Abdominal US Findings of Crimean-Congo Hemorrhagic Fever

Abstract

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is one of the deadly diseases, clinically causing viral hemorrhagic fever outbreaks. It is especially transmitted through tick bite and body secretions and accepted as an indigenous disease in certain regions in the world and in our country. Many of the organs, especially the lungs, are affected by this disease. However, current studies are not sufficiently relate the disease and abdominal organ involvement. Therefore, we aim to discuss the ultrasonography (US) findings of the CCHF disease in the context of the literature. Material and Method: The retrospective analysis of the hospital records of 283 patients, who were serologically diagnosed as CCHF between 2012-2016 was performed. Abdominal ultrasonography examination revealed that, 20 of those patients had findings in the womb. US findings of these 20 patients were analyzed. Results Nine patients (45%) were male, and 11 patients (55%) were female. The most common findings of abdominal US examinations were; the hepatomegalia and the intra-abdominal free fluid. Gallbladder wall thickening and splenomegalia were also commonly found in these patients. Periportal hyperechogenicity, intramuscular hemorrhage, colon wall thickening, sludge in gallbladder, renal hyperechogenicity, renal ectasia and ureter dilatation were rarely observed. Conclusion Our study is among the exceptional studies on the analysis of abdominal US findings of CCHF. The most commonly observed findings in our patients were the hepatomegalia and the intra-abdominal free fluid. Intra-abdominal findings of the disease were extremely variable. This study will shed light to the future comprehensive studies.

Keywords

• Crimean-Congo hemorhagic fever;Ultrasonography

Kırım Kongo Kanamalı Ateşinin Abdominal Ultrasonografi Bulguları

Abstract

Giriş ve Amaç Kırım – Kongo Kanamalı Ateşi, özellikle kene ısırması ve vücut sekresyonları aracılığıyla geçiş gösteren, dünyada ve ülkemizde bazı bölgelerde endemik olarak görülen, klinik olarak genellikle ateş ile seyreden ölümcül viral bir hastalıktır. Bu hastalıktan özellikle akciğerler olmak üzere vücuttaki birçok organ etkilenmektedir. Ancak hastalığa bağlı abdominal organlarda tutulum ile ilgili halen yeterli çalışma bulunmamaktadır. Bu nedenle biz çalışmamızda; Kırım – Kongo Kanamalı Ateşi hastalığının ultrasonografi bulgularını literatür eşliğinde tartışmayı amaçladık. Gereç ve Yöntem 2012- 2016 yılları arasında serolojik olarak Kırım – Kongo Kanamalı Ateşi hastalığı tanısı bulunan 283 hastanın hastanemizde tutulan kayıtları retrospektif olarak değerlendirildi. Bu hastalardan 20’sinde abdominal ultrasonografi incelemesi sonucunda batında bulgu saptandı. Batında bulgu saptanan hastaların ultrasonografi bulguları analiz edildi. Bulgular Hastaların 9’u (%45) erkek, 11’i (%55) kadındı. Abdominal ultrasonografi incelemesinde en yaygın görülen bulgular; hepatomegali ve intraabdominal serbest sıvı idi. Safra kesesi duvar kalınlaşması ve splenomegali diğer sık saptanan bulgulardandı. Periportal ekojenite artışı, kas içi hemoraji, kolon duvar kalınlaşması, safra kesesinde çamur, renal ekojenite artışı, renal ektazi ve üreter dilatasyonu ise nadir görülen bulgular arasındaydı. Sonuç Çalışmamız Kırım – Kongo Kanamalı Ateşinin abdominal ultrasonografi bulguları üzerine yapılmış çok nadir çalışmalar arasındadır. Hastalarımızda hepatomegali, içi serbest sıvı ve safra kesesi duvar kalınlaşması en sık görülen bulgulardır. Hastalık batında hemen hemen tüm organları etkileyebilmekte olup batıniçi bulgular oldukça çeşitlilik göstermektedir. Çalışmamızın ilerde yapılacak daha kapsamlı çalışmalara ışık tutacağı düşünülmektedir.

