of cases in 2010. Exposure and infections with sandfly-borne phleboviruses, such as Toscana virus, are indigenous and widespread. Epidemiology, risk factors, symptomatic infections in susceptible hosts, vectors and reservoirs for these pathogens have been explored in detail. Detection of novel viruses in mosquitoes, sandflies and ticks from several regions is of particular interest, despite scarce information on their epidemiology and pathogenicity in vertebrates. Introduction and emergence of viruses transmitted by invasive Aedes mosquitoes constitute a threat, albeit only imported infections have so far been documented. Detection of Rift valley fever virus exposure is also of concern, due to its detrimental effects on livestock and spillover infections in humans. Vigilance to identify and diagnose probable cases as well as vector surveillance for established and potential pathogens is therefore, imperative.
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Affiliation(s)
- Koray Ergünay
- Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, Virology Unit, Ankara, 06100, Turkey.
| | - Ceylan Polat
- Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, Virology Unit, Ankara, 06100, Turkey
| | - Aykut Özkul
- Ankara University, Faculty of Veterinary Medicine, Department of Virology, Ankara, 06110, Turkey
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Yeşilbağ Z, Karadeniz A, Koçulu S, Kayhan CB. Epidemiological characteristics, clinical and laboratory findings supporting preliminary diagnosis of Crimean-Congo hemorrhagic fever in an endemic region in Turkey. Wien Klin Wochenschr 2020; 132:581-588. [PMID: 32749537 DOI: 10.1007/s00508-020-01719-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease that has various symptoms. Since rapid diagnosis is crucial for survival, understanding the characteristics of patients is important for clinicians while waiting for results. This study aimed to evaluate findings that support the preliminary diagnosis of suspected CCHF in patients and take a look at the management of CCHF in Turkey. METHODS Demographics, presenting symptoms and laboratory findings of the patients admitted with a suspicion of CCHF, were recorded from the patient files and database of Ministry of Health. A diagnosis of CCHF was based on detection of immunoglobulin M (IgM) antibodies and/or viral RNA. The patients with and without CCHF were compared in terms of differences in epidemiological, clinical and laboratory findings. RESULTS Out of 87 patients, 61 (70.1%) were CCHF and 26 (29.9%) were non-CCHF cases. Working with agriculture/livestock, tick exposure, contact with body fluids of animals, travel to rural areas within 2 weeks, fever, headache, leucopenia, anemia, international normalized ratio (INR) elevation were significantly more common in CCHF cases. According to multivariate analysis, tick exposure (odds ratio, OR 9.03, 95% confidence interval, CI 1.96-41.47, p = 0.005), contact with body fluids of animals (OR 14.9, 95% CI 2.23-99.94, p = 0.005), leucopenia (OR 13.65, 95% CI 2.55-72.91, p = 0.02) and anemia (OR 8.41, 95% CI 1.06-66.42, p = 0.04) were independently indicative for CCHF. CONCLUSION As it takes a considerable time for a definitive diagnosis, determining epidemiological features and risk factors is an important step for preliminary diagnosis of CCHF as well as early implementation of precautions against nosocomial transmission of the virus.
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Affiliation(s)
- Zuhal Yeşilbağ
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Dr. Tevfik Saglam street, No:11, 34147, Bakırköy/Istanbul, Turkey.
| | - Aslı Karadeniz
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Maltepe University, Istanbul, Turkey
| | - Safiye Koçulu
- Department of Infectious Diseases and Clinical Microbiology, Florence Nightingale Hospital, Istanbul, Turkey
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Yilmaz R, Karaaslan E, Albayrak SE, Gul A, Kasap T. Analysis of Pediatric Intensive Care Unit Admissions for Crimean–Congo Hemorrhagic Fever in Turkey. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0040-1713162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Objective The aim of this study was to determine the clinical characteristics, course of disease, and outcomes of patients admitted to our pediatric intensive care unit (PICU) for Crimean–Congo hemorrhagic fever (CCHF).
Methods Data of all patients with CCHF who were admitted to PICU during a 3-year period and whose diagnosis was confirmed by serological methods or polymerase chain reaction were retrospectively reviewed. Their presenting characteristics, treatments, and outcomes were extracted from the hospital's electronic database. Disease severity scoring was performed using the severity scoring index and severity grading score system.
Results The data of 22 of 123 patients with suspected CCHF who were admitted to PICU were evaluated. Among them, 68.2% were males and mean age of all patients was 13.4 ± 2.2 years. The average length of stay of 10 patients was >10 days. On average, 3.72 units of platelet suspension per patient was transfused. In the course of the disease, the highest laboratory values were reached on day 3 of admission.
