Crimean-Congo haemorrhagic fever in Turkey

Abstract number: P2049

Ozturk Engin D., Sengoz Inan A., Goktas P., Ceran N., Altintas J., Karli S., Karagul E.

Objective: Crimean-Congo haemorrhagic fever(C-CHF) is severe viral disease afflecting multiple organ systems. It is caused by infection with a member of the genus Nairovirus in the family Bunyaviridiae. C-CHF has been found Eastern Europe, Central Asia, the Middle East, China and Indian subcontinent. Many cases have been reported from Turkey. We herein reported 8 cases with Crimean-Congo haemorrhagic fever.

Methods: The study was performed as retrospectively in adults patients diagnosed with C-CHF in Haydarpasa Numune Training and Research Hospital between 2006 and 2008.

Results: The mean age of patients (male 2, female 6) was 52.7 years. The mean incubation period of the disease (from the bite of an infected tick to onset of symptoms) was 5.6 days. The patients admitted to our hospital from the other provinces of eastern Turkey. 3 of 8 patients were from Giresun, and the other 2 were from Ordu, Kastamonu (1 patiens), Gümü[scedil]hane(1 patients), and Sivas (1 patient). All these patients had high fever. Other clinical features were as follows: weakness (75%), myalgia (75%), headache (38%), petechial rash(38%), nausea (25%), loss of appetite (25%), vomiting (13%), abdominal pain (13%), gingival bleeding (13%), epistaxis (13%). The laboratory results showed leukopenia in all patients, trombocytopenia in 7 of 8 patients. Serum aspartate aminotransferase (AST) (median 107 U/L, <37), alanine aminotransferase (ALT) (median 117 U/L, <42), were elevated in all patients. Lactate dehydrogenase (LDH) (median 636 U/L, >530) were elevated in six patients. Creatine phosphokinase (CPK) levels were elevated in 4 of 8 patients. Methods of diagnosis included antibody detection by enzyme-linked immunassay (ELISA) in four patients. Serum sample of one patient was positive by RT-PCR. Three serum samples were positive for both ELISA and viral genom detection by RT-PCR. All patients were treated with oral ribavirin and supportive therapy. All the patients were cured.

Conclusion: C-CHF is characterised by haemorrhage, myalgia and fever, with case-fatality rate of up to 50%. The lowest case-fatality rate was reported from Turkey. There were no deaths among these patients. Tick bite have been the major transmission routes in this report.