Crimean‐Congo hemorrhagic fever: Five patients with hemophagocytic syndrome

Fışgın, Nuriye Taşdelen; Fışgın, Tunç; Tanyel, Esra; Doğancı, Levent; Tülek, Necla; Güler, Nil; Duru, Feride

doi:10.1002/ajh.20969

Cited by 52 publications

(44 citation statements)

References 24 publications

(51 reference statements)

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“…A loss of lymphocytes through apoptosis, which occurs in Ebola HF through the action of inflammatory mediators, may also occur in CCHF. Recent studies in Turkey and Greece have also documented the occurrence of reactive hemophagocytic lymphohistiocytosis in many patients, which could contribute to pancytopenia (Karti et al, 2004;Tasdelen Fisgin et al, 2008;Papa et al, 2009a). This phenomenon may reflect intense activation of monocytes by high levels of Th1 cytokines.…”

Section: Pathogenesis Of Cchfmentioning

confidence: 99%

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

et al. 2013

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Bente, Dennis A.; Forrester, Naomi L.; Watts, Douglas M.; McAuley, Alexander J.; Whitehouse, Chris A.; and Bray, Mike, "CrimeanCongo hemorrhagic fever: History, epidemiology, pathogenesis, clinical syndrome and genetic diversity" (2013 b s t r a c tCrimean-Congo hemorrhagic fever (CCHF) is the most important tick-borne viral disease of humans, causing sporadic cases or outbreaks of severe illness across a huge geographic area, from western China to the Middle East and southeastern Europe and throughout most of Africa. CCHFV is maintained in vertical and horizontal transmission cycles involving ixodid ticks and a variety of wild and domestic vertebrates, which do not show signs of illness. The virus circulates in a number of tick genera, but Hyalomma ticks are the principal source of human infection, probably because both immature and adult forms actively seek hosts for the blood meals required at each stage of maturation. CCHF occurs most frequently among agricultural workers following the bite of an infected tick, and to a lesser extent among slaughterhouse workers exposed to the blood and tissues of infected livestock and medical personnel through contact with the body fluids of infected patients. CCHFV is the most genetically diverse of the arboviruses, with nucleotide sequence differences among isolates ranging from 20% for the viral S segment to 31% for the M segment. Viruses with diverse sequences can be found within the same geographic area, while closely related viruses have been isolated in far distant regions, suggesting that widespread dispersion of CCHFV has occurred at times in the past, possibly by ticks carried on migratory birds or through the international livestock trade. Reassortment among genome segments during co-infection of ticks or vertebrates appears to have played an important role in generating diversity, and represents a potential future source of novel viruses. In this article, we first review current knowledge of CCHFV, summarizing its molecular biology, maintenance and transmission, epidemiology and geographic range. We also include an extensive discussion of CCHFV genetic diversity, including maps of the range of the virus with superimposed phylogenetic trees. We then review the features of CCHF, including the clinical syndrome, diagnosis, treatment, pathogenesis, vaccine development and laboratory animal models of CCHF. The paper ends with a discussion of the possible future geographic range of the virus. For the benefit of researchers, we include a Supplementary Table listing all published reports of CCHF cases and outbreaks in the English-language literature, plus some principal articles in other languages, with total case numbers, case fatality rates and all CCHFV strains on GenBank.

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Section: Pathogenesis Of Cchfmentioning

confidence: 99%

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

et al. 2013

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“…Recently, increased serum levels of ferritin has been proposed as an independent single predicting factor for severity of various diseases such multiple sclerosis (MS) and also acute interstitial lung disease (ILD) caused by dermatomyositis, histiocytic malignancies, adult still disease and hemophagocytic lymphohistiocytosis [15][16][17][18][19]. Hemophagocytic lymphohistiocytosis phenomenon has recently been suggested in pathogenesis of CCHF [20].…”

Section: Introductionmentioning

confidence: 99%

Can Serum Ferritin Level Predict Disease Severity in Patients with Crimean-Congo Hemorrhagic Fever?

