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Üçer MB, Cevher S, Üçer S. Choroidal changes in Crimean-Congo hemorrhagic fever. J Fr Ophtalmol 2024; 47:103965. [PMID: 37798172 DOI: 10.1016/j.jfo.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/25/2023] [Accepted: 06/19/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE The goal of this study was to evaluate the effect of Crimean-Congo hemorrhagic fever (CCHF) on choroidal tissue. METHODS Thirty-two CCHF patients and 34 healthy individuals were included in this cross-sectional study. All subjects were assessed using spectral domain optical coherence tomography and ImageJ software. The choroidal thickness (CT) in the subfoveal, nasal and temporal regions 1 mm from the foveal center was measured. The total choroidal area (TCA), luminal area (LA), stromal area (SA) and choroidal vascularity index (CVI) were calculated. RESULTS The nasal (P=0.002), subfoveal (P=0.006), and temporal CT (P=0.028) were significantly higher in the CCHF group. The TCA (P=0.021), SA (P=0.001) was significantly higher, and LA/SA (P<0.001) and CVI (P<0.001) were significantly lower in patients with CCHF. Significant negative correlations were found between temporal CT (r=-0.387, P=0.029), TCA (r=-0.461, P=0.008), LA (r=-0.480, P=0.005) SA (r=-0.419, P=0.017) and fibrinogen. Nasal CT, temporal CT, TCA and SA tended to increase with the severity of the disease, while LA/SA tended to decrease when CCHF patients were grouped into mild and moderate stages. CONCLUSIONS This study demonstrates significant changes in the choroidal structure and vascular characteristics in CCHF patients. These findings may be associated with endothelial damage, vascular leakage, capillary fragility, impaired immune response, and/or inflammation.
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Affiliation(s)
- M B Üçer
- Department of Ophthalmology, Hitit University Erol Olçok Education and Research Hospital, 019030 Çorum, Turkey.
| | - S Cevher
- Department of Ophthalmology, Hitit University Erol Olçok Education and Research Hospital, 019030 Çorum, Turkey
| | - S Üçer
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
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Musani SH, Alam MM, Latif A. Covid-19 co-infection with Crimean Congo haemorrhagic fever (CCHF) in a CCHF endemic country: a case report. J PAK MED ASSOC 2023; 73:2465-2468. [PMID: 38083934 DOI: 10.47391/jpma.7996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Covid-19 pandemic affected the health care systems globally. In many countries, healthcare services were overwhelmed by the huge number of Covid cases; hence, shifting the focus from locally endemic infectious diseases. Such a case presented to us that was initially managed along the lines of critical Covid pneumonia with steroids, Remdesivir, and supplemental oxygen for hypoxic respiratory failure. The patient also received Baricitinib, to which he was non-responsive and thus offered invasive mechanical ventilation. Post intubation, the patient was managed for Covid-associated ARDS with lung protective ventilation. He later also developed liver dysfunction, renal failure, coagulation derangements, and shock. Workup for malaria and dengue were negative. Later, Crimean Congo PCR was sent which came positive; a possible cause of progressive deterioration. In CCHF endemic areas, it is crucial to rule out the CCHF infection among patients presenting with critical Covid pneumonia due to similar clinical presentation in both the infections.
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Affiliation(s)
- Sadaf Hanif Musani
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Asad Latif
- Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan
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Ture Z, Kalin-Unuvar G. A case of Crimean Congo hemorrhagic fever complicated with acute pulmonary embolism. J Med Virol 2021; 93:3925-3928. [PMID: 32716057 DOI: 10.1002/jmv.26358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is one of the common causes of tick-borne hemorrhagic infections. The study aims to report a case of a female patient with severe CCHF with pulmonary embolism. CASE REPORT A 61-year-old woman admitted to the emergency department with complaints of high fever, nausea, and weakness. The patient was dealing with animal husbandry and had a tick bite history. At laboratory findings, bicytopenia, abnormal liver function tests, and elevated coagulation parameters were observed. Real-time plymerase chain reaction confirmed the diagnosis of CCHF. Three sessions of plasmapheresis were performed due to continued fever and worsening in laboratory values. Pulmonary embolism was detected in computerized thorax tomography carried out due to respiratory alkalosis on the 6th day. She was successfully treated with supportive and anticoagulation therapy. CONCLUSION CCHF demonstrates different types of clinical presentations apart from fever and hemorrhage. Acute pulmonary embolism is a rare complication that has not been reported before.
