PCR Diagnosis, Epidemiological and Clinical Data of Crimean-Congo Hemorrhagic Fever Virüs in Tokat/Türkiye

Year 2023, , 24 - 31, 29.03.2023

Metin Özdemir , Yelda Dağcıoğlu , Yunus Bulut

https://doi.org/10.58854/jicm.1257106

Abstract

Objectives: To contribute to case management algorithms and guidelines by evaluating the clinical symptoms, laboratory data, risk factors and mortality rates of patients admitted to health institutions with tick bite in Tokat.

Methods: The virus determination was made from the blood by conventional PCR in 141 patient. Epidemiological data such as socio-demographic variables and risk factors were compared with clinical
symptoms, biochemical and hematological parameters.

Results: Of the patients, 83 (58.9%) were male, 84(59.6%) were positive. Five patients (5.95%) died in the PCR-positive group. Fever and tick contact history rates was found to be significantly higher in the PCR
positive patients than the PCR negative group. Thrombocytopenia, leukopenia, aspartate transaminase (AST) elevation were found to be significantly higher in PCR positive patients. Despite the mean alanine transferase (ALT) was not significantly higher, the increase in the number of patients exceeding the reference range was found to be significantly higher in PCR-positive group (p<0.05).

Conclusion: PCR diagnosis has an active role in the incubation and prehemorrhagic period diagnosis of cases with a history and risk factors, clinical symptoms and compatible hematological and biochemical parameters in the endemic region. The place of ALT and AST elevation in the case management algorithm should be better clarified. Mortality rates of the disease can be reduced by providing the health services quality and a well-functioning surveillance system. Efforts to increase the knowledges of people living in rural areas about the disease may be effective in controlling the disease.

Keywords

PCR diagnosis, Crimean-Congo hemorrhagic fever, Epidemiological and Clinical Data

Supporting Institution

Gaziosmanpaşa University Scientific Research Projects Commission

Project Number

Project No: 2007-3

Thanks

Thanks to Gaziosmanpaşa University Scientific Research Projects Commission for this research.

Kırım Kongo Kanamalı Ateşi Virüsünün Tokat/Türkiye’de PCR Tanısı, Epidemiyolojik ve Klinik Verileri

Abstract

Amaç: Tokat ilinde kene ısırığı ile sağlık kuruluşlarına başvuran hastaların klinik semptomları, laboratuvar verileri, risk faktörleri ve mortalite hızlarını değerlendirerek vaka yönetimi algoritmalarına ve kılavuzlarına katkıda bulunmaktır.

Yöntem: 141 hastanın kanında konvansiyonel PCR ile virus tayini yapılmıştır. Sosyodemografik değişkenler ve risk faktörleri gibi epidemiyolojik veriler, klinik semptomlar, biyokimyasal ve hematolojik parametreler ile karşılaştırıldı.

Bulgular: Hastaların 83’ü (%58,9) erkek ve 84’ü (%59,6) pozitifti. PCR pozitif grupta beş hasta (%5.95) öldü. Ateş ve kene temas öyküsü oranları PCR pozitif hastalarda PCR negatif gruba göre anlamlı olarak yüksek bulundu. Trombositopeni, lökopeni, aspartat transaminaz (AST) yüksekliği PCR pozitif hastalarda anlamlı olarak yüksek bulundu. Ortalama alanin transferaz (ALT) anlamlı olarak yüksek olmamasına rağmen, referans aralığı aşan hasta sayısındaki artış, PCR pozitif grupta anlamlı olarak yüksek bulundu (p<0.05).

Sonuç: PCR tanısı, endemik bölgede öyküsü ve risk faktörleri, klinik semptomları ve uyumlu hematolojik ve biyokimyasal parametreleri olan olguların inkübasyon ve prehemorajik dönem tanısında etkin bir role sahiptir. ALT ve AST yükselmesinin vaka yönetimi algoritmasındaki yeri daha iyi aydınlatılmalıdır. Sağlık hizmetlerinin kalitesi ve iyi işleyen bir sürveyans sistemi sağlanarak hastalığa bağlı ölüm oranları azaltılabilir. Kırsal kesimde yaşayan insanların hastalık hakkındaki bilgilerinin artırılmasına yönelik çalışmalar hastalığın kontrol altına alınmasında etkili olabilir.

