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Bozkurt I. We Need More Accuracy in Crimean-Congo Hemorrhagic Fever Diagnosis upon Initial Presentation in Endemic Areas. Vector Borne Zoonotic Dis 2024. [PMID: 38770687 DOI: 10.1089/vbz.2024.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background: The primary aim of this study was to highlight the considerable rate of misdiagnosis associated with Crimean-Congo Hemorrhagic Fever (CCHF) during initial hospital admission. Materials and Methods: A comprehensive face-to-face survey was carried out on hospitalized patients living in endemic areas with confirmed diagnosis of CCHF. The structured questionnaire covered demographic information, specifics of hospital admissions before diagnosis, and adherence to the diagnostic criteria for CCHF as determined by the Ministry of Health (MoH). Results: This cohort consisted of 100 patients with a mean age of 44 (20-77) years, of which 65 (65%) were male. Each patient had undergone at least one hospital visit (0-3) before receiving the confirmed diagnosis of CCHF. Only 45 (45%) patients were thoroughly evaluated in line with the clinical diagnostic criteria set forth by the MoH, while 21% had initially received provisional CCHF diagnoses before final confirmation. Conclusions: This study indicates the urgent necessity to improve diagnostic accuracy for CCHF during the initial presentation in endemic regions.
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Affiliation(s)
- Ilkay Bozkurt
- Department of Clinical Microbiology and Infectious Diseases. Ondokuz Mayis, University School of Medicine, Samsun, Turkiye
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Komut S, Çorakyer N, Kaplan G, Baykam N. An Evaluation of the Hitit Index in Differential Diagnosis of Crimean-Congo Hemorrhagic Fever in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1796. [PMID: 37893514 PMCID: PMC10608086 DOI: 10.3390/medicina59101796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Crimean-Congo Hemorrhagic Fever (CCHF) is a viral zoonotic infection, which is seen over a wide geographic area. The mortality rate is in inverse proportion to the ability of patients to access healthcare services. Therefore, early identification of patients is extremely important. The aim of this study was to test the sensitivity and specificity of the Hitit Index in the differentiation of CCHF cases at the time of presentation at the Emergency Department and to evaluate the agreement of this index with molecular (CCHFV RNA) and/or serological diagnostic tests (ELISA-CCHF IgM). Materials and Methods: The patients included were those who presented at the Emergency Department (ED) with the complaint of a tick bite or those identified as potential CCHF cases as a result of complaints and/or laboratory findings. For cases that met the study inclusion criteria, the Hitit Index score was calculated automatically from the parameters included in the index formula uploaded to the automation system in the ED at the time of presentation. Through comparisons of the agreement of the Hitit Index with the CCHFV-RNA and/or IgM results the power of the Hitit Index for differentiation of CCHF cases in ED was evaluated. Results: The data of 273 patients were analyzed. There was a history of tick bite in 236 (86%) cases. Of the evaluated cases, 110 (40.2%) were hospitalized; CCHF positivity was determined in 72 (26.4%). The Hitit Index values calculated in ED and at 24 h after hospitalization were determined to be significant in the prediction of the CCHF cases (p < 0.001, AUC = 0.919 (0.887-0.951); p < 0.001, AUC = 0.902 (0.841-0.962). For a cut-off point of 0 of the Hitit Index evaluated in ED, the classification success was found to have a sensitivity of 75% and specificity of 88% (PPV-NPV). For a cut-off point of 0 of the Hitit Index evaluated at 24 h after hospitalization, the classification success was found to have a sensitivity of 79.7% and specificity of 84% (PPV-NPV). Conclusions: The defined form of the Hitit Index can be used in the differentiation of CCHF cases in ED with high sensitivity and specificity levels. Just as evaluation with the Hitit Index prevents unnecessary hospitalization, it can also contribute to reducing mortality rates with the early identification of CCHF cases.