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Affiliation(s)
- Zeynep Ture
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gamze Kalin-Unuvar
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Izcı F, Ture Z, Sagiroglu P, Temel S, Yildiz O. A case of Crimean-Congo hemorrhagic fever with the bacteremia of Clostridium perfringens. J Med Virol 2021; 93:3929-3933. [PMID: 33295638 DOI: 10.1002/jmv.26715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a worldwide tick-borne viral infection in humans. The aim of the study is to report a case of a female patient with severe CCHF with the bacteremia of Clostridium perfringens. An 18-year-old woman admitted to the emergency department with sudden onset of fever, nausea and vomiting, myalgia, headache, generalized abdominal pain. It was learned that the patient was living in a rural area and had a history of tick bite 3 days before the admission. At laboratory examination, bicytopenia, abnormal liver function tests, and abnormal coagulation parameters were observed. The diagnosis of the case was confirmed with a positive real-time polymerase chain reaction. On the third day of hospitalization, she had an increase in abdominal pain, confusion, and respiratory distress. She was transferred to the intensive care unit for close monitoring. On the fifth day of hospitalization, she developed fever again. Catheter and peripheral anaerobic blood cultures grew C. perfringens. No evidence of perforation was observed on abdominal tomography. It has been successfully treated with a multidisciplinary approach. CCHF demonstrates different types of clinical presentations, except for common symptoms of fever and hemorrhage. A case of CCHF with C. perfringens bacteremia has not been previously reported before.
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Affiliation(s)
- Feyza Izcı
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zeynep Ture
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Pınar Sagiroglu
- Department of Medical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sahın Temel
- Department of Internal Medicine, Division of Intensive Care Unit, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Orhan Yildiz
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Karavaş E, Karakeçili F. Evaluation of Portal Vein Doppler Findings in Patients with Crimean⁻Congo Hemorrhagic Fever. ACTA ACUST UNITED AC 2019; 55:medicina55050146. [PMID: 31100950 PMCID: PMC6572247 DOI: 10.3390/medicina55050146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/04/2019] [Accepted: 05/14/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: In this study, we compare portal vein Doppler ultrasound (US) findings between patients with Crimean-Congo hemorrhagic fever (CCHF) and healthy persons and investigate the practicability of these findings in the prediction of disease severity. Materials and Methods: In this prospective study, portal vein Doppler US was performed in patients diagnosed with CCHF and healthy persons between March 2016 and May 2018. The patients were grouped according to mild-to-moderate and severe progression of CCHF. Liver size, portal vein diameter, portal vein flow rate, spleen volume, and splenic vein diameter were recorded in the patients and healthy controls. Results: Of the 48 patients diagnosed with CCHF, 25 were male. According to the scoring made, 38 patients were evaluated as having mild-to-moderate disease progression, and 10 were evaluated as having severe disease progression. With respect to the Doppler US findings, liver size, spleen volume, portal vein diameter, splenic vein diameter, and portal vein flow rate were significantly higher in the patient group compared with the controls. However, no significant difference was found in these parameters between the severe and mild-to-moderate progression groups. Conclusions: In the evaluation of and follow-up with patients with CCHF, portal vein Doppler US is a non-invasive and reliable tool for diagnosis.
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Affiliation(s)
- Erdal Karavaş
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100 Erzincan, Turkey.
