Kırım Kongo Kanamalı Ateşi Tanısıyla İzlenen Hastaların Epidemiyolojik ve Biyokimyasal Olarak Değerlendirilmesi

Year 2020, , 320 - 327, 31.12.2020

Emine Parlak , Fatma Kesmez Can , Handan Alay , Mehmet Parlak , Zülal Özkurt , Zahide Koşan

https://doi.org/10.34084/bshr.834435

Cited By: 1

Abstract

Amaç: Kırım Kongo Kanamalı Ateşi (KKKA), ilk kez 1944 yılında Kırım’da tanımlanmış bir viral hemorajik ateştir. Ülkemizde ilk 2002 yılında Tokat ve çevresindeki salgınla dikkati çekmiştir. Bu çalışmada KKKA hastalarının klinik, epidemiyolojik ve laboratuvar özelliklerinin değerlendirilmesi amaçlanmıştır.
Yöntem: Bu çalışma, Atatürk Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları Kliniği’nde Nisan 2012-Ağustos 2013 tarihleri arasında KKKA tanısıyla takip edilen erişkin yaştaki hastalar arasında yapılmıştır. Veriler prospektif olarak toplanıp, IBM-SPSS 20 paket programına kaydedildi. İstatistik analizlerinde Mann-Whitney U, Ki-kare ve Fisher exact testi kullanıldı.
Bulgular: Kırım Kongo Kanamalı Ateşi tanısı Refik Saydam Hıfzısıhha Merkezinde hasta serumlarında Enzyme-linked immunosorbent assay (ELISA) ile anti-CCFV IgM ve/veya virüs antijeni real time Polimeraz zincir reaksiyonu (RT-PCR) yöntemi ile konuldu. Toplam 121 olgu alındı. Hastaların 59 (%48,7)’i erkek, 62 (%51,2)’si kadın olup, yaş ortalaması 50.04 ± 18.22 (16-86) yıl idi. Hastaların %62,8’sinde kene teması saptanmıştır. İnkübasyon süresi 3.9±2,7 gün idi. Hastalardan 5 (%4,1)’i ölmüştür.
Sonuç: KKKA keneler tarafından taşınan ölümcül bir viral infeksiyondur. Korunmada en önemli faktör kene temasını önlemektir. Endemik bölgede yaşayanlar eğitilmeli, günlük kene kontrolü yapılması anlatılmalıdır. Hastalara yüksek ateş, kas ağrısı, baş ağrısı şikâyetleri ve kene teması mutlaka sorulmalıdır. KKKA olgularının erken tanı ve tedavi ile mortalite ve morbiditelerinin azaltılabileceğine inanmaktayız.

Keywords

Kırım Kongo Kanamalı Ateşi, mortalite oranı, Türkiye

Epidemiological and Biochemical Evaluation of Patients Under Monitoring with A Diagnosis of Crimean-Congo Hemorrhagic Fever

Abstract

Aim: Crimean-Congo Hemorrhagic Fever (CCHF) is a viral hemorrhagic fever. To evaluate the clinical, epidemiological and laboratory characteristics of patients with CCHF.
Methods: This study was performed with adult patients under monitoring with diagnosis of CCHF at the Atatürk University Faculty of Medicine Infectious Diseases Clinic between April 2012 and August 2013.
Results: Diagnosis of CCHF was based on presence of Enzyme-linked immunosorbent assay (ELISA) anti-CCFV IgM and/or virus antigen at Refik Saydam Hygiene Center (RSHM) in patient serum and/or real time Polymerase Chain Reaction (PCR). One hundred twenty-one cases were included. Fifty-eight (48.7%) of patients were male and 62(51.2%) female, with a mean age of 50.04 ± 18.22 (16-86) years. Contact with ticks was determined in 62.8% of patients. Length of incubation was 3.9±2.7 days. Five patients (4.1%) died.
Conclusion: CCHF which is carried by ticks is a fatal viral infection. The most important factor in protection is the prevention of tick contact. People living in endemic regions must be educated and instructed how to perform daily tick checks. Patients have got high fever, myalgia, headache and tick bite must be asked in history. We believe that early diagnosis and treatment of CCHF cases may significantly reduce morbidity and mortality.