Keywords

• Kırım Kongo Kanamalı Ateşi,Ultrasonografi

References

1. 1. Chinikar S, Goya M, Shirzadi M, Ghiasi SM, Mirahmadi R, et al. Surveillance and laboratory detection system of Crimean Congo haemorrhagic fever in Iran. Trans bound Emerg Dis. 2008;55:200–04.
2. 2. Aktaş T, Aktaş F, Özmen Z, Altunkaş A, Kaya T, Demir O. Thorax CT findings in patients with Crimean‑Congo hemorrhagic fever. SpringerPlus. 2016;5(1):1823.
3. 3. Aktaş T, Aktaş F, Özmen Z.C, Özmen Z, Kaya T, Demir O. Mean platelet volume (mpv): a new predictor of pulmonary findings and survival in CCHF patients? Acta Medica Mediterranea. 2017;33:183 -90.
4. 4. Leblebicioglu H, Ozaras R, Irmak H, Sencan I. Crimean congo hemorrhagic fever in turkey: current status and future challenges. Antivira lRes. 2016;126:21–34.
5. 5. Aktaş T, Aktaş F, Özmen Z, Kaya T, Demir O. Does Crimean-Congo Hemorrhagic Fever Cause a Vasculitic Reaction with Pulmonary Artery. Enlargement and Acute Pulmonary Hypertension?. Lung.2016;194:807–12.
6. 6. Tufan Z.K, Yigit H, Kacar M, Bulut C, Canpolat G, Hatipoglu C.A, et al. Sonographic Findings in Patients With Crimean-Congo Hemorrhagic Fever. J Ultrasound Med 2014; 33:1999–2003.
7. 7. Yilmaz GR, Buzgan T, Irmak H, et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002–2007. Int J Infect Dis2009;13:380–86.
8. 8. Rhanavardi M, Rajaeinejad M, Pourmalek F, Mardani M, Holakouie-Naieni K, Dowlatshahi S. Knowledge and attitude toward Crimean-Congo hemorrhagic fever in occupationally at risk Iranian health care workers. J Hosp Infect. 2008; 69:77–85.

9. 9. Sari I, Bakir S, Engin A, Aydin H, Poyraz O. Some acut ephasereactants and cholesterol levels in serum of patient with Crimean-Congo haemorrhagic fever. Bosn J Basic Med Sci.2013;13:21–6.
10. 10. Borner N, Schwerk WB, Braun B. Leberin: Braun B, Gunther R, Schwerk WB, editors. Ultra schall diagnostik.Landsberg: Ecomed; 1987.
11. 11. Serter S, Ceylan C, Tunçyürek Ö, Örgüç Ş, Pabuçcu Y. Sonographic evaluation of spleen size and prevalence of accessory spleen in a healthy male Turkish population. Turk J Hematol 2010; 27: 25-8.
12. 12. Ozmen Z, Albayrak E, Ozmen Z.C, Aktas F, Aktas T, Duygu F. The evaluation of abdominal findings in Crimean-Congo hemorrhagic fever. Abdominal Radiology. 2016; 41:384–90.
13. 13. Ergonul O. Crimean-Congo hemorrhagic fever virus: new outbreaks, new discoveries. Curr Opin Virol. 2012; 2:215–20.
14. 14. Hatipoglu CA, Bulut C, Yetkin MA, et al. Evaluation of clinical and laboratory predictors of fatality in patients with Crimean-Congo haemorrhagic fever in a tertiary care hospital in Turkey. Scand J Infect Dis 2010; 42:516–21.
15. 15. Guner R, Tasyaran MA, Keske S, et al. Relationship between total thiol status and thrombocytopenia in patients with Crimean-Congo hemorrhagic fever. Southeast Asian J Trop Med Public Health. 2012;43:1411–18.
16. 16. Mentese A, Koksal I, Sumer AU, Arslan M, Karahan SC, Yilmaz G. Diagnostic and prognostic value of ischemia-modified albumin in patients with Crimean-Congo hemorrhagic fever. J Med Virol 2013; 85:684–88.
17. 17. Mardani M, Namazee N. Close contact precautions could prevent an outbreak of Crimean-Congo hemorrhagi cfever: a case series report froms out hernpart of Tehran. Int J PrevMed. 2013 4:715–19.
18. 18. Ergonul O. Crimean-Congo haemorrhagic fever. Lancet Infect Dis 2006; 6:203–14.
19. 19. Bray M. Pathogenesis of viral hemorrhagic fever. Curr Opin Immunol 2005; 17:399–403.
20. 20. Bui-Mansfield LT, Cressler DK. Imaging of hemorrhagic fever with renal syndrome: a potential bioterrorism agent of military significance. Mil Med. 2011;176:1327–34.
21. 21. Statler J, Mammen M, Lyons A, Sun W. Sonographic findings of healthy volunteer sinfected with dengue virus. J Clin Ultrasound.2008; 36:413–17.
22. 22. Setiawan MW, Samsi TK, Pool TN, Sugianto D, et al. Gallbladder wall thickening in dengue hemorrhagic fever: An ultrasonographic study. J Clin Ultrasound 1995; 23:357–62.
23. 23. Sharma N, Mahi S, Bhalla A, et al. Dengue fever related acalculous cholecystitis in a North Indian tertiary care hospital. J Gastroenterol Hepatol. 2006; 21:664–67.
24. 24. Dogan OT, Engin A, Salk I, et al. Evaluation of respiratory findings in Crimean-Congo hemorrhagic fever. Southeast Asian J Trop Med PublicHealth. 2011; 42:1100–105.
25. 25. Tanir G, Tuygun N, Balaban I, Doksoz O. A case of Crimean-Congo hemorrhagic fever with pleural effusion. Jpn J Infect Dis. 2009; 62:70–72.