Conclusion Poor CCHF outcome depends on thrombocytopenia severity, prolonged coagulation tests, high-liver enzyme levels, and disseminated intravascular coagulation. Poor outcomes can be avoided by CCHF awareness and preparedness, early diagnosis of the disease, and supportive treatment with appropriate fluid and blood product transfusion. Randomized controlled trials on prophylactic transfusion and ribavirin use are needed.
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Affiliation(s)
- Resul Yilmaz
- Division of Pediatric Critical Care, Department of Pediatrics, Selcuk University School of Medicine, Konya, Turkey
| | - Erhan Karaaslan
- Department of Pediatrics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | | | - Ali Gul
- Department of Pediatrics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Tuba Kasap
- Department of Pediatrics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
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Tipih T, Burt FJ. Crimean-Congo Hemorrhagic Fever Virus: Advances in Vaccine Development. Biores Open Access 2020; 9:137-150. [PMID: 32461819 PMCID: PMC7247048 DOI: 10.1089/biores.2019.0057] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2020] [Indexed: 01/12/2023] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a severe human disease with mortality rates of up to 30%. The disease is widespread in Africa, Asia, the Middle East and Eastern Europe. The last few years have seen disease emergence in Spain for the first time and disease re-emergence in other regions of the world after periods of inactivity. Factors, such as climate change, movement of infected ticks, animals, and changes in human activity, are likely to broaden endemic foci. There are therefore concerns that CCHF might emerge in currently nonendemic regions. The absence of approved vaccines or therapies heightens these concerns; thus Crimean-Congo hemorrhagic fever virus (CCHFV) is listed by the World Health Organization as a priority organism. However, the current sporadic nature of CCHF cases may call for targeted vaccination of risk groups as opposed to mass vaccinations. CCHF vaccine development has accelerated in recent years, partly because of the discovery of CCHF animal models. In this review, we discuss CCHF risk groups who are most likely to benefit from vaccine development, the merits and demerits of available CCHF animal models, and the various approaches which have been explored for CCHF vaccine development. Lastly, we present concluding remarks and research areas which can be further explored to enhance the available CCHFV vaccine data.
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Affiliation(s)
- Thomas Tipih
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Felicity Jane Burt
- Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- National Health Laboratory Service, Bloemfontein, South Africa
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Karamese M, Ozmen E, Aydin H, Timurkan MO, Fakirullahoglu M. Molecular characterization of small and medium segments of Crimean-Congo hemorrhagic fever virus in Turkey. Future Virol 2020. [DOI: 10.2217/fvl-2020-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: The objective was to investigate the genotypic relationship of S and M segments in Crimean-Congo hemorrhagic fever virus (CCHFV) by phylogenetic analysis in 25 patients from seven endemic cities in Turkey. Materials & methods: A total of 25 samples from patients with CCHF were included between 2012 and 2015. Phylogenetic tree analyses were inferred using MEGA version-6.0 and distances were calculated by Kimura’s 2-parameter. Results: Phylogenetic analysis showed that all isolated viruses (n = 25) were in the predicted clades such as clade V- Europe-1 regarding both S and M segments of the CCHFV. Conclusion: Further epidemiological, molecular and phylogenic studies should be performed in both reservoir animals/vectors and humans to determine the incidence of tick-borne infectious disease and to help to develop vaccines for prevention of the disease.
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Affiliation(s)
- Murat Karamese
- Department of Medical Microbiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Erkan Ozmen
- Department of Microbiology, Ministry of Health, Public Health Institution, Erzurum, Turkey
| | - Hakan Aydin
- Department of Virology, Faculty of Veterinary Medicine, Ataturk University, Erzurum, Turkey
| | - Mehmet Ozkan Timurkan
- Department of Virology, Faculty of Veterinary Medicine, Ataturk University, Erzurum, Turkey
| | - Mesud Fakirullahoglu
- Department of Microbiology, Ministry of Health, Public Health Institution, Erzurum, Turkey
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Nosocomial infections caused by Crimean-Congo haemorrhagic fever virus. J Hosp Infect 2019; 105:43-52. [PMID: 31821852 DOI: 10.1016/j.jhin.2019.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/03/2019] [Indexed: 11/21/2022]
Abstract
Crimean-Congo haemorrhagic fever (CCHF) is an acute febrile illness, often accompanied by haemorrhagic manifestations, with a high case fatality rate (CFR). The causative agent is CCHF virus (CCHFV), and is transmitted to humans mainly through tick bites or exposure to blood or tissues of viraemic patients or livestock. Human-to-human transmission usually occurs in hospital settings, and healthcare workers (HCWs) are mainly affected. A review on nosocomial CCHFV infections was performed to elucidate the routes and circumstances of CCHFV transmission in hospital settings. From 1953 to 2016, 158 published cases of CCHFV nosocomial infection in 20 countries in Africa, Asia and Europe were found. Almost all cases were symptomatic (92.4%), with an overall CFR of 32.4%. The majority of cases occurred in hospital clinics (92.0%) and 10 cases (8.0%) occurred in laboratories. Most cases occurred among HCWs (86.1%), followed by visitors (12.7%) and hospitalized patients (1.3%). Nursing staff (44.9%) and doctors (32.3%) were the most affected HCWs, followed by laboratory staff (6.3%). The primary transmission route was percutaneous contact (34.3%). Cutaneous contact accounted for 22.2% of cases, followed by exposure to aerosols (proximity) (18.2%), indirect contact (17.2%) and exposure to patient environment (8.1%). CCHFV can cause nosocomial infections with a high CFR. During the care and treatment of patients with CCHF, standard contact precautions, barrier precautions and airborne preventive measures should be applied. In order to improve patient safety and reduce healthcare-associated CCHFV exposure, there is a need for guidelines and education for HCWs to ensure that CCHF is appropriately included in differential diagnoses; this will enable early diagnosis and implementation of infection prevention measures.
