Crimean–Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy

Özkurt, Zülal; Kıkı, İlhami; Erol, Serpil; Erdem, Fuat; Yılmaz, Neziha; Parlak, Mehmet; Gündoğdu, Mehmet; Taşyaran, Mehmet A.

doi:10.1016/j.jinf.2005.05.003

Cited by 163 publications

(189 citation statements)

References 21 publications

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“…Interestingly, this rate is much higher in other parts of the world where the disease is endemic [1][2][3][4][5]. In this tick-borne viral infection, regional differences of the fatality rates were thought to be related to the availability of advanced medical care facilities and the infection acquisition routes.…”

Section: Discussionmentioning

confidence: 96%

“…For instance, nosocomial spread of infection among medical staff carries a considerably higher risk of mortality [1,2]. On the other hand, clinical presentation of the disease shows wide variations while in most of the patients subclinical or a self-limited course is recognized, in some patients as ours a more severe or fatal disease with HPS might be seen [4,5]. HPS is a rare and severe disease characterized by fever, hepatosplenomegaly, cytopenia, elevated ferritin, Lactate dehydrogenase (LDH) and triglyceride levels, and hemophagocytosis in bone marrow, liver and lymph nodes associated with excessive production of various cytokines by hyper activated T helper lymphocytes and macrophages.…”

Section: Discussionmentioning

confidence: 99%

“…Another alternative therapy to prevent the viral replication is CCHF specific IgG, but excessive IgG may have a negative impact on these immunological responses. Although ribavirin is known to increase TH1 response in chronic HCV patients and may be an inappropriate mean of use in such patients, however, it is still the most widely used antiviral agent in CCHF and reported to be beneficial in the timely treatment of most of these patients [2,4,24]. The use of some cytokine-blocking agents or antibodies against cytokines such as TNF-a receptor antagonist, anti-IFNg, or IL-18 binding protein may be the other unproven therapeutic approaches in severe form of the disease [15].…”

Section: Discussionmentioning

confidence: 99%

“…In certain parts of the world, including the countries around the bird migration routes, CCHF constitutes an emerging infectious disease with a disastrous clinical picture and a remarkable fatality rate [1][2][3]. In Turkey, CCHF has been reported endemically in summers of recent 4 years and the disease emerged as a serious public health threat because of its high rate of fatality [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Crimean‐Congo hemorrhagic fever: Five patients with hemophagocytic syndrome

Fışgın

Tanyel

et al. 2007

American J Hematol

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Three pediatric and two adult Turkish patients with Crimean Congo Hemorrhagic Fever (CCHF) induced hemophagocytic syndrome (HPS) were admitted to Ondokuz Mayis University Hospital, which is in the Middle Black Sea Region of Turkey. All of them had remarkable hemophagocytosis in the bone marrow with severe bleeding symptoms along with the other known clinical and laboratory findings of CCHF. We would like to present these patients and to discuss the pathophysiology and the effect of acquired HPS on the severity of the disease. Am. J. Hematol., 2008. © 2007 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Crimean‐Congo hemorrhagic fever: Five patients with hemophagocytic syndrome

Fışgın

Tanyel

et al. 2007

American J Hematol

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“…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%

Crimean-Congo Hemorrhagic Fever: What Do We Know about Pulmonary Injury? A Compilation of Evidence

Leon-Roman¹

2017

Int J Respir Pulm Med

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Ribavirin for treating Crimean Congo haemorrhagic fever

Johnson

Maayan

Mills

et al. 2018

Cochrane Database of Systematic Reviews

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BackgroundCrimean Congo haemorrhagic fever (CCHF) is a tick-borne disease that occurs in parts of Asia, Europe and Africa. Since 2000 the infection has caused epidemics in Turkey, Iran, Russia, Uganda and Pakistan. Good-quality general supportive medical care helps reduce mortality. There is uncertainty and controversy about treating CCHF with the antiviral drug ribavirin.ObjectivesTo assess the effects of ribavirin for treating people with Crimean Congo haemorrhagic fever.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register; the Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (OVID); Science Citation Index-Expanded, Social Sciences Citation index, conference proceedings (Web of Science); and CINAHL (EBSCOHost). We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for trials in progress. We conducted all searches up to 16 October 2017. We also contacted experts in the field and obtained further studies from these sources.Selection criteriaWe evaluated studies assessing the use of ribavirin in people with suspected or confirmed Crimean Congo haemorrhagic fever. We included randomised control trials (RCTs); non-randomised studies (NRSs) that included more than 10 participants designed as cohort studies with comparators; and case-control studies.Data collection and analysisTwo review authors assessed eligibility, risk of bias, and extracted data. For non-randomized studies we used the ROBINS-I tool to assess risk of bias. The main effects analysis included all studies where we judged the risk of bias to be low, moderate or high. We summarized dichotomous outcomes using risk ratios (RRs) and continuous outcomes using mean differences (MDs), and used meta-analyses where appropriate. We carried out a subsidiary appraisal and analysis of studies with critical risk of bias for the primary outcome, as these are often cited to support using ribavirin.Main resultsFor the main effects analysis, five studies met our inclusion criteria: one RCT with 136 participants and four non-randomized studies with 612 participants. We excluded 18 non-randomized studies with critical risk of bias, where none had attempted to control for confounding.We do not know if ribavirin reduces mortality (1 RCT; RR 1.13, 95% confidence interval (CI) 0.29 to 4.32; 136 participants; very low-certainty evidence; 3 non-randomized studies; RR 0.72, 95% CI 0.41 to 1.28; 549 participants; very low-certainty evidence). We do not know if ribavirin reduces the length of stay in hospital (1 RCT: mean difference (MD) 0.70 days, 95% CI -0.39 to 1.79; 136 participants; and 1 non-randomized study: MD -0.80, 95% CI -2.70 to 1.10; 50 participants; very low-certainty evidence). We do not know if it reduces the risk of patients needing platelet transfusions (1 RCT: RR 1.23, 95% CI 0.77 to 1.96; 136 participants; very low-certainty evidence). For adverse effects (including haemolytic anaemia and a need to discontinue treatment), we do not know whether there is a...

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Crimean–Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy

Cited by 163 publications

References 21 publications

Crimean‐Congo hemorrhagic fever: Five patients with hemophagocytic syndrome

Crimean‐Congo hemorrhagic fever: Five patients with hemophagocytic syndrome

Crimean-Congo Hemorrhagic Fever: What Do We Know about Pulmonary Injury? A Compilation of Evidence

Ribavirin for treating Crimean Congo haemorrhagic fever

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