Evaluation of the Cases With Pre-Diagnosis of Crimean-Congo Hemorrhagic Fever in Two District Hospitals in Tokat Province
Öz
Objective: Tokat is one of the cities in Turkey where Crimean–Congo hemorrhagic fever (CCHF) is endemic. Given that CCHF is fatal and contagious,
patients should be isolated and hospitalized. This study aimed to compare the epidemiological, clinical, and laboratory findings of CCHF-positive and
CCHF-negative cases in two district hospitals in Tokat.
Materials and Methods: Patients applied to Turhal and Zile State Hospitals between January 2018 and December 2019 and had a pre-diagnosis of CCHF
were included in this case–control study. The patients’ demographic data, symptoms, treatment, and prognosis were recorded. “Pre-diagnosis for CCHF”
was defined as the presence of leukopenia or thrombocytopenia, in addition to the presence of at least two symptoms. Cases had antibodies to CCHF virus
or CCHF virus-RNA were defined as “CCHF-positive group” and the others were “CCHF-negative group”. Pearson’s chi-square test and Fisher’s test were
used to compare the categorical variables. P values that are less than 0.05 were considered statistically significant.
Results: Symptoms of headache (20 vs. 18), nausea and vomiting (20 vs. 16), myalgia (18 vs. 16), and diarrhea (11 vs. 5) were more common in the
CCHF-positive group than CCHF-negative group. Leukopenia, thrombocytopenia, elevated aspartate aminotransferase (AST), alanine aminotransferase
(ALT), and lactate dehydrogenase (LDH) levels, and prolongated prothrombin time (PT) and activated partial thromboplastin time (aPTT) levels were also
more common. AST elevation and PT prolongation were statistically significant (p=0.01 and p=0.003, respectively). The mortality rate in the CCHF-positive
group was 3.8%.
Conclusion: Even if there is no history of tick bite in patients living in the endemic region and presenting with headache and gastrointestinal symptoms,
CCHF probability is high in the presence of leukopenia, thrombocytopenia, elevated liver enzymes and LDH levels, prolonged PT and aPTT. CCHF should
always be considered in patients with these symptoms and laboratory findings.
Anahtar Kelimeler
Crimean-Congo hemorrhagic fever epidemiology leukopenia thrombocytopenia
Kaynakça
- Blair PW, Kuhn JH, Pecor DB, Apanaskevich DA, Kortepeter MG, Cardile AP et al. An emerging biothreat: Crimean-congo hemorrhagic fever virus in southern and western asia. Am J Trop Med Hyg. 2019;100(1):16–23.
- Ergonul O, Celikbas A, Dokuzoguz B, Eren S, Baykam N, Esener H. Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis. 2004;39(2):284-287.
- Eren Gok S. Crimean- Congo hemorrhagic fever. Eur Arc Med Res. 2016;32(Supp): 13-19.
- Hekimoglu HC, Ates Demirci N. Evaluation of cases with a preliminary diagnosis of Crimean- Congo hemorrhagic fever and comparison of characteristics in patients admitted to a secondary care hospital in Kastamonu, Turkey. Afr Health Sci. 2014;14(4):873-881.
- Leblebicioglu H, Ozaras R, Irmak H, Sencan I. Crimean-Congo hemorrhagic fever in Turkey: current status and future challenges. Antiviral Res. 2016;126:21–34.
- 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(1):1433-1440.
- Hatami H, Qaderi S, Omid AM. Investigation of Crimean-Congo hemorrhagic Fever in Patients Admitted in Antani Hospital, Kabul, Afghanistan, 2017–2018. Int J Prev Med. 2019;10:117.
- Erenler AK, Kulaksiz F, Ulger H, Erdem M, Kocak C, Soylemez F et al. Characteristics of patients admitted to the emergency department due to tick bite. Trop Doct. 2014;44(2):86–88.
- Mostafavi E, Pourhossein B, Chinikar S. Clinical symptoms and laboratory findings supporting early diagnosis of Crimean-Congo hemorrhagic fever in Iran. J Med Virol. 2014;86(7):1188–1192.
- Duran A, Kucukbayrak A, Ocak T, Hakyemez NI, Tas T, Karadag M et al. Evaluation of patients with Crimean- Congo hemorrhagic fever in Bolu, Turkey. Afr Health Sci. 2013;13(2):233–242.