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Blair PW, Kuhn JH, Pecor DB, Apanaskevich DA, Kortepeter MG, Cardile AP, Polanco Ramos A, Keshtkar-Jahromi M. An Emerging Biothreat: Crimean-Congo Hemorrhagic Fever Virus in Southern and Western Asia. Am J Trop Med Hyg 2019; 100:16-23. [PMID: 30652673 DOI: 10.4269/ajtmh.18-0553] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Tick-borne Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in numerous countries, but the epidemiology and epizoology of Crimean-Congo hemorrhagic fever (CCHF) remain to be defined for most regions of the world. Using a broad database search approach, we reviewed the literature on CCHF and CCHFV in Southern and Western Asia to better define the disease burden in these areas. We used a One Health approach, moving beyond a focus solely on human disease burden to more comprehensively define this burden by reviewing CCHF case reports, human and animal CCHFV seroprevalence studies, and human and animal CCHFV isolations. In addition, we used published literature to estimate the distribution of Hyalomma ticks and infection of these ticks by CCHFV. Using these data, we propose a new classification scheme for organizing the evaluated countries into five categories by level of evidence for CCHF endemicity. Twelve countries have reported CCHF cases, five from Southern Asia and seven from Western Asia. These were assigned to level 1 or 2. Eleven countries that have evidence of vector circulation but did not report confirmed CCHF cases were assigned to level 3 or 4. This classification scheme was developed to inform policy toward strengthening CCHF disease surveillance in the Southern and Western Asia regions. In particular, the goal of this review was to inform international organizations, local governments, and health-care professionals about current shortcomings in CCHFV surveillance in these two high-prevalence regions.
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Affiliation(s)
- Paul W Blair
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - David B Pecor
- Department of Entomology, Smithsonian Institution Museum Support Center, Suitland, Maryland
| | | | | | - Anthony P Cardile
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland
| | | | - Maryam Keshtkar-Jahromi
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Crimean-Congo hemorrhagic fever: An update. Med Mal Infect 2019; 49:574-585. [PMID: 31607406 DOI: 10.1016/j.medmal.2019.09.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/22/2018] [Accepted: 09/03/2019] [Indexed: 11/23/2022]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a severe form of hemorrhagic fever caused by a virus of the genus Nairovirus. The amplifying hosts are various mammal species that remain asymptomatic. Humans are infected by tick bites or contact with animal blood. CCHF has a broad geographic distribution and is endemic in Africa, Asia (in particular the Middle East) and South East Europe. This area has expanded in recent years with two indigenous cases reported in Spain in 2016 and 2018. The incubation period is short with the onset of symptoms in generally less than a week. The initial symptoms are common to other infectious syndromes with fever, headache, myalgia and gastrointestinal symptoms. The hemorrhagic syndrome occurs during a second phase with sometimes major bleeding in and from the mucous membranes and the skin. Strict barrier precautionary measures are required to prevent secondary and nosocomial spread. CCHF may be documented by PCR detection of the virus genome during the first days after the onset of illness, and then by serological testing for IgM antibodies as from the 2nd week after infection. Patient management is mainly based on supportive care. Despite a few encouraging retrospective reports, there is no confirmed evidence that supports the use of ribavirin for curative treatment. Nevertheless, the World Health Organization continues to recommend the use of ribavirin to treat CCHF, considering the limited medical risk related to short-term treatment. The prescription of ribavirin should however be encouraged post-exposure for medical professionals, to prevent secondary infection.
