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Kırım Kongo kanamalı ateşinde mortaliteyi etkileyen faktörler

Year 2019, Volume: 3 Issue: 6, 428 - 432, 28.06.2019
https://doi.org/10.28982/josam.567579

Abstract

Amaç: Kırım kongo kanamalı ateşi enfekte kenelerle bulaşan ve yüksek mortaliteye sahip viral bir hastalıktır. Kırım Kongo Kanamalı Ateşi (KKKA) hastalarında mortalite üzerinde etkili faktörleri belirlemeyi amaçladık.

Yöntemler: Hastaların yaş, cinsiyet, kene teması, kene sayısı, kenenin kim tarafından çıkarıldığı, kenenin vücuttaki lokalizasyonu, hastaneye başvuru süresi, semptomları, fizik muayene ve vital bulguları, laboratuvar parametreleri ve mortaliteye etki eden faktörler değerlendirildi. Çalışma retrospektif kohort olarak dizayn edildi.

Bulgular: 172 hastanın yaş ortancası 46 (18-78) yıl olup, olguların %73,8’i erkekti. Hastaneye başvurusu geç olan, baş ve boyun bölgesinden ısırılmış olan, ısıran kene sayısı fazla olan, keneler kendisi veya yakını tarafından çıkartılan hasaların ve bilinç bozukluğu olan hastaların mortalite sıklığı yüksek saptandı (sırası ile P=0,001, P<0,001, P<0,001, P<0,001, P=0,002). Olguların %87,2’sinde kanama saptandı. Mortal seyreden olgularda ekimoz, akciğerde sıvı, hematüri, hematemez ve melena sıklığı yüksekti (sırası ile P<0,001, P<0,001, P<0,001, P=0,006, P=0,006). Mortal seyreden hastalarda ateş ve kalp hızı anlamlı olarak yüksek; sistolik ve diyastolik kan basınçları ise anlamlı olarak düşük saptandı (sırası ile P<0,001, P<0.001, P=0,006, P<0,001). Mortal seyreden hastalarda beyaz küre (BK) sayısı, uluslararası normalleştirilmiş oran (INR), aspartat aminotransferaz (AST) ve alanin aminotransferaz (ALT) düzeyleri anlamlı olarak yüksek, platelet sayısı, anlamlı olarak düşük saptandı (hepsi için P<0,001). 

Sonuç: Kanamanın mortalite gelişmesinde temel faktörlerden biri olduğu saptandı. Kene sayısı, çıkartan kişi sayısı ve ısırılma yeri gibi faktörlerin mortalite üzerine etkili olduğu saptandı. Kan tetkikleri ve vital parametrelerin KKKA tanısı olan hastalarda mortal seyredecek hastaların belirlenmesinde kullanılabileceği kanısındayız.