Keywords

PCR Teşhisi, Kırım-Kongo Kanamalı Ateşi, Epidemiyolojik ve Klinik Veriler

Project Number

Project No: 2007-3

References

• Hoogstraal H. The epidemiology of tick borne Crimean-Congo hemorrhagic fever in Asia, Europe, and Africa. Journal of Medical Entomology 1979; 15 (4): 307–417. https:// doi.org/10.1093/jmedent/15.4.
• Whitehouse CA. Crimean-Congo hemorrhagic fever. Antiviral research 2004; 64 (3): 145–160. https://doi.org/10.1016/j. antiviral.2004.08.001
• Ergönül Ö. Crimean-Congo haemorrhagic fever. The Lancet infectious diseases 2006; 6(4): 203-214.
• Garrison AR, Alkhovsky Альховский Сергей Владимирович SV, Avšič-Županc T, Bente DA, Bergeron É et al. Virus Taxonomy Profile: Nairoviridae. The Journal of general virology 2020; 101 (8): 798–799. https:// doi.org/10.1099/jgv.0.001485
• Wölfel R, Paweska JT, Petersen N, Grobbelaar AA, Leman PA et al. Virus detection and monitoring of viral load in Crimean-Congo hemorrhagic fever virus patients. Emerging infectious diseases 2007; 13(7); 1097–1100. https://doi.org/10.3201/eid1307.070068
• T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü (2022). KKKA Formlar (online). Website https://hsgm.saglik.gov.tr/tr/ zoonotikvektorel-kkka/formlar [accessed 29 12 2022]
• Nasirian H. New aspects about Crimean Congo hemorrhagic fever (CCHF) cases and associated fatality trends: A global systematic review and meta-analysis. Comparative Immunology, Microbiology and Infectious Diseases 2020; 69(), 101429. https://doi. org/10.1016/j.cimid.2020.101429
• Centers for Disease Control and Prevention (2022). Crimean-Congo Hemorrhagic Fever (CCHF) [online]. Website https://www.cdc. gov/vhf/crimean-congo/index.html [29 12 2022]
• Duh D, Saksida A, Petrovec M, Dedushaj I, Avsic-Zupanc T. Novel one-step real time RT-PCR assay for rapid and specific diagnosis of Crimean-Congo hemorrhagic fever encountered in the Balkans. Journal of virological methods 2006; 133 (2): 175–179. https://doi.org/10.1016/j. jviromet.2005.11.006
• Çıtıl R, Eğri, M, Önder Y, Duygu F, Bulut YE et al. Determination of Seroprevalence and Risk Factors of Crimean-Congo Haemorrhagic Fever (CCHF) in the Endemic Region in Turkey: A Population-Based Cross-Sectional Study. Journal of tropical medicine 2021; 9945089. https://doi. org/10.1155/2021/9945089
• T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü (2022). KKKA İstatistik Verileri [online]. Website https://hsgm. saglik.gov.tr/tr/zoonotikvektorel-kkka/ zoonotikvektorel-kkka-istatistik [accessed 29 12 2022]
• Nasirian H. Crimean-Congo hemorrhagic fever (CCHF) seroprevalence: A systematic review and meta-analysis. Acta tropica 2019; 196: 102–120. https://doi.org/10.1016/j. actatropica.2019.05.019
• Gruber CEM, Bartolini B, Castilletti C, Mirazimi A, Hewson R et al. Geographical Variability Affects CCHFV Detection by RT-PCR: A Tool for In-Silico Evaluation of Molecular Assays. Viruses 2019; 11 (10): 953. https://doi.org/10.3390/v11100953