- Bodur H, Akinci E, Ascioglu S, Onguru P, Uyar Y. Subclinical infections with Crimean-Congo hemorrhagic fever virus, Turkey. Emerg Infect Dis.2012;18:640-642.
- Yilmaz GR, Buzgan T, Irmak H, Safran A, Uzun R, Cevik MA et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002–2007. Int J Infect Dis. 2009;13(3):380–386.
- Gunaydin NS, Aydin K, Yilmaz G, Caylan R, Koksal I. Crimean-Congo hemorrhagic fever cases in the eastern Black Sea Region of Turkey: Demographic, geographic, climatic, and clinical characteristics. Turk J Med Sci. 2010;40(6):829-834.
- Shayan S, Bokaean M, Shahrivar MR, Chinikar S. Crimean-Congo Hemorrhagic Fever.Lab Med. 2015;46(3):180-189.
- Ergonul O. Crimean-Congo Haemorrhagic fever: Treatment and use of Ribavirin. Klimik J. 2016;29(1):2-9.
- Public Health Institution of Turkey, Department of Zoonotic and Vectorial Diseases. Avaliable 18 April 2021. Avaliable from: https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-kkka.
- Mourya DT, Viswanathan R, Kumar Jadhav S, Yadav PD, Basu A, Chadha MS. Retrospective analysis of clinical information in Crimean-Congo haemorrhagic fever patients: 2014-2015, India. Indian J Med Res. 2017;145(5):673–678.
- Tasdelen Fisgin N, Ergonul O, Doganci L, Tulek N. The role of ribavirin in the therapy of Crimean-Congo hemorrhagic fever: Early use is promising. Eur J Clin Microbiol Infect Dis. 2009;28(8):929-233.
Tokat ilinde İki İlçe Hastanesinde Kırım-Kongo Kanamalı Ateşi Ön tanısı ile Takipli Olguların Değerlendirilmesi
Öz
Amaç: Tokat, Türkiye’de Kırım-Kongo kanamalı ateşinin (KKKA) endemik görüldüğü illerden biridir. KKKA ölümcül ve bulaşıcı olduğu için, hastalar
hospitalize edilip izole takip edilmelidir. Bu çalışma ile Tokat ili iki ilçe hastanesinde takip edilen konfirme KKKA vakaları ile KKKA’nın ekarte edildiği
olgular arasındaki epidemiyolojik, klinik ve laboratuvar bulgularının karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Bu vaka kontrol çalışmasına, Ocak 2018-Aralık 2019 yılları arasında, Turhal ve Zile Devlet Hastaneleri’nde, KKKA ön tanısı ile takip
edilen vakalar dâhil edildi. Hastaların demografik verileri, klinik bulguları, tedavi ve prognoz bulguları kaydedildi. “KKKA ön tanısı” en az iki semptomla
birlikte lökopeni ya da trombositopeni varlığı olarak tanımlandı. KKKA antikor pozitifliği ya da polimeraz zincir reaksiyonu pozitifliği saptanan olgular
“KKKA-pozitif grup” olarak kabul edilirken, diğerleri “KKKA-negatif grup” olarak belirlendi. Hospitalize edilmeyen ve 18 yaş altı olgular dışlandı. Kategorik
değişkenlerin karşılaştırılmasında Pearson ki kare ve Fisher’s testleri kullanıldı. İstatistiksel anlamlılık için p<0.05 kabul edildi.
Bulgular: KKKA-pozitif grupta, negatif gruba kıyasla, baş ağrısı (20 vs. 18), bulantı-kusma (20 vs. 16), myalji (18 vs. 16) ve ishal (11 vs. 5) semptomları
daha sıktı. Ayrıca, lökopeni, trombositopeni, aspartat aminotransaminaz (AST), alanin aminotransaminaz (ALT), laktat dehidrogenaz (LDH) yüksekliği ile
protrombin zamanı (PTZ) ve aktive parsiyel tromboplastin zamanında (aPTT) uzama daha sıktı. AST yüksekliği ve PTZ uzaması istatistiksel olarak anlamlıydı
(sırasıyla; p=0.01 ve p=0.003). KKKA-pozitif grupta mortalite hızı %3.8’di.
Sonuç: Endemik bölgede yaşayıp baş ağrısı ve gastrointestinal semptomlarla başvuran olgularda, kene ısırığı öyküsü olmasa bile, lökopeni, trombositopeni,
karaciğer enzim yüksekliği (KCFT) ve LDH yüksekliği, PTZ ve aPTT uzaması saptandığında KKKA olasılığı yüksektir. Bu yakınmalar ve laboratuvar
bulguları ile başvuran hastalarda KKKA mutlaka akılda tutulmalıdır.