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Kayadibi H, Yapar D, Akdogan O, Ulusu NN, Baykam N. Hitit Index to distinguish patients with and without Crimean-Congo hemorrhagic fever. Ticks Tick Borne Dis 2019; 10:1035-1040. [PMID: 31160263 DOI: 10.1016/j.ttbdis.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/20/2019] [Accepted: 05/25/2019] [Indexed: 02/07/2023]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is fatal. Therefore, it is very important to use an inexpensive, easily accessible, quick and accurate screening index based on clinical signs and laboratory parameters to identify patients suspected of having CCHF. Laboratory test results on the day of hospitalization for 268 inpatients suspected of having CCHF were used to calculate the laboratory section of the Hitit Index, while 65 of these were also monitored daily during their hospital stay to develop the clinical section of the Hitit Index. Two-hundred CCHF-negative outpatients were also evaluated. One-hundred and forty-nine inpatients were CCHF-positive and 119 inpatients were CCHF-negative. The Hitit Index is 5.6 - (5.3*lymphocyte) - (0.02*fibrinogen) - (12*direct bilirubin) + (0.04*AST) + (0.32*hematocrit) - (0.5*neutrophil) - (0.07*CKD-EPI) - (0.001*CK) ± conjunctival hyperemia (+1.5 in conjunctival hyperemia presence and -1.5 in conjunctival hyperemia absence). In 65 inpatients monitored daily, Hitit Index results for CCHF-positive and negative inpatients were 6.10(1.90-12.30) and -5.35(-8.83- -1.95), while CCHF-negative outpatients were -10.99(-15.64- -6.95) (P < 0.001), respectively. On hospitalization day, just one inpatient was false-negative in 27 CCHF-positive inpatients, while four were false-positive among 38 CCHF-negative inpatients using the Hitit Index. After 24 h, just one inpatient was diagnosed falsely among 27 CCHF-positive and 38 CCHF-negative inpatients, and there was no change after 48 h. Management of patients living in endemic regions suspected of having CCHF could be achieved within minutes using the Hitit Index. Patients with Hitit Index less than zero can be monitored as outpatients, while patients with Hitit Index results above zero must be hospitalized in infectious diseases wards. This study was not registered since it was retrospective.
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Affiliation(s)
- Huseyin Kayadibi
- Hitit University School of Medicine, Department of Medical Biochemistry, Corum, Turkey.
| | - Derya Yapar
- Hitit University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
| | - Ozlem Akdogan
- Hitit University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
| | - Nuray N Ulusu
- Koc University School of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
| | - Nurcan Baykam
- Hitit University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Corum, Turkey
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Vandegrift KJ, Kapoor A. The Ecology of New Constituents of the Tick Virome and Their Relevance to Public Health. Viruses 2019; 11:v11060529. [PMID: 31181599 PMCID: PMC6630940 DOI: 10.3390/v11060529] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/07/2019] [Accepted: 05/29/2019] [Indexed: 01/19/2023] Open
Abstract
Ticks are vectors of several pathogens that can be transmitted to humans and their geographic ranges are expanding. The exposure of ticks to new hosts in a rapidly changing environment is likely to further increase the prevalence and diversity of tick-borne diseases. Although ticks are known to transmit bacteria and viruses, most studies of tick-borne disease have focused upon Lyme disease, which is caused by infection with Borrelia burgdorferi. Until recently, ticks were considered as the vectors of a few viruses that can infect humans and animals, such as Powassan, Tick-Borne Encephalitis and Crimean–Congo hemorrhagic fever viruses. Interestingly, however, several new studies undertaken to reveal the etiology of unknown human febrile illnesses, or to describe the virome of ticks collected in different countries, have uncovered a plethora of novel viruses in ticks. Here, we compared the virome compositions of ticks from different countries and our analysis indicates that the global tick virome is dominated by RNA viruses. Comparative phylogenetic analyses of tick viruses from these different countries reveals distinct geographical clustering of the new tick viruses. Some of these new tick RNA viruses (notably severe fever with thrombocytopenia syndrome virus and Heartland virus) were found to be associated with serious human diseases. Their relevance to public health remains unknown. It is plausible that most of these newly identified tick viruses are of endogenous origin or are restricted in their transmission potential, but the efforts to identify new tick viruses should continue. Indeed, future research aimed at defining the origin, the ecology and the spillover potential of this novel viral biodiversity will be critical to understand the relevance to public health.
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Affiliation(s)
- Kurt J Vandegrift
- The Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Amit Kapoor
- Center for Vaccines and Immunity, Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Department of Pediatrics, Ohio State University, Columbus, OH 43205, USA.