• Ozdemir M. Epidemiology and Laboratory Diagnosis of Crimean-Congo Hemorrhagic Fever. Diseases Transmitted by Ticks. 1th ed. Nova Science Publishers, Inc. 2022. pp. 201- 214. https://doi.org/10.52305/MVXE4447.
• Chinikar S, Goya MM, Shirzadi MR, Ghiasi SM, Mirahmadi R et al. Surveillance and laboratory detection system of Crimean Congo haemorrhagic fever in Iran. Transboundary and emerging diseases 2008; 55 (5-6): 200–204. https://doi. org/10.1111/j.1865-1682.2008.01028.x
• Aslani D, Salehi-Vaziri M, Baniasadi V, Jalali T, Azad-Manjiri S et al. Crimean-Congo hemorrhagic fever among children in Iran. Archives of virology 2017; 162 (3): 721– 725. https://doi.org/10.1007/s00705-016- 3162-7
• Karakecili F, Cikman A, Aydin M, Binay UD, Kesik OA et al. Evaluation of epidemiological, clinical, and laboratory characteristics and mortality rate of patients with Crimean Congo hemorrhagic fever in the northeast region of Turkey. Journal of vector borne diseases 2018; 55 (3): 215–221. https://doi. org/10.4103/0972-9062.249479
• Gürbüz E, Ekici A, Ünlü AH, Yılmaz H. Evaluation of seroprevalence and clinical and laboratory findings of patients admitted to health institutions in Gümüşhane with suspicion of Crimean-Congo hemorrhagic fever. Turkish journal of medical sciences. 2021; 51 (4): 1825–1832. https://doi. org/10.3906/sag-2001-82
• Duran A, Küçükbayrak A, Ocak T, Hakyemez NI, Taþ T et al., Karadađ, M., & Mengelođlu, Z. F. (2013). Evaluation of patients with Crimean-Congo hemorrhagic fever in Bolu, Turkey. African health sciences, 13(2), 233– 242. https://doi.org/10.4314/ahs.v13i2.5
• Alavi-Naini, R., Moghtaderi, A., Koohpayeh, H. R., Sharifi-Mood, B., Naderi, M 2006. Crimean-Congo hemorrhagic fever in Southeast of Iran. The Journal of infection 2006; 52 (5): 378–382. https://doi. org/10.1016/j.jinf.2005.07.015
• Sağmak Tartar A, Balın ŞÖ, Akbulut A, Demirdağ K. Crimean Congo Hemorrhagic Fever in Eastern Turkey: Epidemiological and Clinical Evaluation. Turkiye Parazitoloji Dergisi 2019; 43 (1): 26–29. https://doi. org/10.4274/tpd.galenos.2019.6142
• Khurshid A, Hassan M, Alam MM, Aamir UB, Rehman L et al. CCHF virus variants in Pakistan and Afghanistan: Emerging diversity and epidemiology. Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 2015; 67: 25–30. https://doi.org/10.1016/j.jcv.2015.03.021
• Mardani M, Keshtkar-Jahromi M. Crimean Congo hemorrhagic fever. Archives of Iranian medicine 2007; 10 (2): 204–214.
• Bakir M, Ugurlu M, Dokuzoguz B, Bodur H, Tasyaran MA et al. Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures. Journal of medical microbiology 2005; 54 (Pt 4): 385–389. https://doi.org/10.1099/ jmm.0.45865-0
• Yilmaz GR, Buzgan T, Irmak H, Safran A, Uzun R et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007. International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 2009; 13 (3): 380–386. https://doi.org/10.1016/j. ijid.2008.07.021
• Swanepoel R, Gill DE, Shepherd AJ, Leman PA, Mynhardt JH et al. The clinical pathology of Crimean-Congo hemorrhagic fever. Reviews of infectious diseases 1989; 11 (4): 794– 800. https://doi.org/10.1093/clinids/11. supplement_4.s794