Anahtar Kelimeler
Kırım-Kongo kanamalı ateşi epidemiyoloji lökopeni trombositopeni Tokat
Kaynakça
- Blair PW, Kuhn JH, Pecor DB, Apanaskevich DA, Kortepeter MG, Cardile AP et al. An emerging biothreat: Crimean-congo hemorrhagic fever virus in southern and western asia. Am J Trop Med Hyg. 2019;100(1):16–23.
- Ergonul O, Celikbas A, Dokuzoguz B, Eren S, Baykam N, Esener H. Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis. 2004;39(2):284-287.
- Eren Gok S. Crimean- Congo hemorrhagic fever. Eur Arc Med Res. 2016;32(Supp): 13-19.
- Hekimoglu HC, Ates Demirci N. Evaluation of cases with a preliminary diagnosis of Crimean- Congo hemorrhagic fever and comparison of characteristics in patients admitted to a secondary care hospital in Kastamonu, Turkey. Afr Health Sci. 2014;14(4):873-881.
- Leblebicioglu H, Ozaras R, Irmak H, Sencan I. Crimean-Congo hemorrhagic fever in Turkey: current status and future challenges. Antiviral Res. 2016;126:21–34.
- 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(1):1433-1440.
- Hatami H, Qaderi S, Omid AM. Investigation of Crimean-Congo hemorrhagic Fever in Patients Admitted in Antani Hospital, Kabul, Afghanistan, 2017–2018. Int J Prev Med. 2019;10:117.
- Erenler AK, Kulaksiz F, Ulger H, Erdem M, Kocak C, Soylemez F et al. Characteristics of patients admitted to the emergency department due to tick bite. Trop Doct. 2014;44(2):86–88.
- Mostafavi E, Pourhossein B, Chinikar S. Clinical symptoms and laboratory findings supporting early diagnosis of Crimean-Congo hemorrhagic fever in Iran. J Med Virol. 2014;86(7):1188–1192.
- Duran A, Kucukbayrak A, Ocak T, Hakyemez NI, Tas T, Karadag M et al. Evaluation of patients with Crimean- Congo hemorrhagic fever in Bolu, Turkey. Afr Health Sci. 2013;13(2):233–242.
- Bodur H, Akinci E, Ascioglu S, Onguru P, Uyar Y. Subclinical infections with Crimean-Congo hemorrhagic fever virus, Turkey. Emerg Infect Dis.2012;18:640-642.
- Yilmaz GR, Buzgan T, Irmak H, Safran A, Uzun R, Cevik MA et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002–2007. Int J Infect Dis. 2009;13(3):380–386.
- Gunaydin NS, Aydin K, Yilmaz G, Caylan R, Koksal I. Crimean-Congo hemorrhagic fever cases in the eastern Black Sea Region of Turkey: Demographic, geographic, climatic, and clinical characteristics. Turk J Med Sci. 2010;40(6):829-834.
- Shayan S, Bokaean M, Shahrivar MR, Chinikar S. Crimean-Congo Hemorrhagic Fever.Lab Med. 2015;46(3):180-189.
- Ergonul O. Crimean-Congo Haemorrhagic fever: Treatment and use of Ribavirin. Klimik J. 2016;29(1):2-9.
- Public Health Institution of Turkey, Department of Zoonotic and Vectorial Diseases. Avaliable 18 April 2021. Avaliable from: https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-kkka.
- Mourya DT, Viswanathan R, Kumar Jadhav S, Yadav PD, Basu A, Chadha MS. Retrospective analysis of clinical information in Crimean-Congo haemorrhagic fever patients: 2014-2015, India. Indian J Med Res. 2017;145(5):673–678.
- Tasdelen Fisgin N, Ergonul O, Doganci L, Tulek N. The role of ribavirin in the therapy of Crimean-Congo hemorrhagic fever: Early use is promising. Eur J Clin Microbiol Infect Dis. 2009;28(8):929-233.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Erken Görünüm Tarihi | 10 Temmuz 2023 |
| Yayımlanma Tarihi | 12 Temmuz 2023 |
| Gönderilme Tarihi | 12 Nisan 2022 |
| Kabul Tarihi | 14 Haziran 2022 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 18 Sayı: 2 |
