The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey

Köksal, İftihar; Yılmaz, Gürdal; Aksoy, Firdevs; Aydin, Hava; Yavuz, İlknur; İskender, Serap; Akcay, Korhan; Erensoy, Şükrü; Çaylan, Refik; Aydın, Kemalettin

doi:10.1016/j.jcv.2009.11.007

Cited by 94 publications

(105 citation statements)

References 21 publications

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“…Studies on this topic are mostly retrospective, and their methodologies are inadequate 42 . In a randomized study by Köksal et al 43 , no effects of ribavirin were found on clinical and laboratory findings or mortality. In a systematic review and meta-analysis by Ascioglu et al 44 , ribavirin reportedly had no effects on mortality, clinical recovery, shorter hospital stay, earlier recovery of laboratory findings, or a decreased need for blood products.…”

Section: Resultsmentioning

confidence: 91%

Evaluation of patients with Crimean-Congo hemorrhagic fever in Bolu, Turkey

Duran¹,

Küçükbayrak²,

Ocak³

et al. 2013

Afr H. Sci.

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Background: Crimean-Congo hemorrhagic fever (CCHF), which is associated with a high mortality rate in the Black Sea region of Turkey, has received increasing attention. Objective: In this study, the epidemiological features, clinical and laboratory findings, treatments, and outcomes of patients diagnosed with CCHF between 2006 and 2012 based on data obtained from the Bolu Provincial Directorate of Health (BPDH) were evaluated. Methods: BPDH data were reviewed for the period between 1 January 2006 and 31 July 2012. The locations where the tick had attached to the patient, the site of the tick bite on the patient's body, the dates of tick bite and removal, and the demographic characteristics of each patient were recorded. BPDH data on the total number of tick bites, patients with confirmed CCHF, and deaths due to CCHF in Bolu Province during the study period were also evaluated. Results: A total of 46 patients with CCHF and 38 patients without CCHF but who had been bitten by ticks were admitted to the BPDH. Of the patients with CCHF, 54.3% were female. The mean age of the patients was 46.88 ± 2.05 years (range, 1-79 years). The mortality rate was 8.82%. Patients were predominantly observed in June and July. When the patients were distributed according to their occupations, the majority was houswife (48.6%), followed by animal husbandry worker (27.0%), farmer (10.8%), health worker (5.4%), and other (8.1%). The symptoms of the patients with CCHF included fatigue (60.9%), fever (60.9%), and myalgia (60.9%). Of those patients with CCHF, 41.3% were determined to have a high fever. Conclusions: The probability of developing CCHF decreased as the duration of tick attachment increased. Moreover, although the clinical presentation is important, it is not diagnostic. Physical examination and laboratory findings become more specific in later stages.

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Section: Resultsmentioning

confidence: 91%

Evaluation of patients with Crimean-Congo hemorrhagic fever in Bolu, Turkey

Duran¹,

Küçükbayrak²,

Ocak³

et al. 2013

Afr H. Sci.

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“…(Tasdelen Fisgin et al, 2009). However, a recent attempt to identify a benefit of ribavirin in a randomized clinical trial was unable to show that treatment significantly altered the disease (Koksal et al, 2010). A review of 21 published observational and experimental studies of ribavirin therapy concluded that, although most reports claimed a therapeutic benefit, the quality of the evidence was low (Soares-Weiser et al, 2010).…”

Section: Ribavirinmentioning

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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“…9 Until now, there is only one prospective randomized clinical study investigating the efficacy of oral ribavirin in CCHF in Turkey. In that study, Koksal et al 60 showed that no positive effects were observed both in clinical or laboratory parameters in CCHF patients treated with ribavirin. Due to the embryotoxic and teratogenic effects of ribavirin, it is contraindicated in pregnant women.…”

Section: J Microbiol Infect Dis Wwwjmidonlineorg Special Issue 1 2014mentioning

confidence: 91%

Crimean-Congo Hemorrhagic Fever

Elaldı¹,

Kaya²

2014

Journal of Microbiology and Infectious Diseases

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Crimean-Congo hemorrhagic fever (CCHF), a tick-borne viral hemorrhagic fever, is a zoonotic infection that caused by CCHF virus (CCHFV) of the family Bunyaviridae, genus Nairovirus. Transmission occurs mainly by Hyalomma m. marginatum tick exposure. Blood and bloody excretions of the patients are highly infectious and contact of skin and mucous membrane may lead to CCHF transmission. CCHF was described firstly in the Crimean peninsula in 1944, in former Soviet Union and in Kelkit Valley in 2002 in Turkey. By the year 2013, it has been notified in more than 30 countries of Asia, the Middle East, Southeastern part of Europe and Africa. The disease is characterized by fever and thrombocytopenia, in severe cases, hemorrhage and shock. Although, the case fatality rate for the infection is generally ranged from 10 to 50%, it was reported as 5% for Turkey. Main targets of CCHFV are immune cells and endothelium. Both innate and adaptive immunity are important for fighting against CCHFV in the host. Headache, fever, fatigue and muscle, joint pain, conjunctival injection, facial hyperemia, thrombocytopenia, elevated liver enzymes, hepatomegaly and splenomegaly are the main symptoms and findings for CCHF. Hemorrhagic manifestations including ecchymosis, melena, hematochezia, hematemesis, and epistaxis are commonly seen in severe cases. Supportive treatment is essential and nowadays neither a special drug, nor safe vaccine for humans is available for the treatment and prevention of CCHF. In case of penetrating injury with contaminated material, the oral ribavirin prophylaxis may be offered after the area being washed with soapy water and ethanol. J Microbiol Infect Dis 2014; Special Issue 1: S1-S9

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The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey

Cited by 94 publications

References 21 publications

Evaluation of patients with Crimean-Congo hemorrhagic fever in Bolu, Turkey

Evaluation of patients with Crimean-Congo hemorrhagic fever in Bolu, Turkey

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

Crimean-Congo Hemorrhagic Fever

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