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Aydin H, Uyanik MH, Karamese M, Sozdutmaz I, Timurkan MO, Gulen A, Ozmen E, Aktas O. Serological Investigation of Occupational Exposure to Zoonotic Crimean-Congo Hemorrhagic Fever Infection. Eurasian J Med 2019; 52:132-135. [PMID: 32612419 DOI: 10.5152/eurasianjmed.2020.19176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/24/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Crimean-Congo hemorrhagic fever (CCHF) is an acute and highly fatal disease. In this study, our aim was to compare and evaluate the prevalence of CCHF virus (CCHFV) antibody among occupational high-risk groups by using the enzyme-linked immunosorbent assay and draw attention to the occupational groups that are at high risk for CCHF infection in an endemic region for this zoonotic infection in Erzurum, Turkey. Materials and Methods The antibody levels against CCHFV were surveyed among slaughterhouse workers, animal breeders, and veterinarians. The study population was composed of 72 participants having direct contact with animals and 19 blood donors who were not in direct contact with animals. Results The overall rate of CCHF immunoglobulin G positivity in risk groups was found to be 6.94% (5/72). CCHFV antibodies were found in 4 (12.5%) individuals of the animal breeder group. This ratio was considered significantly higher compared with the healthy control group. CCHFV antibodies were found in only one person (4.0%) who was an abattoir worker. In the veterinarian group, all people were found negative. Conclusion In our study, the variables showing important associations with the prevalence of anti-CCHFV antibodies were livestock breeding, rural areas, and age. It was concluded that our region is endemic with regard to CCHF infection and persons who had direct contact with animals are at high risk. Thus, these participants must take necessary measures to protect themselves from CCHF and should be trained by health authorities.
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Affiliation(s)
- Hakan Aydin
- Department of Virology, Ataturk University School of Veterinary Medicine, Erzurum, Turkey
| | | | - Murat Karamese
- Department of Microbiology, Kafkas University School of Medicine, Kars, Turkey
| | - Ibrahim Sozdutmaz
- Department of Virology, Erciyes University School of Veterinary Medicine, Kayseri, Turkey
| | - Mehmet Ozkan Timurkan
- Department of Virology, Ataturk University School of Veterinary Medicine, Erzurum, Turkey
| | - Abdulkadir Gulen
- Department of Microbiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Erkan Ozmen
- Department of Microbiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Osman Aktas
- Department of Microbiology, Ataturk University School of Medicine, Erzurum, Turkey
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Papa A. Emerging arboviruses of medical importance in the Mediterranean region. J Clin Virol 2019; 115:5-10. [PMID: 30928817 DOI: 10.1016/j.jcv.2019.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 01/02/2023]
Abstract
The epidemiology of viral infections transmitted by arthropods is changing due to a variety of parameters related to the virus, the host and the environment. The Mediterranean region is highly affected by changes in the intensity and extension of global-scale climate patterns, and, due to its location, it provides a vulnerable environment for emergence of arboviral diseases. The main arboviruses that pose currently a public health threat in the Mediterranean region are West Nile virus and Crimean-Congo hemorrhagic fever virus and, in less extend, tick-borne encephalitis virus. Usutu virus that affects mainly birds, can infect also humans, while Dengue and Chikungunya viruses showed that they are capable to cause sporadic autochthonous cases, and even outbreaks in the Mediterranean region. Sandly-transmitted viruses continue to have a public health impact, and novel ones have been identified. The presence of competent vectors (mainly mosquitoes), combined by arbovirus introduction through viremic travelers returning from endemic regions, prompt for increased surveillance to mitigate the risk for local transmission. In order to tackle efficiently and effectively the emerging arboviral diseases, an integrated "One Health initiative" is required to be maintained, involving public health, animal health and environmental authorities. Awareness of medical and veterinary staff and laboratory capacity are crucial for the early detection of pathogens, while reporting the unusual and enhance surveillance are important.
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Affiliation(s)
- Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece.
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Gozdas HT. Evaluation of Crimean-Congo hemorrhagic fever suspected cases admitted to a secondary care hospital in Kastamonu, Turkey between 2014-2017. Afr Health Sci 2019; 19:1433-1440. [PMID: 31148970 PMCID: PMC6531986 DOI: 10.4314/ahs.v19i1.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Crimean-Congo hemorrhagic fever (CCHF) is an endemic zoonosis in Kastamonu, Turkey. Clinical and laboratory findings may not be specific in the early phase of the disease, hence bringing a challenge to the clinician. Objective We aimed to distinguish CCHF cases among all suspected cases by comparing them with non-CCHF cases with respect to characteristics during admission. Methods Cases with a presumptive diagnosis of CCHF at a secondary care hospital in Kastamonu in between 2014–2017 were evaluated, retrospectively. CCHF and non-CCHF cases were compared with respect to their clinical, laboratory and epidemiological characteristics during admission. Results Among 76 suspected patients, CCHF was found in 46.1% of them. Four-year fatality rate was 9.6% in CCHF cases. The frequency of headache, nausea/vomiting, leukopenia, thrombocytopenia less than 50x109/L, AST-ALT and LDH elevation, tick bites and contact with blood or body fluids of animals in CCHF cases were significantly higher than in non-CCHF cases (p<0.05). Conclusion Headache and nausea/vomiting accompanied with leukopenia, thrombocytopenia less than 50x109/L, AST-ALT and LDH elevations raise the possibility of CCHF in endemic regions especially when there is a history of tick bite and contact with blood or body fluids of animals.