References

  • 1. Ahmeti S, Berisha L, Halili B, Ahmeti F, von Possel R, Thome-Bolduan C, et al. Crimean-Congo Hemorrhagic Fever, Kosovo, 2013-2016. Emerg Infect Dis. 2019;25(2):321–24. doi:10.3201/eid2502.171999.
  • 2. Appannanavar SB, Mishra B. An update on crimean congo hemorrhagic Fever. J Glob Infect Dis. 2011;3 (3):285-92. doi:10.4103/0974-777X.83537.
  • 3. Karakecili F, Cikman A, Aydin M, Binay UD, Kesik OA, Ozcicek F. Evaluation of epidemiological, clinical, and laboratory characteristics and mortality rate of patients with Crimean-Congo hemorrhagic fever in the northeast region of Turkey. J Vector Borne Dis. 2018;55 (3):215-21. doi: 10.4103/0972-9062.249479.
  • 4. Karlberg H, Tan YJ, Mirazimi A. Induction of caspase activation and cleavage of the viral nucleocapsid protein in different cell types during Crimean-Congo hemorrhagic fever virus infection. J Biol Chem. 2011;286(5):3227-34. doi:10.1074/jbc.M110.149369.
  • 5. Spengler JR, Bergeron E, Spiropoulou CF. Crimean-Congo hemorrhagic fever and expansion from endemic regions. Curr Opin Virol. 2019;34:70-8. doi: 10.1016/j.coviro.2018.12.002.
  • 6. Bente DA, Forrester NL, Watts DM, McAuley AJ, Whitehouse CA, Bray M. Crimean-Congo hemorrhagic fever: history, epidemiology, pathogenesis, clinical syndrome and genetic diversity. Antiviral Res. 2013;100(1):159-89. doi: 10.1016/j.antiviral.2013.07.006.
  • 7. Hasanoglu I, Guner R, Carhan A, Kocak Tufan Z, Yagci-Caglayik D, Guven T, et al. Crucial parameter of the outcome in Crimean Congo hemorrhagic fever: Viral load. J Clin Virol. 2016;75:42-6. doi: 10.1016/j.jcv.2015.12.006.
  • 8. Franz DR, Jahrling PB, Friedlander AM, McClain DJ, Hoover DL, Byrne WR, et al. Clinical recognition and management of patients exposed to biological warfare agents. Jama. 1997;278(5):399-411.
  • 9. Saksida A, Duh D, Wraber B, Dedushaj I, Ahmeti S, Avsic-Zupanc T. Interacting roles of immune mechanisms and viral load in the pathogenesis of crimean-congo hemorrhagic fever. Clin Vaccine Immunol. 2010;17(7):1086-93. doi: 10.1128/CVI.00530-09.
  • 10. Yilmaz GR, Buzgan T, Irmak H, Safran A, Uzun R, Cevik MA, et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007. Int J Infect Dis. 2009;13(3):380-6. doi: 10.1016/j.ijid.2008.07.021.
  • 11. Uluğ M. Kene Isırması Nedeniyle Başvuran Olguların Epidemiyolojik, Klinik ve Laboratuvar Bulgularının İrdelenmesi. Klimik Dergisi. 2011;24(1):40-3. doi: 10.5152/kd.2011.08.
  • 12. Gök ŞE. Kırım-Kongo Kanamalı Ateşi. Okmeydanı Tıp Dergisi 2016;32:13-9. doi: 10.5222/otd.2016.013.
  • 13. Sümer A. Kene Isırığı Nedeniyle Kaş Devlet Hastanesi Acil Servisine Başvuran Hastaların Değerlendirilmesi. Kafkas Univ Vet Fak Derg.2010;16:49-53. doi: 10.9775/kvfd.2009.378.
  • 14. Hussain Q, Shaikh BH, Bhutto AR, Sohaib M. An Unusual Case of Crimean Congo Hemorrhagic Fever: Prolonged Bleeding with Successful Recovery. J Coll Physicians Surg Pak. 2016;26 (2):151-3. doi: 02.2016/JCPSP.151153.
  • 15. Kleib AS, Salihy SM, Ghaber SM, Sidiel BW, Sidiya KC, Bettar ES. Crimean-Congo Hemorrhagic Fever with Acute Subdural Hematoma, Mauritania, 2012. Emerg Infect Dis. 2016;22(7):1305-6. doi: 10.3201/eid2207.151782.
  • 16. Bartolini B, Gruber CE, Koopmans M, Avšič T, Bino S, Christova I, et al. Laboratory management of Crimean-Congo haemorrhagic fever virus infections: perspectives from two European networks. Euro Surveill. 2019;24(5). doi: 10.2807/1560-7917.ES.2019.24.5.1800093.
  • 17. Swanepoel R, Gill DE, Shepherd AJ, Leman PA, Mynhardt JH, Harvey S. The clinical pathology of Crimean-Congo hemorrhagic fever. Rev Infect Dis. 1989;11(4):794-800.

Factors affecting mortality in Crimean-Congo hemorrhagic fever

Year 2019, Volume: 3 Issue: 6, 428 - 432, 28.06.2019
https://doi.org/10.28982/josam.567579

Abstract

Aim: Crimean-Congo hemorrhagic fever is a viral disease that is transmitted by infected ticks and has high mortality. We aim to determine the factors affecting mortality in patients with Crimean–Congo hemorrhagic fever (CCHF).

Methods: Age, gender, number of ticks, tick removal procedures, tick location, time to hospital admission, symptoms, physical examination findings, vital signs, laboratory parameters and factors affecting mortality were evaluated. The study was designed as a retrospective cohort study.

