Characteristics of Patients with Crimean-Congo Hemorrhagic Fever in a Recent Outbreak in Turkey and Impact of Oral Ribavirin Therapy

Ergönül, Önder; Çelikbaş, Aysel Kocagül; Dokuzoğuz, Başak; Eren, Selim Sırrı; Baykam, Nurcan; Esener, Harika

doi:10.1086/422000

Cited by 259 publications

(262 citation statements)

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“…14,[27][28][29][30] In a historical cohort study in Iran, we concluded that oral ribavirin is an effective treatment of the hemorrhagic form of CCHF. 9 Prophylaxis is suggested after high-risk contamination.…”

Section: T Able 1 Laboratory Findings Of Three Nosocomial Cases Of Crmentioning

confidence: 99%

Crimean-Congo Hemorrhagic Fever Virus as a Nosocomial Pathogen in Iran

Mardani¹,

Keshtkar-Jahromi²,

Ataie³

et al. 2009

Am J Trop Med Hyg

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Abstract. Crimean-Congo hemorrhagic fever (CCHF) is a viral disease with several different modes of transmission. We describe the manifestations, outcome, and likely modes of transmission for three nosocomial cases. All threee cases were healthcare workers (two men and one woman). They had fever, myalgia, and petechia. Disseminated intravascular coagulation resulted in the death occurred in the woman. Because this disease is manifested with non-specific influenzalike symptoms, diagnosis can be difficult. Data for these patients can be used to investigate airborne or sexual transmission of this virus, although neither route was substantiated for these patients. Use of universal precautions and early case detection are the most helpful strategy for preventing nosocomial transmission of CCHF.Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease that has been reported in more than 30 countries in Africa, Asia, southeastern Europe, and the Middle East.1 It was first described in the Crimea in 1944. Later, a virus isolated from the Congo was identified as the same virus, resulting in the name Crimean-Congo hemorrhagic fever virus (CCHFV).2 Infection with CCHFV is manifested as an acute viral disease (fever, myalgia, and arthralgia) and in severe cases, hemorrhagic manifestations may ensue. It is transmitted mainly through tick bite or animal contact but repeatedly has caused nosocomial outbreaks.3-7 Human-to-human transmission occurs by infected blood or secretions, but airborne transmission of the disease has not been documented. 8 We describe the manifestations and outcomes in three confirmed cases of CCHF in healthcare workers in Iran. The risk factors and routes of transmission in a hospital setting are discussed. INDEX CASE 1On August 2, 1999, a 55-year-old man (a shepherd) was referred to the emergency room of a hospital with hematemesis. He had a history of animal contact. Epistaxis developed after a nasogastric tube was inserted in an attempt to control gastrointestinal (GI) bleeding. Unfortunately, he died of intractable GI bleeding and disseminated intravascular coagulation (DIC) four days later. SECONDARY CASE 1On August 16, 1999, a 32 -year -old man (a physician) came to a clinic in Shahrekord in central Iran with severe headache, malaise, fever, vomiting, and diarrhea for one week. Petechiae, epistaxis and gum bleeding then developed, which resulted in his referral to the clinic. He was admitted to a hospital and treated with broad-spectrum antibiotics. There was no history of recent travel or contact with domestic animals. It was later discovered that he had been in contact with index case 1, who had died of severe GI bleeding two weeks before his first symptoms. The index case had coughed and splashed blood on the physician's face while he was trying to insert a nasogastric tube. Physical examination showed right cervical lymphadenopathy and a palpable spleen, but the patient was not febrile. Laboratory examinations showed leukopenia, thrombocytopenia, increased levels of aminotransferase...

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Section: T Able 1 Laboratory Findings Of Three Nosocomial Cases Of Crmentioning

confidence: 99%

Crimean-Congo Hemorrhagic Fever Virus as a Nosocomial Pathogen in Iran

Mardani¹,

Keshtkar-Jahromi²,

Ataie³

et al. 2009

Am J Trop Med Hyg

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“…6 In trials conducted on CCHF, leukocytosis, elevated ALT and AST, PT and aPTT and LDH (lactate dehydrogenase) values were used in assessing prognosis. 4,11,12 No information is available in the literature indicating the role of blood groups in the prognosis of CCHF. In the current trial, high ALT and AST levels and low leukocyte and platelet values were observed, in accordance with the results of other trials.…”

Section: Discussionmentioning

confidence: 99%

Is blood group associated with mortality in Crimean-Congo Hemorrhagic Fever?

Duygu¹

2011

JMID

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Objectives: In this trial, our purpose was to determine the distribution of blood groups in Tokat region and CrimeanCongo hemorrhagic fever (CCHF) patient group and to investigate the impact of blood groups on fatal prognosis of the disease. Material and Method:Demographic and laboratory values and blood groups of patients were recorded. In addition, distribution of blood groups among blood donors who referred to the blood center during same time interval was determined.Results: Distribution of blood groups among CCHF patients and donors in blood center were found to be similar to Turkish data (P>0.05). On the other hand, a discrepancy was determined in blood group distribution of CCHF patients with a fatal outcome, with a significantly high rate of AB Rh negative blood group in this patient group (P<0.001). Conclusion:We suggest that blood group may be associated with mortality in CCHF patients and AB Rh negative blood group may be an indicator of poor prognosis. J Microbiol Infect Dis 2011;1(3):118-121

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“…They realized that dyspnoea and cough were common symptoms, but haemoptysis was only present in Discussion CCHF incidence and prevalence have increased recently with more than 1000 cases reported from southeastern Europe and western Asia each year [9]. This is important because fatality rates in hospitalized patients have reached approximately 50% and death occurs mainly due to disseminated intravascular coagulation and multi organ failure [11][12][13][14][15][16][17][18][19][20][21]. There are no specific treatment or vaccine prophylaxes at this moment.…”

Section: Evidencesmentioning

confidence: 99%

“…It can last up to 9 days when the disease is acquired through a tick bite and a maximum of 13 days when transmission occurs by infected tissues or blood [3]. Next, the pre-haemorrhagic period involves a broad-albeit non-specific range of symptoms such as fever, chills, severe headache, photophobia, myalgia, abdominal pain, nausea, flushing, hypotension, and bradycardia [17,18]. The haemorrhagic stage can develop as soon as 3 days into the disease [3].…”

mentioning

confidence: 99%

“…The haemorrhagic stage can develop as soon as 3 days into the disease [3]. Evidence of haemorrhage can be as subtle as small petechiae, through large ecchymosis, all the way up to mucosal (eg: gums) and internal organs (eg: lungs and GI tract) haemorrhage [18,19]. Fatality rates in hospitalized patients are as high as 50% and death occurs mainly due to disseminated intravascular coagulation and multi organ failure [11,20].…”

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confidence: 99%

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