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Affiliation(s)
- Hasan Tahsin Gozdas
- Department of Infectious Diseases and Clinical Microbiology, Kastamonu State Hospital, Kastamonu, Turkey
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Say Coskun US, Asık Z. Genotypic analysis of S segment of Crimean-Congo hemorrhagic fever virus in Turkey. Acta Microbiol Immunol Hung 2019; 66:79-89. [PMID: 30203691 DOI: 10.1556/030.65.2018.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Crimean-Congo hemorrhagic fever (CCHF) virus (CCHFV) is a tick-borne virus, whose viral RNA consists of S, L, and M segments. The virus is migrating through the ticks with animals and migratory birds and the geographical distribution can be investigated based on genetic analysis. To better understand the connection between the seropositivity and the mortality rate, the key factor could be the temporal and spatial analysis of the different strains. In this study, serum samples (n = 26) were selected from CCHFV RNA-positive patients and subjected to sequence analysis of the gene regions encoding the S segments. According to the neighbor-joining analysis, the obtained partial sequences were linked to the European strain. The strains were closely related to Turkey-Kelkit06, Turkey 200310849 viruses, and viruses from Russia and Kosovo. The comparison with previously analyzed isolates from the GenBank showed 95%-99% sequence similarity. The isolates in phylogenetic branches were divided into two groups. AST, platelet, and APTT levels were found significantly higher in Group 2 compared to Group 1. Nucleotide differences can be prognostic factor in CCHF disease. Increasing CCHF cases not originating from local isolates were circulating strains imported from different neighboring countries of Turkey. The results show new evidence to the emerging threat of the CCHF disease.
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Affiliation(s)
- Umut Safiye Say Coskun
- 1 Faculty of Medicine, Department of Medical Microbiology, Gaziosmanpasa University, Tokat, Turkey
| | - Zahide Asık
- 2 Infection Disease Clinic, Tokat State Hospital, Tokat, Turkey
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Oguzturk H, Kama A, Mete B, Gungorer B, Ozlem M, Kayipmaz A, San I. Epidemiological and clinical data of patients with stings and bites at a medical center of Turkey. JOURNAL OF ACUTE DISEASE 2019. [DOI: 10.4103/2221-6189.263706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Barzon L. Ongoing and emerging arbovirus threats in Europe. J Clin Virol 2018; 107:38-47. [PMID: 30176404 DOI: 10.1016/j.jcv.2018.08.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/20/2018] [Indexed: 11/17/2022]
Abstract
During the last decades, arboviruses that are endemic in Europe have expanded their geographic range and caused an increasing number of human outbreaks. These viruses include West Nile virus, which is expanding its area of circulation in central and southern Europe; Usutu virus, with increasing evidence of a role in human disease; tick-borne encephalitis virus, which is being detected in northern areas and at higher altitudes as a consequence of climate warming; Crimean-Congo hemorrhagic fever virus, which is endemic in Eastern Europe and the Middle East, but has been recently detected in Spain; other viruses, such as California encephalitis virus antigenic group, which circulate in northern and central Europe but whose relevance for human disease in largely unknown. In addition, the rise in global travel and trade has posed Europe to an increased risk of introduction and expansion of exotic arthropod vectors and autochthonous transmission of arboviruses, like dengue and chikungunya viruses, following new introductions from endemic areas. Implementation of integrated arbovirus surveillance programs has been crucial to adopt proper control measures. The identification of emerging outbreaks is however challenging and requires a high degree of awareness and laboratory capacity, especially for the most neglected but potentially threatening pathogens.
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Affiliation(s)
- Luisa Barzon
- Department of Molecular Medicine, University of Padova, via A. Gabelli 63, 35121, Padova, Italy.