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Affiliation(s)
- Seval Komut
- Department of Emergency Medicine, Faculty of Medicine, Hitit University, 19040 Çorum, Turkey;
| | - Nurullah Çorakyer
- Department of Emergency Medicine, Faculty of Medicine, Hitit University, 19040 Çorum, Turkey;
| | - Gülcan Kaplan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hitit University, 19040 Çorum, Turkey; (G.K.); (N.B.)
| | - Nurcan Baykam
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hitit University, 19040 Çorum, Turkey; (G.K.); (N.B.)
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Kaygusuz TÖ, Tartar AS, Balin ŞÖ, Akbulut A, Demirdağ K. Predictive epidemiological, clinical and laboratory parameters in the diagnosis of Crimean-Congo hemorrhagic fever. Biomark Med 2023; 17:533-540. [PMID: 37791843 DOI: 10.2217/bmm-2023-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background: The aim of this study is to determine predictive parameters that can be used in the differential diagnosis of Crimean-Congo Hemorrhagic Fever (CCHF) and other diseases with similar clinical and laboratory findings. Materials & methods: In this study, epidemiological, clinical and laboratory parameters of 107 CCHF-positive and 71 CCHF-negative patients were compared. Results: Alanine amino transferase, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, red blood cell, hemoglobin and hematocrit were significantly higher in CCHF-positive patients, whereas total and direct bilirubin, alkaline phosphatase, prothrombin time, international normalization ratio, white blood cell, C-reactive protein and procalcitonin were higher in CCHF-negative patients. In binary logistic regression analysis, an increase in activated partial thromboplastin time level was identified as an independent predictor of having CCHF, while alanine amino transferase, white blood cell and C-reactive protein elevations were identified as independent predictors of not having CCHF. Conclusion: In endemic areas where PCR and serological tests are delayed, knowing the predictive parameters may be of vital importance in the early diagnosis of CCHF.
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Affiliation(s)
- Türkkan Ö Kaygusuz
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Ayşe S Tartar
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Şafak Ö Balin
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Ayhan Akbulut
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Kutbeddin Demirdağ
- Department of Infectious Diseases & Clinical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
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Sağmak Tartar A, Akbulut A, Demirdağ K, Balin ŞÖ. Crimean-Congo Hemorrhagic Fever in Differential Diagnosis During the Coronavirus Disease-2019 Pandemic. TURKIYE PARAZITOLOJII DERGISI 2022; 46:50-53. [PMID: 35232706 DOI: 10.4274/tpd.galenos.2021.32042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Crimean-Congo Hemorrhagic Fever (CCHF) is a disease of the viral hemorrhagic fever group and is endemic in certain regions in Turkey. Here, the demographic, clinical, and laboratory findings of patients diagnosed with CCHF during the Coronavirus disease-2019 (COVID-19) pandemic were examined, and differential diagnosis was stressed. METHODS This study comprised 12 patients over the age of 18 who were admitted to our clinic after the onset of the COVID-19 pandemic on March 11, 2020 and whose CCHF diagnosis was confirmed by reverse transcription-polymerase chain reaction with viral-RNA or enzyme-linked immunosorbent assay with immunoglobulin M antibodies. Epidemiological, clinical, and laboratory findings as well as treatment and prognosis of the patients were investigated. RESULTS Of the 12 cases, 10 (83.3%) were men and 2 (16.7%) were women. The median (interquartile range) age was 51 (27-64) years. Eleven (91.7%) patients lived in rural regions, and seven (58.3%) had a history of tick contact. Five patients were hospitalized in an external center with a preliminary diagnosis of COVID-19 and transferred to our center due to clinical and laboratory deterioration. Loss of appetite, headache, fever, weakness, and muscle-joint pain were the most common complaints of the patients. Following the suspicion of COVID-19, thoracic computed tomography (CT) was performed in six patients, five of whom were transferred to an external center. None of the patients had any pathological findings following thoracic CT. CONCLUSION Although it is thought that the COVID-19 pandemic will end in the following months owing to vaccine applications, it can be predicted that sporadic cases will still occur for a long time. Therefore, clinicians should take CCHF into consideration in their differential diagnosis. Also, it should be remembered that co-infections can be observed in endemic areas.
