Crimean-Congo Hemorrhagic Fever

Abstract

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.

Keywords

• Crimean-Congo hemorrhagic fever (CCHF), CCHF virus, epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, prevention

Crimean-Congo Hemorrhagic Fever

Öz

Kırım-Kongo kanamalı ateşi (KKKA) Bunyaviridae ailesi, Nairovirüs cinsine mensup KKKA virüsü (CCHFV) tarafından oluşturulan kene kaynaklı bir viral hemorajik ateş ve zoonotik bir enfeksiyon hastalığıdır. Bulaş başlıca Hyalomma m. marginatum keneleri ile temas sonucu oluşur. Hastalara ait kan ve kanlı vücut çıkartıları son derece bulaştırıcı ve cilt ve mukoza temasıyla KKKA bulaşı olabilir. KKKA ilk olarak eski Sovyetler Birliği’nde 1944 yılında Kırım yarımadasında, Türkiye’de Kelkit Vadisi’nde 2002 yılında ilk olarak tarif edilmiştir. KKKA 2013 yılı itibarıyla Güneydoğu Asya, Orta Doğu, Avrupa ve Afrika’da 30’dan fazla ülkede bildirilmiştir. Hastalık ateş, trombositopeni ve ciddi vakalarda kanama ve şok ile karakterizedir. Vaka-ölüm oranı genellikle %10-%50 arasında değişmekle birlikte Türkiye için %5 olarak bildirilmiştir. CCHFV’nin konak dokuda ana hedefleri bağışıklık hücreleri ve endotel olup, CCHFV’ye karşı korunmada konakta hem doğal ve hem de özgül bağışıklık önemlidir. Baş ağrısı, ateş, halsizlik, kas ve eklem ağrısı, konjuktiva ve yüzde kızarıklık, trombositopeni, karaciğer enzimlerinde yükselme, hepatomegali ve splenomegali KKKA için önemli belirti ve bulgulardır. Ekimoz, melena, hematokezia, hematemez ve burun kanaması gibi kanama bulgular ağır vakalarda görülür. Destek tedavisi esas tedavi olup günümüzde insanlarda kullanılan KKKA’ya özgül ne bir ilaç ne de güvenli bir aşı bulunmamaktadır. Penetran yaralanma durumunda yaralanan bölgenin sabunlu su ve etanol ile yıkanmasından sonra oral ribavirin profilaksisi verilebilir

Anahtar Kelimeler

• Kırım-Kongo kanamalı ateşi (KKKA), CCHFV, epidemiyoloji, patogenez, klinik belirtiler, tanı, tedavi, korunma

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