Metanat

Sharifi-Mood

Tabatabaei

et al. 2013

EAJM

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Objective: Crimean-Congo hemorrhagic fever (CCHF) is an acute viral disease. Several factors have already been suggested to explain the pathogenesis as well as predict the disease severity. In our study we aim to investigate the role of serum ferritin level as a possible predicting factor of disease severity in these patients. Materials and Methods:We evaluated all patients with laboratory confirmed diagnosis of CCHF who were admitted to Boo-Ali Hospital of Zahedan from May 2011 to June 2012. Confirmation of the disease determined using the presence of anti-CCHFV IgM in the serum by enzyme-linked immunosorbent assay (ELISA) or by polymerase chain reaction(PCR). After ethical approval, patients were categorized into two groups of mild and severe disease according to disseminated intravascular coagulation (DIC) severity using the scoring system of International Society on Thrombosis and Hemostasis (ISTH) . Serum ferritin levels were evaluated and compared between these two groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the optimal cutoff value of serum ferritin for predicting the disease severity.Results: A total of 42 patients (36 men, 6 women, age range: 17-78 years) were included in this study, of whom 38% had Persian and 62% had Baloch ethnicity. According to DIC severity score, 54.7% of the patients had severe disease and 45.3% had mild disease. The area under the ROC curve was 0.896 and 95% CI was 0.801-0.991 (p<0.0001). A cut-off point of 1060 ng/dL, had a sensitivity of 78.9%, a specificity of 87%, a positive predictive value of 6% and a negative predictive value of 100%. Positive and negative likelihood ratios for this serum ferritin level were 6.05 and 0.24, respectively. Conclusion:Increased serum ferritin level has a significant positive correlation with disease severity in patients with CCHF and can evaluate the prognosis of these patients with a high sensitivity and specificity.Key Words: Crimean-Congo hemorrhagic fever, disease severity, ferritin Bulgular:Toplam 42 hasta (36 erkek, 6 kadın, yaş aralığı: 17-78 yıl olmak üzere) bu çalışmaya dahil edilmiştir, hastaların %38 Pers ve %62 Baloch etnik grubuna dahildir. DIC şiddet skoruna göre, hastaların %54.7 ciddi ve %45.3 'ü hafif olarak sınıflandırılmıştır. ROC eğrisi altında kalan alan 0.896 ve %95 CI 0.801-0.991 (p değeri <0.05) bulunmuştur. 1.060 ng/dL bir kesim noktası %78.9 bir duyarlılık, %87 özgüllük, %6 bir pozitif prediktif değer ve %100 bir negatif prediktif değer tespit edilmiştir. Bu serum ferritin düzeyi için pozitif ve negative olabilirlik oranları sırasıyla 6.05 ve 0.24 olarak bulunmuştur.Sonuç: Artmış serum ferritin düzeyi KKKA hastalarında hastalık şid-deti ile anlamlı pozitif korelasyona sahiptir ve bu hastalarda prognozu yüksek bir duyarlılık ve özgüllük ile gösterebilir.

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“…Bak te ri yel me nen jit ler le il gi li çe-şit li ça lış ma lar da bil di ri len oran lar Tab lo 4'te ve rilmiş tir. Ça lış ma mız da bak te ri yel me nen jit ler için de tü ber kü loz me nen jit le rin ora nı nın Sır ma tel ve ark.nın ça lış ma sı 7 dı şın da, Tür ki ye' de ya pı lan di ğer ça lış ma lar dan 3,[8][9][10][11][12][13][14][15][16][17][18] yük sek gö rün me si nin, sosyo e ko no mik açı dan ge ri kal mış böl ge miz de tü berkü loz ol gu la rı nın sık lı ğıy la ve bu ol gu la rın çev re il ler den ser vi si mi ze se çi le rek gel me si ile il gi li oldu ğu dü şü nül dü. Ek ola rak, 1999-2001 yıl la rın da TM ol gu la rı mı zın üç te bi rin den faz la sı nın baş vurmuş ol ma sı nın ül ke miz de ki gö rü len eko no mik kriz ler le il gi li ola bi le ce ği dü şü nül dü.…”

Section: Tar Tiş Maunclassified

“…Bru sel loz me nen jit le ri nin ço -ğu za man göz ar dı edil di ği, bi zim ve Fış gın ve ark.nın 15 ça lış ma la rın dan an la şıl mak ta dır. Bru sello zun en de mik ol du ğu ül ke miz de bru sel la me nenji ti nin di ğer bak te ri yel me nen jit ler le ya da vi ral me nen jit ler le ka rış tı rıl dı ğı dü şü nül me li dir.…”

Section: 15unclassified

“…44 ol guluk bak te ri yel me nen jit se ri le rin de risk fak tör le ri ara sın da ope ras yon hi ka ye si ni %22.7, si nü zit hi kaye si ni %18.1, trav ma hi ka ye si ni %11.3 ve otit-masto i dit hi ka ye si ni %6.8 ola rak bil dir mek te dir ler. 15 Bü yük ço cuk lar ve ye tiş kin ler de ABM 'nin en sık gö rü len bul gu su ateş, baş ağ rı sı ve me ninks irri tas yon bul gu la rı dır.…”