Results: The median age of the 172 patients was 46 (range, 18–78) years, and 73.8% of the patients were men. The mortality rate was high in patients with delayed time to hospital admission, those who were bitten on the head and neck region, those who had a high number of tick bites, those who had removed the tick themselves or had the tick removed by a relative and those who had impaired consciousness (P=0.001, P<0.001, P<0.001, P<0.001 and P=0.002, respectively). Bleeding was detected in 87.2% of cases. The frequency of ecchymosis, pleural effusion, hematuria, hematemesis and melena occurrence was high in non-survivors (P<0.001, P<0.001, P<0.001, P=0.006 and P=0.006, respectively). Fever and heart rate were significantly higher, systolic and diastolic blood pressure was significantly lower in non-survivors (P<0.001, P<0.001, P=0.006 and P<0.001, respectively). Additionally, the white blood cell (WBC) count, international normalized ratio (INR), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were significantly higher and platelet count were significantly lower in non-survivors (P<0.001 for all). 

Conclusion: We found that in patients with CCHF, bleeding was a major factor associated with mortality. Factors such as a number of ticks, the number of people removing the ticks and tick location were found to affect mortality. We believe that blood tests and vital parameters can be used to predict mortality in patients with CCHF.

References

  • 1. Ahmeti S, Berisha L, Halili B, Ahmeti F, von Possel R, Thome-Bolduan C, et al. Crimean-Congo Hemorrhagic Fever, Kosovo, 2013-2016. Emerg Infect Dis. 2019;25(2):321–24. doi:10.3201/eid2502.171999.
  • 2. Appannanavar SB, Mishra B. An update on crimean congo hemorrhagic Fever. J Glob Infect Dis. 2011;3 (3):285-92. doi:10.4103/0974-777X.83537.
  • 3. Karakecili F, Cikman A, Aydin M, Binay UD, Kesik OA, Ozcicek F. Evaluation of epidemiological, clinical, and laboratory characteristics and mortality rate of patients with Crimean-Congo hemorrhagic fever in the northeast region of Turkey. J Vector Borne Dis. 2018;55 (3):215-21. doi: 10.4103/0972-9062.249479.
  • 4. Karlberg H, Tan YJ, Mirazimi A. Induction of caspase activation and cleavage of the viral nucleocapsid protein in different cell types during Crimean-Congo hemorrhagic fever virus infection. J Biol Chem. 2011;286(5):3227-34. doi:10.1074/jbc.M110.149369.
  • 5. Spengler JR, Bergeron E, Spiropoulou CF. Crimean-Congo hemorrhagic fever and expansion from endemic regions. Curr Opin Virol. 2019;34:70-8. doi: 10.1016/j.coviro.2018.12.002.
  • 6. Bente DA, Forrester NL, Watts DM, McAuley AJ, Whitehouse CA, Bray M. Crimean-Congo hemorrhagic fever: history, epidemiology, pathogenesis, clinical syndrome and genetic diversity. Antiviral Res. 2013;100(1):159-89. doi: 10.1016/j.antiviral.2013.07.006.
  • 7. Hasanoglu I, Guner R, Carhan A, Kocak Tufan Z, Yagci-Caglayik D, Guven T, et al. Crucial parameter of the outcome in Crimean Congo hemorrhagic fever: Viral load. J Clin Virol. 2016;75:42-6. doi: 10.1016/j.jcv.2015.12.006.
  • 8. Franz DR, Jahrling PB, Friedlander AM, McClain DJ, Hoover DL, Byrne WR, et al. Clinical recognition and management of patients exposed to biological warfare agents. Jama. 1997;278(5):399-411.
  • 9. Saksida A, Duh D, Wraber B, Dedushaj I, Ahmeti S, Avsic-Zupanc T. Interacting roles of immune mechanisms and viral load in the pathogenesis of crimean-congo hemorrhagic fever. Clin Vaccine Immunol. 2010;17(7):1086-93. doi: 10.1128/CVI.00530-09.
  • 10. Yilmaz GR, Buzgan T, Irmak H, Safran A, Uzun R, Cevik MA, et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007. Int J Infect Dis. 2009;13(3):380-6. doi: 10.1016/j.ijid.2008.07.021.
  • 11. Uluğ M. Kene Isırması Nedeniyle Başvuran Olguların Epidemiyolojik, Klinik ve Laboratuvar Bulgularının İrdelenmesi. Klimik Dergisi. 2011;24(1):40-3. doi: 10.5152/kd.2011.08.
  • 12. Gök ŞE. Kırım-Kongo Kanamalı Ateşi. Okmeydanı Tıp Dergisi 2016;32:13-9. doi: 10.5222/otd.2016.013.
  • 13. Sümer A. Kene Isırığı Nedeniyle Kaş Devlet Hastanesi Acil Servisine Başvuran Hastaların Değerlendirilmesi. Kafkas Univ Vet Fak Derg.2010;16:49-53. doi: 10.9775/kvfd.2009.378.
  • 14. Hussain Q, Shaikh BH, Bhutto AR, Sohaib M. An Unusual Case of Crimean Congo Hemorrhagic Fever: Prolonged Bleeding with Successful Recovery. J Coll Physicians Surg Pak. 2016;26 (2):151-3. doi: 02.2016/JCPSP.151153.
  • 15. Kleib AS, Salihy SM, Ghaber SM, Sidiel BW, Sidiya KC, Bettar ES. Crimean-Congo Hemorrhagic Fever with Acute Subdural Hematoma, Mauritania, 2012. Emerg Infect Dis. 2016;22(7):1305-6. doi: 10.3201/eid2207.151782.
  • 16. Bartolini B, Gruber CE, Koopmans M, Avšič T, Bino S, Christova I, et al. Laboratory management of Crimean-Congo haemorrhagic fever virus infections: perspectives from two European networks. Euro Surveill. 2019;24(5). doi: 10.2807/1560-7917.ES.2019.24.5.1800093.
  • 17. Swanepoel R, Gill DE, Shepherd AJ, Leman PA, Mynhardt JH, Harvey S. The clinical pathology of Crimean-Congo hemorrhagic fever. Rev Infect Dis. 1989;11(4):794-800.
There are 17 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Research article
Authors