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Büyüktuna SA, Doğan HO, Bakir M, Elaldi N, Gözel MG, Engin A. The protective effect and diagnostic performance of NOX-5 in Crimean-Congo haemorrhagic fever patients. J Med Microbiol 2018; 67:543-548. [PMID: 29509132 DOI: 10.1099/jmm.0.000712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Crimean-Congo haemorrhagic fever (CCHF) is an acute viral haemorrhagic disease. Reactive oxygen species that are mainly generated by the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) enzyme family have a pivotal role in the pathophysiology of many diseases. The serum levels of NOX isoforms in patients with CCHF have yet to be assessed. METHODS This prospective study was conducted at Cumhuriyet University, Turkey. Only patients with CCHF confirmed by the National Reference Virology Laboratory were enrolled in the study. The study subjects comprised 67 CCHF patients and 70 healthy control subjects. The quantitative sandwich ELISA technique was used for the determination of serum NOX 1, 2, 4 and 5. RESULTS Higher median median NOX-1 (P=0.001) and NOX-5 (P<0.001) levels were found in patients compared to the control group. Higher median serum NOX-5 levels were found in the low-grade disease group compared to the intermediate-high disease group according to two different severity scores (P=0.003). Negative correlations were also found between the serum NOX-5 levels and the severity scores [(P<0.05, r=-0.259), (P<0.01, r=-0.417)]. The area under the curve (AUC) values for the NOX-1 and NOX-5 were 0.67 (confidence interval: 0.58-0.75) and 0.99 (confidence interval: 0.95-1.00), respectively. Lower NOX-5 levels were found in patients receiving thrombocyte suspension (P=0.004)Conclusions. NOX-5 may have a protective effect on CCHF patients and the measurement of serum NOX-5 levels may be used as a novel biochemical test in the diagnosis of CCHF.
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Affiliation(s)
- Seyit Ali Büyüktuna
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Halef Okan Doğan
- Department of Biochemistry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Mehmet Bakir
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Nazif Elaldi
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Mustafa Gökhan Gözel
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Aynur Engin
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Kleib AS, Salihy SM, Ghaber SM, Sidiel BW, Sidiya KC, Bettar ES. Crimean-Congo Hemorrhagic Fever with Acute Subdural Hematoma, Mauritania, 2012. Emerg Infect Dis 2018; 22:1305-6. [PMID: 27315138 PMCID: PMC4918161 DOI: 10.3201/eid2207.151782] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
MESH Headings
- Antibodies, Viral/immunology
- Biomarkers
- Genome, Viral
- Glasgow Outcome Scale
- Hematoma, Subdural, Acute/diagnosis
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/therapy
- Hemorrhagic Fever Virus, Crimean-Congo/classification
- Hemorrhagic Fever Virus, Crimean-Congo/genetics
- Hemorrhagic Fever Virus, Crimean-Congo/immunology
- Hemorrhagic Fever, Crimean/complications
- Hemorrhagic Fever, Crimean/diagnosis
- Hemorrhagic Fever, Crimean/epidemiology
- Hemorrhagic Fever, Crimean/history
- History, 21st Century
- Humans
- Male
- Mauritania/epidemiology
- Middle Aged
- Tomography, X-Ray Computed
- Treatment Outcome
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Monitoring for the possible introduction of Crimean-Congo haemorrhagic fever virus in Italy based on tick sampling on migratory birds and serological survey of sheep flocks. Prev Vet Med 2018; 149:47-52. [DOI: 10.1016/j.prevetmed.2017.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 11/18/2022]
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Evaluation of the associations between endothelial dysfunction, inflammation and coagulation in Crimean-Congo hemorrhagic fever patients. Arch Virol 2017; 163:609-616. [DOI: 10.1007/s00705-017-3653-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/09/2017] [Indexed: 12/29/2022]
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Mansfield KL, Jizhou L, Phipps LP, Johnson N. Emerging Tick-Borne Viruses in the Twenty-First Century. Front Cell Infect Microbiol 2017; 7:298. [PMID: 28744449 PMCID: PMC5504652 DOI: 10.3389/fcimb.2017.00298] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
Ticks, as a group, are second only to mosquitoes as vectors of pathogens to humans and are the primary vector for pathogens of livestock, companion animals, and wildlife. The role of ticks in the transmission of viruses has been known for over 100 years and yet new pathogenic viruses are still being detected and known viruses are continually spreading to new geographic locations. Partly as a result of their novelty, tick-virus interactions are at an early stage in understanding. For some viruses, even the principal tick-vector is not known. It is likely that tick-borne viruses will continue to emerge and challenge public and veterinary health long into the twenty-first century. However, studies focusing on tick saliva, a critical component of tick feeding, virus transmission, and a target for control of ticks and tick-borne diseases, point toward solutions to emerging viruses. The aim of this review is to describe some currently emerging tick-borne diseases, their causative viruses, and to discuss research on virus-tick interactions. Through focus on this area, future protein targets for intervention and vaccine development may be identified.