Keywords

Crimean-Congo Hemorrhagic Fever, mortality rate, Turkey

References

• Ergonul O. Crimean-Congo hemorrhagic fever. Lancet Infect Dis 2006; 6: 203-214.
• Tuygun N, Tanir G, Caglayık DY, et al. Pediatric cases of Crimean-Congo hemorrhagic fever in Turkey. Pediatrics International 2012; 54:402-406.
• Leblebicioglu H, Bodur H, Dokuzoguz B, et al. Case management and supportive treatment for patients with Crimean-Congo hemorrhagic fever. Vector Borne Zoonotic Dis 2012; 12(9): 805-811.
• Dilber E, Cakir M, Acar EA, et al. Crimean-Congo hemorrhagic fever among children in north-eastern Turkey. Ann Trop Paediatr 2009;29: 23-28.
• Swanepoel R, Gill DE, Shepherd AJ, et al. The clinical pathology of Crimean-Congo hemorrhagic fever. Rev Infect Dis 1989; 11(Suppl 4): 794-800. 1-4.
• Cevik MA, Erbay A, Bodur H, et al. Clinical and laboratory features of Crimean-Congo haemorrhagic fever: predictors of fatality. Int J Infect Dis 2008; 12: 374-379.
• Leblebicioglu H. Crimean-Congo haemorrhagic fever in Eurasia. Int J Antimicrob Agents 2010; 36(1): S43-S46.
• Ertugrul B, Uyar Y, Yavas K, et al. An outbreak of Crimean-Congo haemorrhagic fever in western Anatolia, Turkey. Int J Infec Dis 2009;13: e431-e436.
• Anonymous.SouthAfrica1981.http//www.angefire.com/punk/lymedisease/cchf81.html
• Bakir M, Ugurlu M, Dokuzoguz B, et al. Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures. J Med Microbiol 2005: 54 385-389.
• Ergonul O, Celikbas A, Baykam N, et al. Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited. Clin Microbiol Infect 2006; 12 (6): 551-554.
• Karti SS, Odabasi Z, Korten V, et al. Crimean-Congo Hemorrhagic Fever in Turkey. Emerg Infect Dis 2004; 19: 1379-1384.
• Parlak E, Koşan Z, Ertürk A, et al. A nosocomial outbreak of Crimean-Congo hemorrhagic fever. J Microbiol Infect Dis 2015;5(1): 5-9.
• Ozkurt Z, Kiki I, Erol S, et al: Crimean-Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy, J Infect 2006; 52 (3): 207-215.
• Shepherd AJ, Swanepoel R, Leman PA, et al. Comparison of methods for isolation and titration of Crimean-Congo hemorrhagic fever virus. J Clin Microbiol 1986; 24: 654-656.
• LeDue JW. Epidemiology hemorrhagic fever viruses. Rev Infect Dıs 1989:11 (Suppl 11):S370-5.
• Ftika L, Maltezou HC. Viral haemorrhagic fevers in healthcare settings. J Hosp Infect 2013; 83(3):185-192.
• Aradaib IE, Erickson BR, Mustafa ME, et al. Nosocomial outbreak of Crimean-Congo hemorrhagic fever, Sudan. Emerg Infect Dis 2010;16: 837-839.
• Gürbüz Y, Sencan İ, Öztürk B, et al. A case of nosocomial transmission of Crimean—Congo hemorrhagic fever from patient to patient. Int J Infect Dis 2009;13:e105—e107.
• Mardani M, Namazee N. Close contact precautions could prevent an outbreak of Crimean-Congo Hemorrhagic Fever: A case series report from southern part of Tehran. Int J Prev Med 2013;4(6):715–719.
• Ergönül Ö. Crimean-Congo hemorrhagic fever virus: new outbreaks, new discoveries. Curr Opin Virol in 2012; 2: 215-220.
• Jamil B, Hasan RS, Sarwari AR, et al. Crimean-Congo hemorrhagic fever: experience at a tertiary care hospital in Karachi, Pakistan. Trans R Soc Trop Med Hyg 2005;99(8):577-661.
• Burt FJ, Swanepoel R, Shieh WJ, et al.. Immunohistochemical and in situ localization of Crimean-Congo hemorrhagic fever virus in human tissues and implications for CCHF pathogenesis. Arch Pathol Lab Med 1997; 121(8): 839-846.
• Rodrigues R, Paranhos-Baccalà G, Vernet G, Peyrefitte CN. Crimean Congo hemorrhagic fever virus infected hepatocytes induce ER-stress and apoptosis crosstalk. PLoS One 2012;7(1):e29712.
• Duygu F, Kaya T, Baysan P. Re-evaluation of 400 Crieman-Congon Hemorrhagic Fever Cases in an Endemic area: Is Ribavirin treatment suitable? Vector Borne Zoonotic Dis 2012;12(9): 812-816.
• Bakır M, Engin A, Gozel MG, et al. A new perspective to determine the severity of cases Crimean-Congo hemorrhagic fever. J Vector Borne Dis 2012; 49(2):105-110.
• Whitehouse CA. Crimean-Congo hemorrhagic fever. Antiviral Res 2004; 64:145-60.
• Duh D, Saksida A, Petrovec M, et al. Viral load as predictor of Crimean-Congo haemorrhagic fever outcome. Emerg Infect Dis 2007; 13: 1769-72.
• Cevik MA, Erbay A, Bodur H, et al. A. Viral load as a predictor of outcome in Crimean-Congo hemorrhagic fever. Clin Infect Dis 2007; 45(7): e 96-100.
• Saksida A, Duh D, Wraber B, et al. Interacting roles of immune mechanisms and viral load in the pathogenesis of crimean-congo hemorrhagic fever. Clin Vaccine Immunol 2010;17(7):1086-1179.
• Bente DA, Whitehouse CA. Crimean-Congo hemorrhagic fever. Antiviral research 2013; 100:159-189.
• Tasdelen Fisgin N, Tanyel E, Doganci L, et al. Risk factors for fatality in patients with Crieman-Congo hemorrhagic fever. Trop Doct 2009; 39:158-160.