| | - Faruk Karakeçili
- Departments of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100 Erzincan, 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] [What about the content of this article? (0)] [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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Abstract
BACKGROUND On December 8th, 2015, World Health Organization published a priority list of eight pathogens expected to cause severe outbreaks in the near future. To better understand global research trends and characteristics of publications on these emerging pathogens, we carried out this bibliometric study hoping to contribute to global awareness and preparedness toward this topic. METHOD Scopus database was searched for the following pathogens/infectious diseases: Ebola, Marburg, Lassa, Rift valley, Crimean-Congo, Nipah, Middle Eastern Respiratory Syndrome (MERS), and Severe Respiratory Acute Syndrome (SARS). Retrieved articles were analyzed to obtain standard bibliometric indicators. RESULTS A total of 8619 journal articles were retrieved. Authors from 154 different countries contributed to publishing these articles. Two peaks of publications, an early one for SARS and a late one for Ebola, were observed. Retrieved articles received a total of 221,606 citations with a mean ± standard deviation of 25.7 ± 65.4 citations per article and an h-index of 173. International collaboration was as high as 86.9%. The Centers for Disease Control and Prevention had the highest share (344; 5.0%) followed by the University of Hong Kong with 305 (4.5%). The top leading journal was Journal of Virology with 572 (6.6%) articles while Feldmann, Heinz R. was the most productive researcher with 197 (2.3%) articles. China ranked first on SARS, Turkey ranked first on Crimean-Congo fever, while the United States of America ranked first on the remaining six diseases. Of retrieved articles, 472 (5.5%) were on vaccine - related research with Ebola vaccine being most studied. CONCLUSION Number of publications on studied pathogens showed sudden dramatic rise in the past two decades representing severe global outbreaks. Contribution of a large number of different countries and the relatively high h-index are indicative of how international collaboration can create common health agenda among distant different countries.
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MESH Headings
- Animals
- Bibliometrics/history
- Communicable Diseases/epidemiology
- Communicable Diseases, Emerging/epidemiology
- Communicable Diseases, Emerging/prevention & control
- Coronavirus Infections/complications
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Disease Outbreaks/prevention & control
- Hemorrhagic Fever, Crimean/complications
- Hemorrhagic Fever, Crimean/epidemiology
- Hemorrhagic Fever, Crimean/prevention & control
- Hemorrhagic Fever, Ebola/complications
- Hemorrhagic Fever, Ebola/epidemiology
- Hemorrhagic Fever, Ebola/prevention & control
- History, 20th Century
- History, 21st Century
- Humans
- Lassa Fever/complications
- Lassa Fever/epidemiology
- Lassa Fever/prevention & control
- Marburg Virus Disease/complications
- Marburg Virus Disease/epidemiology
- Marburg Virus Disease/prevention & control
- Nipah Virus/pathogenicity
- Research/statistics & numerical data
- Research/trends
- Rift Valley Fever/complications
- Rift Valley Fever/epidemiology
- Rift Valley Fever/prevention & control
- Severe Acute Respiratory Syndrome/complications
- Severe Acute Respiratory Syndrome/epidemiology
- Severe Acute Respiratory Syndrome/prevention & control
- World Health Organization/organization & administration
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology and Pharmacology/Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Bastug A, Kayaaslan B, But A, Aslaner H, Sertcelik A, Akinci E, Onguru P, Yetkin MA, Bodur H. A case of Crimean-Congo hemorrhagic fever complicated with acute pancreatitis. Vector Borne Zoonotic Dis 2017; 14:827-9. [PMID: 25409276 DOI: 10.1089/vbz.2014.1623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease characterized by nonspecific symptoms like fever, myalgia, severe headache, nausea, vomiting, diarrhea, and abdominal pain. It can result in various complications during the course of the disease due to the diffuse endothelial injury involved in the pathogenesis of CCHF. OBJECTIVES Here we present a patient with CCHF complicated by acute pancreatitis, including pleural and intra-abdominal effusions. CASE REPORT A 70-year-old patient was referred to our hospital from an endemic area with the suspicion of CCHF. The physical examination of the patient revealed high fever (38°C), somnolence, and petechial eruption. The diagnosis of case was confirmed with positive reverse transcriptase polymerase chain reaction (RT-PCR). The viral load of the patient was 4×10(9) copies/mL. On the fifth day of admission, upper abdominal pain, scleral ichter, and abdominal distention developed. The patient had abdominal tenderness with guarding. The laboratory tests revealed an amylase level of 1740 U/L (28-100), lipase level of 583 U/L (13-60), and total bilirubin level of 3.75 mg/dL (<0.3). The diagnosis of acute pancreatitis was confirmed with radiological findings. CONCLUSIONS Until now, atypical presentations of CCHF have been reported in some case reports, but not acute pancreatitis. To the best of our knowledge, this is the first case of acute pancreatitis in the literature seen in the course of CCHF.