Section: 15unclassified

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Retrospective Evaluation of Two Hundred and Four Bacterial Meningitis Cases

Buzğan¹,

Karahocagil²,

Irmak³

et al. 2010

Turkiye Klinikleri J Med Sci

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1675İki Yüz Dört Bakteriyel Menenjit Olgusunun Retrospektif İncelenmesi Ö ÖZ ZE ET T A Am ma aç ç: : Ocak 1995-Ağus tos 2008 ta rih le ri ara sın da Yü zün cü Yıl Üni ver si te si Tıp Fa kül te si İnfek si yon Has ta lık la rı Ser vis in de bak te ri yel me nen jit ta nı sıy la ta kip le ri ya pı lan ol gu la rı mı zın klinik ve la bo ra tu ar bul gu la rı nın ret ros pek tif de ğer len di ril me si amaç lan dı. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Hasta la rın de mog ra fik özel lik le ri, anam nez le ri, fi zik mu a ye ne ve la bo ra tu ar bul gu la rı dos ya la rı nın ta ran ma sı ile el de edil di. Bak te ri yel me nen jit ta nı sı; kli nik açı dan me nen jit şüp he li ol gu lar da, beyin omurilik sıvısı (BOS) 'nın mik ro bi yo lo jik, bi yo kim ya sal ve se ro lo jik, merkezi sinir sistemi (MSS)'nin rad yo lo jik tet kik le ri ve an ti mik ro bi yal te da vi ye ver dik le ri ya nıt la rın bir lik te de ğer len di ril me si ile ko nul du. B Bu ul l g gu u l la ar r: : İki yüz dört ol gu nun 96'sı ka dın, 108'i er kek, yaş or ta la ma sı 30.8 ± 13.9 idi. Olgu la rın %33'ü akut bak te ri yel me nen jit (ABM), %44'ü tü ber kü loz me nen jit (TM), %23'ü bru sel la me nen ji ti (BrM) idi. Baş ağ rı sı en faz la gö rü len semp tom olup (%80), ABM 'li ol gu la rın %89.5, TM'li ol gu la rın %71 ve BrM'li ol gu la rın %74.5'in de mev cut tu. ABM 'li has ta la rın BOS kül tü rün de S. pneu mo ni a e %13.4, N. me nin gi ti dis %7.5 ve S. au re us %3 ora nın da izo le edil di. TM'li has ta la rın %20'sin de asi do re zis tan bak te ri gös te ril di. BrM'li has ta la rı nın %10.6'sın da BOS' tan, %17.2'sin de kan dan B. me li ten sis izo le edil di. Mor ta li te ora nı ABM için %13.4, TM için %14.4 ve BrM için %2.1 idi. S So o n nu uç ç: : Tü ber kü loz me nen jit böl ge miz de di ğer bak te ri yel me nen jit ler den da ha sık gö rül mek te ve yük sek mor ta li te ve mor bi di te si ile dik ka ti çek mek te dir. Bru sel la me nen jit ler ise kli nik ve la bora tu var bul gu la rı di ğer bak te ri yel me nen jit le re gö re da ha si lik sey ret mek te dir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Me nen jit, bak te ri yel; tü ber kü loz, me nin ge al; bru sel la A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : We ai med to ret ros pec ti vely eva lu a te our ca ses fol lo wed up in de part ment of In fec ti o us Di se a ses, Me di cal Fa culty of Yü zün cü Yıl Uni ver sity with the di ag no sis of bac te ri al menin gi tis bet we en Ja nu ary 1995 and Au gust 2008 in vi ew of the ir cli ni cal and la bo ra tory fin dings. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : De mog rap hic fe a tu res, his tory, physi cal exa mi na ti on and la bo ra tory fin dings we re ac hi e ved by scre e ning the fi les. The di ag no sis of bac te ri al me nin gi tis in ca ses cli ni cally con sis tent with sus pected me nin gi tis was do ne by mic ro bi o lo gi cal, bi oc he mi cal and se ro lo gi cal tests per for med on cerebrospinal fluid (CSF) samp les, by ra di o lo gi cal ex...

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Crimean‐Congo hemorrhagic fever: Five patients with hemophagocytic syndrome

Cited by 52 publications

References 24 publications

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

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

Can Serum Ferritin Level Predict Disease Severity in Patients with Crimean-Congo Hemorrhagic Fever?

Retrospective Evaluation of Two Hundred and Four Bacterial Meningitis Cases

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