Original Studies
Evaluation of Children with Crimean-Congo Hemorrhagic Fever in the Central Blacksea Region Nurşen Belet, MD,* Ayşe Top, MD,† Özlem Terzi, MD,‡ Hatice Nilden Arslan, MD,‡ Kemal Baysal, MD,§ and Gülnar Şensoy, MD† Background: Crimean-Congo hemorrhagic fever (CCHF) is endemic in some regions of our country. It is seen in all age groups; however, its prevalance is low in children. The studies on CCHF have been mostly in adults. The aim of this study was to evaluate the epidemiologic, demographic, clinical and laboratory findings of children with CCHF. Methods: Between May 2008 and September 2011, the medical records of patients who were admitted to the Children Infectious Diseases Service of Ondokuz Mayis University School of Medicine with positive blood IgM by enzyme-linked immunosorbent assay or polymerase chain reaction positive for CCHF were retrospectively evaluated. Epidemiologic and demographic features, clinical and laboratory data and therapy were recorded. Results: Fifty-four patients with the diagnosis of CCHF were recorded between May 2008 and September 2011. Main symptoms during hospital admission were fever (98%), vomiting (59%), headache (39%), nausea (39%), diarrhea (22%), abdominal pain (22%), bleeding (22%) and rash (20%). During admission, thrombocytopenia was found in 74%, elevated aspartate aminotransferase in 61%, leucopenia in 57%, elevated creatine kinase (33%) and alanine aminotransaminase (29%), and prolonged prothrombin time and partial thromboplastine time in 28% were noted. Thirty-nine patients received ribavirin treatment. During clinical follow up, bradycardia was recorded in 18 patients (33%) all of whom received ribavirin treatment. One patient died. Conclusions: This study reports the largest series of children with CCHF and the first to describe bradycardia associated with ribavirin therapy. Key Words: Crimean-Congo hemorrhagic fever, children, bradycardia, ribavirin (Pediatr Infect Dis J 2014;33:e194–e197)
C
rimean-Congo hemorrhagic fever (CCHF) is a viral infection with a potential fatal course and described in about 30 countries from Africa, Asia, East Europe and the Middle East.1–4 Virus belongs to the genus Nairovirus in the Bunyaviridae family and has a mortality of 15–70% in humans.4,5 CCHF cases were first described in 2002 in Turkey and important increases were seen in frequency up to date.5–7 CCHF is endemic in the Middle, East and North Anatolia and the Blacksea regions. Although CCHF can be seen in all age groups, its prevalence is low in children and thus studies on CCHF have been mostly adult in origin. Central Blacksea Region is an endemic location for CCHF. Our hospital is a reference center where suspicious cases for CCHF in Central Blacksea Region admit directly or cases are referred Accepted for publication January 17, 2014. From the *Department of Pediatric Infectious Diseases; †Department of Pediatrics; ‡Department of Public Health; and §Department of Pediatric Cardiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey. The authors have no funding or conflicts of interest to disclose. Address for correspondence: Nurşen Belet, Ondokuz Mayis University Faculty of Medicine, Department of Pediatric Infectious Diseases, 55100 Samsun, Turkey. E-mail: [email protected]. Copyright © 2014 by Lippincott Williams & Wilkins ISSN: 0891-3668/14/3308-e194 DOI: 10.1097/INF.0000000000000281
e194 | www.pidj.com
from other centers. The aim of this study is to evaluate the epidemiologic, clinical and laboratory findings, therapies and their results in children with CCHF between May 2008 and September 2011, retrospectively.