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Affiliation(s)
- Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital , Ankara, Turkey
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Sahin IO, Güven AS, Kaya A, Güney C, Cevit O, Arslan M. A child with an unusual complication of Crimean-Congo hemorrhagic fever: Hemorrhagic pleural effusion. J Vector Borne Dis 2016; 53:87-89. [PMID: 27004585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Irfan Oguz Sahin
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Abstract
In mid-September 2009, a 22-year-old critically ill Soldier was medically evacuated from a treatment facility in southern Afghanistan to Landstuhl Regional Medical Center in Germany. Despite the efforts of the team at Landstuhl, this patient died and became the US military's first known victim of Crimean-Congo hemorrhagic fever (CCHF). CCHF is caused by a virus, which bears the same name. Because a vaccine is lacking, as well as an effective antiviral treatment, prevention is key.
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Özer S, Kazancı NÖ, Sönmezgöz E, Karaaslan E, Yılmaz R. Syndrome of inappropriate antidiuretic hormone associated with Crimean-Congo hemorrhagic fever. Turkiye Parazitol Derg 2014; 38:275-277. [PMID: 25732889 DOI: 10.5152/tpd.2014.3603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal systemic disease in children caused by a tick- borne virus. Many different clinical and laboratory findings are seen in CCHF. We report here an atypical presentation of CCHF with hyponatremia. CCHF with electrolyte imbalance is not reported before. A 4-year-old girl presented with fever, fatigue and unconsciousness with hyponatremia. Based on the clinical and epidemiological findings, virus infection was suspected. Hyponatremia is has never been reported in Crimean-Congo hemorrhagic fever (CCHF), as was observed in this case. The diagnosis was confirmed by detection of IgM antibody to CCHF virus and positive Real-Time PCR. We report the first case of imported CCHF presenting as hyponatremia. This electrolyte imbalance has never been reported before in CCHF in children, and the clinician should consider this entity in complications to explain unconsciousness.
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Affiliation(s)
- Samet Özer
- Gaziosmanpaşa Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı, Tokat, Türkiye.
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Bilgin G, Ataman Hatipoglu C, Altun S, Bulut C, Kinikli S, Demiröz AP. An investigation of pulmonary findings of Crimean-Congo haemorrhagic fever patients. Turk J Med Sci 2014; 44:162-167. [PMID: 25558578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
AIM Crimean-Congo haemorrhagic fever (CCHF) generally affects many organs. In this study a retrospective evaluation of the pulmonary findings of CCHF patients was made. MATERIALS AND METHODS The records of patients were retrospectively analysed. For each patient an evaluation was made of age, sex, occupation, place of residence, contact with ticks, smoking history, and pulmonary radiological and laboratory findings. A confirmed diagnosis of CCHF was made on determination by enzyme-linked immunosorbent assay or polymerase chain reaction. RESULTS Of the 128 patients, 48.4% were female. Symptoms of coughing were determined in 18% of patients, sputum in 4.7%, chest pain in 3.9%, dyspnoea in 3.1%, and haemoptysis in 0.8%. The mortality rate was 7%. In terms of sex, place of residence, contact with ticks, smoking, findings of the respiratory system, and physical examination findings, no statistically significant difference was seen between the survivor and nonsurvivor groups (P > 0.05). The white blood cell count values of the survivors were determined to be significantly lower compared to those of the nonsurvivors and the alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, creatine phosphokinase, and C-reactive protein values of the nonsurvivors were significantly higher compared to those of the survivors (P < 0.05). CONCLUSION CCHF can be fatal for the respiratory system. An early diagnosis of CCHF and referral to a specialised centre is therefore important.
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Affiliation(s)
- Gülden Bilgin
- Department of Chest Diseases, Ministry of Health Ankara Training and Research Hospital, Turkey.
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Oflaz MB, Kucukdurmaz Z, Guven AS, Karapinar H, Kaya A, Sancakdar E, Deveci K, Gul I, Erdem A, Cevit O, Icagasioglu FD. Bradycardia seen in children with Crimean-Congo hemorrhagic fever. Vector Borne Zoonotic Dis 2013; 13:807-11. [PMID: 24107209 DOI: 10.1089/vbz.2012.1200] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy. METHODS Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age. RESULTS Fifty-two patients (mean age 11.2 ± 4.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 ± 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively). CONCLUSION Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.