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Affiliation(s)
- Ayşe Sağmak Tartar
- Fırat Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Elazığ, Türkiye
| | - Ayhan Akbulut
- Fırat Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Elazığ, Türkiye
| | - Kutbeddin Demirdağ
- Fırat Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Elazığ, Türkiye
| | - Şafak Özer Balin
- Fırat Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Elazığ, Türkiye
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Yapar D, Akdoğan Ö, Boyacı H, Yılmaz YA, Topçu H, Arslan S, Yılmaz B, Kodalak G, Çebi K, Kayadibi H, Çelikbaş AK, Gülhan M, Baykam N. COVID-19 and Crimean-Congo Hemorrhagic Fever: Is there any Similarity in Chest Radiology? INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:1-6. [PMID: 38633543 PMCID: PMC10986582 DOI: 10.36519/idcm.2022.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/04/2021] [Indexed: 04/19/2024]
Abstract
Objective While the coronavirus disease 2019 (COVID-19) pandemic was continuing at full speed, patients with Crimean-Congo hemorrhagic fever (CCHF), which is endemic in our region, apply to the emergency department simultaneously. The presence of computed tomography (CT) lesions suggesting COVID-19 in some CCHF patients has brought to our mind the question of whether there is CCHF lung involvement even though respiratory symptoms are not at the forefront. Methods In this study, the findings of chest CT, demographic data and clinical symptoms of cases who had thorax tomography scan with suspicion of COVID-19 in the emergency department in the spring and summer of 2020 and were diagnosed with CCHF as a result of the evaluation and followed up in our clinic were compared with the findings of COVID-19 cases that were hospitalized and treated in the same period. Results Seventy-seven COVID-19 and 25 CCHF cases were included in the study. Myalgia, headache, diarrhea, nausea and vomiting were significantly higher in CCHF patients ( p<0.05). Cough was significantly more common in COVID-19 patients ( p=0.034). Ground-glass opacity (GGO) was the most common tomography finding in CCHF, and cases without lung involvement were significantly higher (p=0.001). GGO, consolidation, vascularization, atelectasis band, reverse halo, air-bubble, nodule were significantly high in COVID-19 patients. Conclusion During the epidemic period, no pathological finding was found in thoracic CT in most of the CCHF cases, and the presence of involvement in the lung tomography in cases with similar clinical and laboratory findings should primarily suggest the diagnosis of COVID-19.
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Affiliation(s)
- Derya Yapar
- Department of Infectious Diseases and Clinical Microbiology, Hitit University School of Medicine, Çorum, Turkey
| | - Özlem Akdoğan
- Department of Infectious Diseases and Clinical Microbiology, Hitit University School of Medicine, Çorum, Turkey
| | - Hilal Boyacı
- Department of Chest Diseases, Hitit University School of Medicine, Çorum, Turkey
| | - Yasemin Arı Yılmaz
- Department of Chest Diseases, Hitit University School of Medicine, Çorum, Turkey
| | - Hülya Topçu
- Department of Anesthesiology, Hitit University School of Medicine, Çorum, Turkey
| | - Sertaç Arslan
- Department of Chest Diseases, Hitit University School of Medicine, Çorum, Turkey
| | - Burak Yılmaz
- Department of Chest Diseases, Hitit University School of Medicine, Çorum, Turkey
| | - Gamze Kodalak
- Department of Internal Medicine, Hitit University School of Medicine, Çorum, Turkey
| | - Kazım Çebi
- Department of Infectious Diseases and Clinical Microbiology, Hitit University Çorum Erol Olçok Education and Training Hospital, Çorum, Turkey
| | - Hüseyin Kayadibi
- Department of Medical Biochemistry, Hitit University School of Medicine, Çorum, Turkey
- Department of Medical Biochemistry, Eskişehir Osmangazi University, School of Medicine, Eskişehir, Turkey
| | - Aysel Kocagül Çelikbaş
- Department of Infectious Diseases and Clinical Microbiology, Hitit University School of Medicine, Çorum, Turkey
| | - Meral Gülhan
- Department of Chest Diseases, Hitit University School of Medicine, Çorum, Turkey
| | - Nurcan Baykam
- Department of Infectious Diseases and Clinical Microbiology, Hitit University School of Medicine, Çorum, Turkey
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Ergünay K, Polat C, Özkul A. Vector-borne viruses in Turkey: A systematic review and bibliography. Antiviral Res 2020; 183:104934. [PMID: 32949637 DOI: 10.1016/j.antiviral.2020.104934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