MATERIALS AND METHODS Blood samples of patients were, admitted with a prediagnosis of CCHF, withdrawn during admission and after the first week of hospitilization they were sent to Refik Saydam Hygiene Center in Ankara, which is the national reference laboratory of Turkey, between May 2008 and September 2011. Patients with positive IgM or polymerase chain reaction (PCR) by enzyme-linked immunosorbent assay (ELISA) for CCHF virus were included into the study. The demographic and epidemiologic properties, clinical and laboratory findings at admission and during hospitilization, applied therapies and their results were recorded on the patient files retrospectively. Reference laboratory values are total leukocyte counts × 109/L, hemoglobin 4–10 × 109/L, platelet counts 150–350 11.35–14.35 g/dL, Aspartate aminotransferase (AST) 8–46 U/L, alanine aminotransaminase (ALT) 8–46 U/L, creatine kinase (CK) 35–195 U/L, prothrombin time (PT) 10–14 seconds and activated partial thromboplastin time (aPTT) 22–35 seconds. Leucopenia was described as a white blood cell count 12 × 109/L and thrombocytopenia was described as a platelet count
Evaluation of Children with Crimean-Congo Hemorrhagic Fever in the Central Blacksea Region Nurşen Belet, MD,* Ayşe Top, MD,† Özlem Terzi, MD,‡ Hatice Nilden Arslan, MD,‡ Kemal Baysal, MD,§ and Gülnar Şensoy, MD† Background: Crimean-Congo hemorrhagic fever (CCHF) is endemic in some regions of our country. It is seen in all age groups; however, its prevalance is low in children. The studies on CCHF have been mostly in adults. The aim of this study was to evaluate the epidemiologic, demographic, clinical and laboratory findings of children with CCHF. Methods: Between May 2008 and September 2011, the medical records of patients who were admitted to the Children Infectious Diseases Service of Ondokuz Mayis University School of Medicine with positive blood IgM by enzyme-linked immunosorbent assay or polymerase chain reaction positive for CCHF were retrospectively evaluated. Epidemiologic and demographic features, clinical and laboratory data and therapy were recorded. Results: Fifty-four patients with the diagnosis of CCHF were recorded between May 2008 and September 2011. Main symptoms during hospital admission were fever (98%), vomiting (59%), headache (39%), nausea (39%), diarrhea (22%), abdominal pain (22%), bleeding (22%) and rash (20%). During admission, thrombocytopenia was found in 74%, elevated aspartate aminotransferase in 61%, leucopenia in 57%, elevated creatine kinase (33%) and alanine aminotransaminase (29%), and prolonged prothrombin time and partial thromboplastine time in 28% were noted. Thirty-nine patients received ribavirin treatment. During clinical follow up, bradycardia was recorded in 18 patients (33%) all of whom received ribavirin treatment. One patient died. Conclusions: This study reports the largest series of children with CCHF and the first to describe bradycardia associated with ribavirin therapy. Key Words: Crimean-Congo hemorrhagic fever, children, bradycardia, ribavirin (Pediatr Infect Dis J 2014;33:e194–e197)
C
rimean-Congo hemorrhagic fever (CCHF) is a viral infection with a potential fatal course and described in about 30 countries from Africa, Asia, East Europe and the Middle East.1–4 Virus belongs to the genus Nairovirus in the Bunyaviridae family and has a mortality of 15–70% in humans.4,5 CCHF cases were first described in 2002 in Turkey and important increases were seen in frequency up to date.5–7 CCHF is endemic in the Middle, East and North Anatolia and the Blacksea regions. Although CCHF can be seen in all age groups, its prevalence is low in children and thus studies on CCHF have been mostly adult in origin. Central Blacksea Region is an endemic location for CCHF. Our hospital is a reference center where suspicious cases for CCHF in Central Blacksea Region admit directly or cases are referred Accepted for publication January 17, 2014. From the *Department of Pediatric Infectious Diseases; †Department of Pediatrics; ‡Department of Public Health; and §Department of Pediatric Cardiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey. The authors have no funding or conflicts of interest to disclose. Address for correspondence: Nurşen Belet, Ondokuz Mayis University Faculty of Medicine, Department of Pediatric Infectious Diseases, 55100 Samsun, Turkey. E-mail: [email protected]. Copyright © 2014 by Lippincott Williams & Wilkins ISSN: 0891-3668/14/3308-e194 DOI: 10.1097/INF.0000000000000281
e194 | www.pidj.com
from other centers. The aim of this study is to evaluate the epidemiologic, clinical and laboratory findings, therapies and their results in children with CCHF between May 2008 and September 2011, retrospectively.
MATERIALS AND METHODS Blood samples of patients were, admitted with a prediagnosis of CCHF, withdrawn during admission and after the first week of hospitilization they were sent to Refik Saydam Hygiene Center in Ankara, which is the national reference laboratory of Turkey, between May 2008 and September 2011. Patients with positive IgM or polymerase chain reaction (PCR) by enzyme-linked immunosorbent assay (ELISA) for CCHF virus were included into the study. The demographic and epidemiologic properties, clinical and laboratory findings at admission and during hospitilization, applied therapies and their results were recorded on the patient files retrospectively. Reference laboratory values are total leukocyte counts × 109/L, hemoglobin 4–10 × 109/L, platelet counts 150–350 11.35–14.35 g/dL, Aspartate aminotransferase (AST) 8–46 U/L, alanine aminotransaminase (ALT) 8–46 U/L, creatine kinase (CK) 35–195 U/L, prothrombin time (PT) 10–14 seconds and activated partial thromboplastin time (aPTT) 22–35 seconds. Leucopenia was described as a white blood cell count 12 × 109/L and thrombocytopenia was described as a platelet count