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Affiliation(s)
- Mehmet Burhan Oflaz
- 1 Pediatrics Department, Cumhuriyet University Medical School , Sivas, Turkey
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Bıçakçı Z, Tavil B, Tezer H, Olcay L. Hemophagocytosis in a case with Crimean-Congo hemorrhagic fever and an overview of possible pathogenesis with current evidence. Turk J Pediatr 2013; 55:344-348. [PMID: 24217086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a clinicopathologic condition characterized by high fever, hepatosplenomegaly, cytopenia, hyperferritinemia, and increased hemophagocytic macrophage proliferation and activation in the reticuloendothelial system. Primary HLH is familial and is a fatal disease that begins during early childhood. Secondary HLH may be acquired after intense activation of the immune system due to infection. Clinical and biologic symptoms result from cytokines secreted by T-lymphocytes and macrophages. Subtypes of primary HLH are caused by genetic defects in several cell types, including perforin-dependent cytotoxic T-lymphocytes and natural killer (NK) cells. Secondary HLH is often associated with intracellular pathogen infections. Crimean-Congo hemorrhagic fever (CCHF) is caused by a tick-borne virus, Nairovirus, from the Bunyaviridae family. It is characterized by a poor prognosis and has a high mortality. We report the case of a 14-year-old boy living in a CCHF-endemic area with no history of tick exposure. He presented with fever, and laboratory tests showed bicytopenia and hemophagocytosis in the bone marrow aspiration. Blood samples were polymerase chain reaction (PCR)-negative for CCFH but immunoglobulin (Ig)M-positive. In conclusion, patients with hemophagocytosis should be assessed for CCHF during the evaluation of cytopenia.
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Affiliation(s)
- Zafer Bıçakçı
- Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey.
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16
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Guner R, Tasyaran MA, Keske S, Hasanoglu I, Kalem AK, Yapar D, Gulen TA, Neselioglu S, Isikoglu S, Erel O. Relationship between total thiol status and thrombocytopenia in patients with Crimean-Congo hemorrhagic fever. Southeast Asian J Trop Med Public Health 2012; 43:1411-1418. [PMID: 23413704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this study was to investigate the relationship between serum total thiol level and total oxidant status (TOS) and thrombocytopenia among patients with Crimean-Congo hemorrhagic fever (CCHF). Eighty-three subjects and 56 controls were enrolled in the study. Thiol levels were measured with the DTNB method and TOS was measured with the Erel's method among subjects and controls. Thiol levels were lower in subjects than controls and TOS levels were higher in subjects than controls. There was a significant correlation between total thiol levels and platelet counts (r = 0.84, p < 0.0001) among subjects. Further investigations are needed into the link between total thiol level and TOS and the pathogenesis of hemorrhage in CCHF.
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Affiliation(s)
- Rahmet Guner
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Abadoglu O, Engin A. The frequency of self-reported allergic diseases in patients with crimean-congo haemorrhagic fever. Allergol Immunopathol (Madr) 2009; 37:234-8. [PMID: 19775796 DOI: 10.1016/j.aller.2009.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Crimean-Congo haemorrhagic fever (CCHF) is an acute, tick-borne viral disease. In temperate areas, CCHF cases occur between spring and early autumn when tick activity is high. This period is also the pollen season during which symptoms of allergic diseases are exacerbated. Viruses induce inflammatory and antiviral responses by binding to specific receptors on the surface of airway epithelial cells, resulting in activation of innate immune responses; release of mediators such as cytokines and chemokines; and recruitment of neutrophils and mononuclear cells to the area. AIM We aimed to evaluate the frequency of self-reported allergic diseases and the effect on CCHF severity. METHOD Between June and August 2008, a questionnaire was applied to 114 CCHF (+) patients and 122 healthy control subjects, 16 to 88 years old who attended the Infectious Diseases clinic and were hospitalised with CCHF suspected, by face to face interview including history of allergic rhinitis (AR), asthma symptoms and nonspecific bronchial reactivity, doctor diagnosed AR and/or asthma, and familial allergic diseases history. RESULTS According to PCR and/or enzyme-linked immunoassay (ELISA) results, 51.7% of patients (n=114) had CCHF. There was no significant relation between CCHF and history of AR, asthma symptoms and nonspecific bronchial reactivity, doctor diagnosed AR and/or asthma, and familial allergic diseases history. The severity of CCHF has not affected these parameters (p>.05). Of patients with positive CCHF test, 2.6% (n=3) and 3.5% (n=4) had doctor diagnosed AR and asthma, respectively. CONCLUSION Self-reported allergic diseases and CCHF are not related with each other.
