Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited

Abstract

The aim of this study was to determine the predictors of mortality among patients infected with Crimean-Congo haemorrhagic fever (CCHF) virus. Among patients with acute febrile syndrome, characterised by malaise, bleeding, leukopenia and thrombocytopenia, who were admitted to hospital during the spring and summer of 2002-2004, 54 had positive IgM and/or PCR results for CCHF virus in blood or tissue. The overall case fatality rate was 7.4%. Among the fatalities, haematemesis (p 0.009), melaena (p 0.001) and somnolence (p 0.022) were more common, the median platelet count was significantly lower (10,600/mL vs. 20,000/mL; p 0.038), the mean prothrombin time (27 s vs. 16 s; p 0.002) and mean activated partial thromboplastin time (73 s vs. 44 s; p < 0.001) were longer, and the mean alanine transferase (ALT) level (1,125 vs. 331; p < 0.001), the mean aspartate transferase (AST) level (3,118 vs. 913; p 0.004) and the mean fibrinogen level (119 vs. 340; p 0.012) were higher. Serum IgM and IgG against CCHF virus was detected in 25% and 0%, respectively, of fatal cases, compared with 94% and 62%, respectively, of cases with favourable outcomes. Oral ribavirin was prescribed to 22 (41%) patients. Of the four fatal cases, it was the intention to prescribe ribavirin to three patients, but this was not possible because of haematemesis and melaena. Higher levels of AST (>or= 700 U/L) and ALT (>or= 900 U/L) are suggested for use as severity criteria. Oral ribavirin was not effective for patients with haematemesis, and intravenous ribavirin is necessary for treatment of CCHF.

Crimean-Congo hemorrhagic fever: History, epidemiology, pathogenesis, clinical syndrome and genetic diversity

“…Early studies in South Africa found that most patients who went onto survive the disease had detectable anti-CCHFV IgM by day 7 and IgG by day 7-9 of illness, while no response was detected in fatally infected individuals (Burt et al, 1994;Shepherd et al, 1989c;van Eeden et al, 1985b). The correlation of antibody responses with survival has been demonstrated more recently in patients in Turkey and Kosovo (Ergonul et al, 2006a;Saksida et al, 2010).…”

“…Experience over the past decade in Turkey has shown that gingival bleeding, ecchymoses, hematemesis, diarrhea, melena, confusion and somnolence are significantly more common in fatal cases (Ergonul et al, 2006a;Cevik et al, 2008;Hatipoglu et al, 2010). Lethal illness was associated with more severe thrombocytopenia, more prolonged PT and aPTT, lower fibrinogen levels and increased serum AST and ALT (Ergonul et al, 2006a;Ozkurt et al, 2006;Onguru et al, 2010).…”

Serum chitotriosidase enzyme activity in patients with Crimean-Congo hemorrhagic fever

“…Serum ChT could be a prognostic marker in patients with CCHF. Different predictors of fatality were reported as risk factors for CCHF (27,(29)(30)(31)(32), and those previously defined severity criteria were not always consistent. These criteria include decreased platelet counts, prolonged aPTT, increased AST, ALT and LDH activities in a univariate analysis from five different studies.…”

Crimean-Congo Hemorrhagic Fever

“…Daha önceki yayınlarda, bildirilen taşikardi, nabızda düzensizlikler, ağız kuruluğu, saç dökülmesi, polinörit görme bozukluğu gibi bulguların hiçbirisi son yayınlarda belirtilmemiştir (2,5,13,(29)(30)(31) .…”