Use of Routine Laboratory Tests for Diagnosis of Crimean-Congo Hemorrhagic Fever Disease in Emergency Department

Öz

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is a disease effecting multiple organ systems by microvascular damage and deterioration of hemostasis. Even though the main diagnosis relies on reverse transcriptase-polymerase chain reaction (rt-PCR), it is also known that thrombocytopenia, and/or leukopenia, elevated levels of alanine aminotranferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK) may be determined. In this study, our aim was to analyse the patients hospitalized with suspected CCHF Disease and consequently undergone PCR testing. PCR (+) and PCR (-) patients were compared according to their laboratory results obtained in the Emergency Department (ED). Materials and Methods: In a 2-year period, a total of 150 (female/male: 47/103) patients of any age hospitalized with the suspicion of CCHF were involved into the study. The patients were divided into 2 groups according to their rt-PCR results as PCR (+) (and PCR (-) patients. Two groups were compared according to the laboratory results obtained in the ED. Results: The most common complaint on admission was weakness (n=111, 74%) followed by fever (n=95, 63.3%) and headache (n=16, 10.7%). Ribavirin therapy was administered to 62 patients (41.3%). In 62 patients, PCR test was positive (41.3%). When PCR (+) and PCR (-) groups were compared according to the laboratory results obtained in the ED, number of patients with high AST/ALT, thrombocytopenia, low fibrinogen and aPTT levels were significantly higher in PCR (+) group. Conclusion: The diagnosis of CCHF is a challenging issue which requires high suspicion, particularly in the endemic regions. High AST/ALT, thrombocytopenia, low fibrinogen and aPTT levels determined in the ED should raise the suspect for the possibility of PCR positivity.

Anahtar Kelimeler

• Crimean-Congo hemorrhagic fever
• diagnosis
• emergency department

Kaynakça

1. Soares-Weiser K, Thomas S, Thomson G, et al. Ribavirin for Crimean-Congo hemorrhagic fever: systematic review and meta-analysis. BMC Infect Dis 2010; 10: 207.
2. Erenler AK, Kulaksiz F, Ülger H, et al. Predictors of Crimean-Congo hemorrhagic fever in the Emergency Department. Eur Rev Med Pharmacol Sci. 2015;19(20):3811-3816.
3. Fillâtre P, Revest M, Tattevin P. Crimean-Congo hemorrhagic fever: An update [published correction appears in Med Mal Infect. 2020 Feb;50(1):95-96]. Med Mal Infect. 2019;49(8):574-585. doi:10.1016/j.medmal.2019.09.005
4. Papa A, Mirazimi A, Köksal I, et al. Recent advances inresearch on Crimean-Congo hemorrhagic fever. J Clin Virol 2015;64:137–43
5. Erenler AK, Kulaksiz F, Ülger H, et al. Characteristics of patients admitted to the emergency department due to tick bite. Trop Doct. 2014;44(2):86-88. doi:10.1177/0049475513519625
6. Hamzeh Pour S, Najafi M, Danaei Koik N. Emergency Department Response in Dealing with Crimean-Congo Hemorrhagic Fever Patients. Iran J Public Health. 2018;47(9):1430-1431.
7. Tekin YK, Engin A. An Evaluation of the Different Serum Markers Associated with Mortality in Crimean-Congo Hemorrhagic Fever. Rambam Maimonides Med J. 2020;11(4):e0032. Published 2020 Oct 14. doi:10.5041/RMMJ.10393
8. Ergönül O. Crimean-Congo haemorrhagic fever. Lancet Infect Dis2006;6(4):203–14.

9. Cevik MA, Erbay A, Bodur H, et al. Clinical and laboratory features of Crimean-Congo hemorrhagic fever: predictors of fatality. Int J Infect Dis 2008; 12: 374–379
10. Raabe VN. Diagnostic Testing for Crimean-Congo Hemorrhagic Fever. J Clin Microbiol. 2020;58(4):e01580-19. Published 2020 Mar 25. doi:10.1128/JCM.01580-19
11. Graci JD, Cameron CE. Mechanisms of action of ribavirin against distinct viruses. RevMed Virol 2006; 16: 37–48.
12. Arab-Bafrani Z, Jabbari A, Mostakhdem Hashemi M, et al. Identification of the crucial parameters regarding the efficacy of ribavirin therapy in Crimean-Congo haemorrhagic fever (CCHF) patients: a systematic review and meta-analysis. J Antimicrob Chemother. 2019;74(12):3432-3439. doi:10.1093/jac/dkz328
13. 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: 551–554.
14. Yilmaz GR, Buzgan T, Irmak H, et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007. Int J Infect Dis 2009; 13: 380-386
15. Hoogstraal H. The epidemiology of tick-borne Crimean-Congo hemorrhagic fever in Asia, Europe, and Africa. J Med Entomol 1979; 15: 307-417.