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MESH Headings
- Adolescent
- Adult
- Aged
- Cell Movement
- Cytokines/metabolism
- Female
- Hemorrhagic Fever Virus, Crimean-Congo/immunology
- Hemorrhagic Fever Virus, Crimean-Congo/pathogenicity
- Hemorrhagic Fever, Crimean/complications
- Hemorrhagic Fever, Crimean/epidemiology
- Hemorrhagic Fever, Crimean/immunology
- Hemorrhagic Fever, Crimean/pathology
- Hemorrhagic Fever, Crimean/physiopathology
- Humans
- Immunity, Innate
- Leukocytes, Mononuclear/metabolism
- Leukocytes, Mononuclear/pathology
- Male
- Middle Aged
- Neutrophils/metabolism
- Neutrophils/pathology
- Prevalence
- Respiratory Mucosa/immunology
- Respiratory Mucosa/metabolism
- Respiratory Mucosa/pathology
- Respiratory Mucosa/virology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/pathology
- Rhinitis, Allergic, Seasonal/physiopathology
- Seasons
- Self Disclosure
- Surveys and Questionnaires
- Virus Attachment
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Affiliation(s)
- O Abadoglu
- Cumhuriyet University, Faculty of Medicine, Chest Diseases Dept., Allergic Diseases Subdept., Sivas, Turkey.
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Tanir G, Tuygun N, Balaban I, Doksöz O. A case of Crimean-congo hemorrhagic fever with pleural effusion. Jpn J Infect Dis 2009; 62:70-72. [PMID: 19168966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral zoonosis with the potential of human-to-human transmission that affects wide areas in Asia, Southeastern Europe, and Africa. Hemorrhagic manifestations constitute a prominent symptom of late stage disease with case fatality rates from 3 to 50%. We present a case of CCHF complicated by hemorrhagic pleural effusion and resulting in resolution without chest tube drainage in a 9-year-old boy. The diagnosis of CCHF was confirmed by enzyme-linked immunosorbent assay tests. Both serum and pleural fluid CCHF IgM were positive at titers of 1/1,600 and 1/6,400, respectively.
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Affiliation(s)
- Gonul Tanir
- Dr. Sami Ulus Children's Health and Diseases Training and Research Center, Ankara, Turkey.
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Engin A, Yildirim A, Kunt T, Bakir M, Dokmetas I, Ozdemir L. Clinical investigation of the transient evoked otoacoustic emission test in Crimean–Congo hemorrhagic fever. Int J Infect Dis 2008; 12:162-5. [PMID: 17714968 DOI: 10.1016/j.ijid.2007.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 04/18/2007] [Accepted: 06/12/2007] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate cochlear damage in Crimean-Congo hemorrhagic fever (CCHF) infection. METHODS Thirty-two CCHF patients (study group) and 13 healthy people (controls) were included in the study. CCHF patients were also grouped for the presence of fever. CCHF was diagnosed with the presence of CCHF virus-specific IgM antibody or CCHF virus (CCHFV) antigen by ELISA. Cochlear damage was determined by a 'fail' in the transient evoked otoacoustic emission (TEOAE) test. RESULTS The proportion of TEOAE test 'fail' results in the CCHF patients was significantly higher than in the control group (p<0.05). We found no increase in the proportion of TEOAE test 'fail' results related to fever in the study group. CONCLUSIONS CCHF disease damages cochlear function regardless of fever.
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Affiliation(s)
- Aynur Engin
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas 58140, Turkey.
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Sannikova IV, Pacechnikov VD, Maleev VV. [Respiratory lesions in Congo-Crimean hemorrhagic fever]. TERAPEVT ARKH 2007; 79:20-23. [PMID: 18219967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM To characterize pathogenesis, clinical, laboratory and x-ray features of respiratory disease in Congo-Crimean hemorrhagic fever (CCHF). MATERIAL AND METHODS CCHF diagnosis was made in 283 patients basing on the detection in blood of specific antibodies by enzyme immunoassay (EIA) and virus RNA by polymerase chain reaction (PCR). Serum cytokines were measured with EIA. RESULTS Pulmonary lesion in CCHF had characteristics of acute respiratory distress syndrome (ARDS). It manifested in the hemorrhagic period with blood spitting, pulmonary hemorrhage and bleeding into the pleural cavity. A high level of proinflammatory cytokines in the blood correlated with the disease severity. CONCLUSION Respiratory affection in CCHF was seen at all the stages of the infectious process. ARDS occurs during hemorrhagic manifestations and is accompanied with systemic inflammatory reaction.