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Affiliation(s)
- Karen L Mansfield
- Animal and Plant Health AgencyAddlestone, United Kingdom.,Institute of Infection and Global Health, University of LiverpoolLiverpool, United Kingdom
| | - Lv Jizhou
- Animal and Plant Health AgencyAddlestone, United Kingdom.,Chinese Academy of Inspection and QuarantineBeijing, China
| | - L Paul Phipps
- Animal and Plant Health AgencyAddlestone, United Kingdom
| | - Nicholas Johnson
- Animal and Plant Health AgencyAddlestone, United Kingdom.,Faculty of Health and Medicine, University of SurreyGuildford, United Kingdom
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Draft Genome Sequences of Eight Crimean-Congo Hemorrhagic Fever Virus Strains. GENOME ANNOUNCEMENTS 2017; 5:5/23/e00240-17. [PMID: 28596387 PMCID: PMC5465606 DOI: 10.1128/genomea.00240-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Crimean-Congo hemorrhagic fever virus (CCHFV) is a geographically widespread RNA virus with a high degree of genomic diversity that complicates sequence-based diagnostics. Here, we sequenced eight CCHFV strains for improved assay design and deposition into FDA-ARGOS, the FDA’s pathogen database for development and verification of next generation sequencing assays.
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Papa A. Emerging arboviral human diseases in Southern Europe. J Med Virol 2017; 89:1315-1322. [PMID: 28252204 DOI: 10.1002/jmv.24803] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 02/20/2017] [Indexed: 01/13/2023]
Abstract
Southern Europe is characterized by unique landscape and climate which attract tourists, but also arthropod vectors, some of them carrying pathogens. Among several arboviral diseases that emerged in the region during the last decade, West Nile fever accounted for high number of human cases and fatalities, while Crimean-Congo hemorrhagic fever expanded its geographic distribution, and is considered as a real threat for Europe. Viruses evolve rapidly and acquire mutations making themselves stronger and naive populations more vulnerable. In an effort to tackle efficiently the emerging arboviral diseases, preparedness and strategic surveillance are needed for the early detection of the pathogen and containment and mitigation of probable outbreaks. In this review, the main human arboviral diseases that emerged in Southern Europe are described.
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Affiliation(s)
- Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Medlock J, Jameson L. Ecological approaches to informing public health policy and risk assessments on emerging vector-borne zoonoses. EMERGING HEALTH THREATS JOURNAL 2017. [DOI: 10.3402/ehtj.v3i0.7095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jolyon Medlock
- Medical Entomology and Zoonoses Ecology Group, Microbial Risk Assessment, Health Protection Agency, Salisbury, UK
| | - Lisa Jameson
- Medical Entomology and Zoonoses Ecology Group, Microbial Risk Assessment, Health Protection Agency, Salisbury, UK
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Ertem G, Sönmezer MÇ, Temoçin F, Ataman Hatipoğlu Ç, Tülek N, Oral B. The efficacy of oral ribavirin on clinical and laboratory parameters inCrimean-Congo hemorrhagic fever: an observational study from Turkey. Turk J Med Sci 2016; 46:1407-1414. [PMID: 27966306 DOI: 10.3906/sag-1506-92] [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: 06/20/2015] [Accepted: 01/02/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM In this observational study, the effects of oral ribavirin on clinical and laboratory parameters and blood products use in patients with Crimean-Congo hemorrhagic fever (CCHF) were evaluated. MATERIALS AND METHODS CCHF patients (n = 100) who were hospitalized between 2007 and 2010 were included. Oral ribavirin was administered to 56 patients with symptom duration less than 5 days. Forty-four patients did not receive ribavirin (control group). The patients that received ribavirin in the first 3 days following the initiation of symptoms were designated as Group 1 (n = 29) and the others were designated as Group 2. RESULTS Ribavirin-treated and untreated groups were similar in terms of demographic and most clinical characteristics. Leukocyte and platelet counts were lower in the ribavirin group than in the control group, but values of prothrombin time, activated partial thromboplastin time, aspartate aminotransferase, creatinine phosphokinase, and lactate dehydrogenase were higher (P = 0.011, P = 0.015, P = 0.001, P = 0.001, P = 0.021, P = 0.019, P = 0.004, respectively). Platelet concentrates use was greater in the ribavirin group (P = 0.01). CONCLUSION No positive effects of oral ribavirin on blood products use or clinical or laboratory parameters of CCHF patients were observed. Moreover, no difference was shown between early and late initiation of ribavirin.
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Affiliation(s)
- Günay Ertem
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Meliha Çağla Sönmezer
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Fatih Temoçin
- Department of Infectious Diseases and Clinical Microbiology, Yozgat State Hospital, Yozgat, Turkey
| | - Çiğdem Ataman Hatipoğlu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Necla Tülek
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Behiç Oral
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Ankara, Turkey
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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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