Nezih Kavak 0000-0003-2751-0046

Yunus Gürbüz This is me 0000-0002-8772-0769

Publication Date June 28, 2019
Published in Issue Year 2019 Volume: 3 Issue: 6

Cite

APA Kavak, N., & Gürbüz, Y. (2019). Factors affecting mortality in Crimean-Congo hemorrhagic fever. Journal of Surgery and Medicine, 3(6), 428-432. https://doi.org/10.28982/josam.567579
AMA Kavak N, Gürbüz Y. Factors affecting mortality in Crimean-Congo hemorrhagic fever. J Surg Med. June 2019;3(6):428-432. doi:10.28982/josam.567579
Chicago Kavak, Nezih, and Yunus Gürbüz. “Factors Affecting Mortality in Crimean-Congo Hemorrhagic Fever”. Journal of Surgery and Medicine 3, no. 6 (June 2019): 428-32. https://doi.org/10.28982/josam.567579.
EndNote Kavak N, Gürbüz Y (June 1, 2019) Factors affecting mortality in Crimean-Congo hemorrhagic fever. Journal of Surgery and Medicine 3 6 428–432.
IEEE N. Kavak and Y. Gürbüz, “Factors affecting mortality in Crimean-Congo hemorrhagic fever”, J Surg Med, vol. 3, no. 6, pp. 428–432, 2019, doi: 10.28982/josam.567579.
ISNAD Kavak, Nezih - Gürbüz, Yunus. “Factors Affecting Mortality in Crimean-Congo Hemorrhagic Fever”. Journal of Surgery and Medicine 3/6 (June 2019), 428-432. https://doi.org/10.28982/josam.567579.
JAMA Kavak N, Gürbüz Y. Factors affecting mortality in Crimean-Congo hemorrhagic fever. J Surg Med. 2019;3:428–432.
MLA Kavak, Nezih and Yunus Gürbüz. “Factors Affecting Mortality in Crimean-Congo Hemorrhagic Fever”. Journal of Surgery and Medicine, vol. 3, no. 6, 2019, pp. 428-32, doi:10.28982/josam.567579.
Vancouver Kavak N, Gürbüz Y. Factors affecting mortality in Crimean-Congo hemorrhagic fever. J Surg Med. 2019;3(6):428-32.