Turkey serves as a natural hub for the dissemination of vector-borne viruses and provides many suitable habitats with diverse ecologies for introduction and establishment of new pathogens. This manuscript provides an updated systematic review and meta-analysis of the vector-borne viruses documented in Turkey. Following web-based identification, screening and eligibility evaluation, 291 published reports were reviewed. The publications were categorized and listed as a supplementary bibliography accompanying the manuscript. In brief, Crimean-Congo hemorrhagic fever virus (CCHFV) and West Nile virus (WNV) are currently documented as prominent tick and mosquito-borne viral pathogens in Turkey. CCHFV produces a significant number of infections annually, with severe outcome or death in a portion of cases. WNV gained attention following the clustering of cases in 2010. Exposure and infections with sandfly-borne phleboviruses, such as Toscana virus, are indigenous and widespread. Epidemiology, risk factors, symptomatic infections in susceptible hosts, vectors and reservoirs for these pathogens have been explored in detail. Detection of novel viruses in mosquitoes, sandflies and ticks from several regions is of particular interest, despite scarce information on their epidemiology and pathogenicity in vertebrates. Introduction and emergence of viruses transmitted by invasive Aedes mosquitoes constitute a threat, albeit only imported infections have so far been documented. Detection of Rift valley fever virus exposure is also of concern, due to its detrimental effects on livestock and spillover infections in humans. Vigilance to identify and diagnose probable cases as well as vector surveillance for established and potential pathogens is therefore, imperative.
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Affiliation(s)
- Koray Ergünay
- Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, Virology Unit, Ankara, 06100, Turkey.
| | - Ceylan Polat
- Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, Virology Unit, Ankara, 06100, Turkey
| | - Aykut Özkul
- Ankara University, Faculty of Veterinary Medicine, Department of Virology, Ankara, 06110, Turkey
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Vishvakarma VK, Chandra R, Singh P. An Experimental and Theoretical Approach to Understand Fever, DENF & its Cure. Infect Disord Drug Targets 2020; 21:495-513. [PMID: 32888275 DOI: 10.2174/1871526520999200905122052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/21/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
Fever is a response of a human body, due to an increase in the temperature, against certain stimuli. It may be associated with several reasons and one of the major causes of fever is a mosquito bite. Fever due to dengue virus (DENV) infection is being paid most attention out of several other fever types because of a large number of deaths reported worldwide. Dengue virus is transmitted by biting of the mosquitoes, Aedes aegypti and Aedes albopictus. DENV1, DENV2, DENV3 and DENV4 are the four serotypes of dengue virus and these serotypes have 65% similarities in their genomic structure. The genome of DENV is composed of single-stranded RNA and it encodes for the polyprotein. Structural and non-structural proteins (nsP) are the two major parts of polyprotein. Researchers have paid high attention to the non-structural protease (nsP) of DENV like nsP1, nsP2A, nsP2B, nsP3, nsP4A, nsP4B and nsP5. The NS2B-NS3 protease of DENV is the prime target of the researchers as it is responsible for the catalytic activity. In the present time, Dengvaxia (vaccine) is being recommended to patients suffering severely from DENV infection in few countries only. Till date, neither a vaccine nor an effective medicine is available to combat all four serotypes. This review describes the fever, its causes, and studies to cure the infection due to DENV using theoretical and experimental approaches.
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Affiliation(s)
- Vijay Kumar Vishvakarma
- Department of Chemistry, Atma Ram Sanatan Dharma College, University of Delhi, New Delhi, India
| | - Ramesh Chandra
- Drug Discovery & Development Laboratory, Department of Chemistry, University of Delhi, Delhi, India
| | - Prashant Singh
- Department of Chemistry, Atma Ram Sanatan Dharma College, University of Delhi, New Delhi, India
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