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Ardalan MR, Tubbs RS, Chinikar S, Shoja MM. Crimean–Congo haemorrhagic fever presenting as thrombotic microangiopathy and acute renal failure. Nephrol Dial Transplant 2006; 21:2304-7. [PMID: 16735392 DOI: 10.1093/ndt/gfl248] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohammed Reza Ardalan
- Department of Nephrology, Tabriz University of Medical Sciences (TUMS), Tabriz, Iran.
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Moghtaderi A, Alavi-Naini R, Azimi H. Compartment syndrome: an unusual course for a rare disease. Am J Trop Med Hyg 2005; 73:450-2. [PMID: 16103620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
We report a case of compartment syndrome of the left upper limb following hemorrhage due to Crimean-Congo hemorrhagic fever in a 45-year-old man. As far as we know, there is not such a report in the literature. We discuss clinical manifestations, electrophysiologic findings, differential diagnosis, and management of the patient. A high degree of awareness for an early diagnosis may participate to improve the poor prognosis.
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Affiliation(s)
- Ali Moghtaderi
- Neurology Department, Zahedan University of Medical Sciences, Zahedan, Iran.
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Sheikh NS, Sheikh AS, Sheikh AA. Knowledge, attitude and practices regarding Crimean-Congo haemorrhagic fever among healthcare workers in Balochistan. J Ayub Med Coll Abbottabad 2004; 16:39-42. [PMID: 15631370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND The objective of this study was to determine the knowledge, attitude and practices regarding Crimean-Congo Haemorrhagic Fever (CCHF) among healthcare workers at a tertiary care referral hospital in Balochistan. METHODS A cross-sectional survey was conducted in April-May 2000 among the doctors, nurses and laboratory technicians of Sandeman Provincial Teaching Hospital, Quetta, Balochistan. A questionnaire was formulated which included the demographic data of the respondents and their knowledge, attitude and practices towards CCHF. RESULTS A total of 235 healthcare personnel including 150 (63.8%) doctors, 50 (21.2%) nurses and 35 (15%) laboratory technicians were interviewed during the survey. Seventy percent (164) of the subjects were males while 30% (71) were females. One fifty-five (66%) of the total respondents claimed to know what CCHF was. By designation 120 (80%) of doctors, 30 (60%) of nurses and 5 (14%) of laboratory technicians had a prior knowledge about CCHF. One twenty (80%) of the doctors knew the most common presentations of CCHF. All categories of the respondents had a poor knowledge regarding the burial procedure of dead patients. CONCLUSION This study was an indicator of the poor level of knowledge of healthcare workers regarding the clinical presentations and the modes of spread of CCHF. It is the dire need of the time to educate the healthcare workers about the common preventive measures of this disease, which has resulted in the loss of several important lives in the past in this region.
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Affiliation(s)
- Nadeem S Sheikh
- Department of Pathology, Bolan Medical College, Quetta, Balochistan.
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Joubert JR, King JB, Rossouw DJ, Cooper R. A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part III. Clinical pathology and pathogenesis. S Afr Med J 1985; 68:722-8. [PMID: 3933128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in 8 patients; 7 were staff members at Tygerberg Hospital who had been infected by a patient in whom the disease had not initially been diagnosed. Two patients, the initial case and a staff member, died and 4 became seriously ill. The immunopathogenesis of CCHF appears to be multifactorial. Certain features were common to all patients--leucopenia, thrombocytopenia, elevated liver enzyme values and low serum total protein levels. Ultrastructural changes in and around skin capillaries, including intracytoplasmic endothelial tuboreticulated bodies, were found. Virus-like particles were found on electron microscopy. Important individual factors related to prognosis were identified. The patients who survived all mounted a good antibody response, and manifested no coagulation defect extensive enough to explain the haemorrhagic tendency. In the patients who died no evidence of antibody production was detected; both developed diffuse intravascular coagulation and in 1 evidence of immune complex formation and complement consumption was found. Hepatorenal failure and cardiovascular collapse characterized the terminal period. Early clinical recognition of CCHF with specific attention to factors amenable to treatment may vastly improve the prognosis.
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