Investigation of Cases with Tick Attachment at the Emergency Department

Abstract

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Tick-borne diseases and especially Crimean-Congo Hemorrhagic Fever (CCHF) are serious epidemiological problems in many parts of the world. In this study, we aimed to emphasize the importance of an emergency approach to treat these diseases and to stress the importance of identifying characteristics of patients who are admitted to the hospital for tick attachment. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This study included 336 patients who admitted to Uludag University Medical Faculty Hospital Emergency Department (ED) and presented with tick attachment between April 2009 and May 2010. Patient demographics, clinical and laboratory findings and follow-up data were recorded. Laboratory parameters of hospitalized patients and non-hospitalized patients were statistically compared. R Re es su ul lt ts s: : The mean age of the patients was 43.85±13.88 years. Males comprised %50.9 of the patients. The most common months for hospital admission for tick attachment were July (33.0%) and August (32.4%). Of total, %49.1 of the patients acquired the tick in urban areas while %35.4 of them acquired it in the rural areas such as picnic areas, forest, field or animal shelters. The tick attachments were found in the lower extremities in 27.4% of the patients. In 65.5% of patients, the tick was removed by a physician in the ED using a forceps (54.2%) which was the most commonly used tool for tick removal. Laboratory parameters [aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), creatine phosphokinase (CK), white blood cell, neutrophil and platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT) and the international normalized ratio (INR)] of the hospitalized patients who were suspected CCHF were statistically significantly different when compared to the ones who were not hospitalized. C Co on nc cl lu us si io on n: : In tick attachment cases who admitted to the ED, decreased levels of thrombocyte, leukocyte and neutrophil counts and increased levels of AST, ALT, LDH, CK, aPTT, PT and INR are significant for CCHF. An emergency department physician should be alert for these results. Bu ul lg gu ul la ar r: : Çalışmaya alınan hastaların yaş ortalaması 43,85±13,88'idi. Hastaların %50,9'u erkekti. En sık başvuru Temmuz (%33,3) ve Ağustos (%32,7) aylarında oldu. Hastaların %49,1'inde kene tutunması yerleşim yerinde, %35,4'ünde piknik alanları, hayvan barınağı, orman, tarla gibi kırsal alanlarda meydana gelmişti. Olgularının %27,4'ünde kene alt ekstremiteye tutunmuştu. Kenelerin %65,5'i AS'de doktor tarafından çıkarılmıştı ve çıkartma yöntemi olarak en sık %54,2 oranında forseps kullanılmıştı. KKKA şüphesi ile hastaneye yatırılan olguların laboratuar parametreleri [aspartat transaminaz (AST), alanin transaminaz (ALT), laktat dehidrogenaz (LDH), kreatin fosfokinaz (CK), lökosit, nötrofil, trombosit, aktive parsiyel promboplastin zamanı (aPTZ), protrombin zamanı (PT), international normalize ratio (I...