Download PDF
J Pediatr Infect Dis 2020; 15(05): 242-247
DOI: 10.1055/s-0040-1713162
Original Article

Analysis of Pediatric Intensive Care Unit Admissions for Crimean–Congo Hemorrhagic Fever in Turkey

Resul Yilmaz 
1   Division of Pediatric Critical Care, Department of Pediatrics, Selcuk University School of Medicine, Konya, Turkey
,
Erhan Karaaslan 
2   Department of Pediatrics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
,
Suleyman Ekrem Albayrak 
3   Clinic of Pediatrics, Simav DoçDr İsmail Karakuyu State Hospital, Kütahya, Turkey
,
Ali Gul 
2   Department of Pediatrics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
,
Tuba Kasap 
2   Department of Pediatrics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Objective The aim of this study was to determine the clinical characteristics, course of disease, and outcomes of patients admitted to our pediatric intensive care unit (PICU) for Crimean–Congo hemorrhagic fever (CCHF).

Methods Data of all patients with CCHF who were admitted to PICU during a 3-year period and whose diagnosis was confirmed by serological methods or polymerase chain reaction were retrospectively reviewed. Their presenting characteristics, treatments, and outcomes were extracted from the hospital's electronic database. Disease severity scoring was performed using the severity scoring index and severity grading score system.

Results The data of 22 of 123 patients with suspected CCHF who were admitted to PICU were evaluated. Among them, 68.2% were males and mean age of all patients was 13.4 ± 2.2 years. The average length of stay of 10 patients was >10 days. On average, 3.72 units of platelet suspension per patient was transfused. In the course of the disease, the highest laboratory values were reached on day 3 of admission.

Conclusion Poor CCHF outcome depends on thrombocytopenia severity, prolonged coagulation tests, high-liver enzyme levels, and disseminated intravascular coagulation. Poor outcomes can be avoided by CCHF awareness and preparedness, early diagnosis of the disease, and supportive treatment with appropriate fluid and blood product transfusion. Randomized controlled trials on prophylactic transfusion and ribavirin use are needed.

Keywords

Crimean–Congo hemorrhagic fever - pediatric intensive care unit - Turkey

Note

The study was performed at the Gaziosmanpasa University Health Research and Training Center.




Publication History

Received: 27 January 2020

Accepted: 04 May 2020

Article published online:
22 June 2020

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Leblebicioglu H. Crimean-Congo haemorrhagic fever in Eurasia. Int J Antimicrob Agents 2010; 36 (Suppl. 01) S43-S46
    CrossrefPubMedGoogle Scholar
  • 2 Bodur H, Akinci E, Ascioglu S, Öngürü P, Uyar Y. Subclinical infections with Crimean-Congo hemorrhagic fever virus, Turkey. Emerg Infect Dis 2012; 18 (04) 640-642
    CrossrefPubMedGoogle Scholar
  • 3 Tuygun N, Tanir G, Caglayik DY, Uyar Y, Korukluoglu G, Cenesiz F. Pediatric cases of Crimean-Congo hemorrhagic fever in Turkey. Pediatr Int 2012; 54 (03) 402-406
    CrossrefPubMedGoogle Scholar
  • 4 Leblebicioglu H, Ozaras R, Irmak H, Sencan I. Crimean-Congo hemorrhagic fever in Turkey: current status and future challenges. Antiviral Res 2016; 126: 21-34
    CrossrefPubMedGoogle Scholar
  • 5 Ergonul O, Tuncbilek S, Baykam N, Celikbas A, Dokuzoguz B. Evaluation of serum levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha in patients with Crimean-Congo hemorrhagic fever. J Infect Dis 2006; 193 (07) 941-944
    CrossrefPubMedGoogle Scholar
  • 6 Sunbul M, Leblebicioglu H, Fletcher TE. , et al. Crimean-Congo haemorrhagic fever and secondary bacteraemia in Turkey. J Infect 2015; 71 (05) 597-599
    CrossrefPubMedGoogle Scholar
  • 7 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 (Suppl. 04) S794-S800
    CrossrefPubMedGoogle Scholar
  • 8 Bakir M, Engin A, Gozel MG, Elaldi N, Kilickap S, Cinar Z. A new perspective to determine the severity of cases with Crimean-Congo hemorrhagic fever. J Vector Borne Dis 2012; 49 (02) 105-110
    PubMedGoogle Scholar
  • 9 Bakır M, Gözel MG, Köksal I. , et al. Validation of a severity grading score (SGS) system for predicting the course of disease and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF). Eur J Clin Microbiol Infect Dis 2015; 34 (02) 325-330
    CrossrefPubMedGoogle Scholar
  • 10 Bozkurt I, Sunbul M, Yilmaz H, Esen S, Leblebicioglu H, Beeching NJ. Direct healthcare costs for patients hospitalized with Crimean-Congo haemorrhagic fever can be predicted by a clinical illness severity scoring system. Pathog Glob Health 2016; 110 (01) 9-13
    CrossrefPubMedGoogle Scholar
  • 11 Dokuzoguz B, Celikbas AK, Gök ŞE, Baykam N, Eroglu MN, Ergönül Ö. Severity scoring index for Crimean-Congo hemorrhagic fever and the impact of ribavirin and corticosteroids on fatality. Clin Infect Dis 2013; 57 (09) 1270-1274
    CrossrefPubMedGoogle Scholar
  • 12 Akinci E, Bodur H, Sunbul M, Leblebicioglu H. Prognostic factors, pathophysiology and novel biomarkers in Crimean-Congo hemorrhagic fever. Antiviral Res 2016; 132: 233-243
    CrossrefPubMedGoogle Scholar
  • 13 WHO, Crimean-Congo haemorrhagic fever. 2016 ; Available at: http://www.who.int/mediacentre/factsheets/fs208/en/ (PMID: . Accessed August 22, 2016)
    PubMed
  • 14 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 (03) 215-221
    CrossrefPubMedGoogle Scholar
  • 15 Papa A, Bino S, Velo E, Harxhi A, Kota M, Antoniadis A. Cytokine levels in Crimean-Congo hemorrhagic fever. J Clin Virol 2006; 36 (04) 272-276
    CrossrefPubMedGoogle Scholar
  • 16 Onguru P, Dagdas S, Bodur H. , et al. Coagulopathy parameters in patients with Crimean-Congo hemorrhagic fever and its relation with mortality. J Clin Lab Anal 2010; 24 (03) 163-166
    CrossrefPubMedGoogle Scholar
  • 17 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 (01) 159-189
    CrossrefPubMedGoogle Scholar
  • 18 Sharifi-Mood B, Mardani M, Keshtkar-Jahromi M, Rahnavardi M, Hatami H, Metanat M. Clinical and epidemiologic features of Crimean-Congo hemorrhagic fever among children and adolescents from southeastern Iran. Pediatr Infect Dis J 2008; 27 (06) 561-563
    CrossrefPubMedGoogle Scholar
  • 19 Dilber E, Cakir M, Acar EA. , et al. Crimean-Congo haemorrhagic fever among children in north-eastern Turkey. Ann Trop Paediatr 2009; 29 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 20 Ergönül O. Crimean-Congo haemorrhagic fever. Lancet Infect Dis 2006; 6 (04) 203-214
    CrossrefPubMedGoogle Scholar
  • 21 Ergönül O, Celikbaş A, Dokuzoguz B, Eren S, Baykam N, Esener H. Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis 2004; 39 (02) 284-287
    CrossrefPubMedGoogle Scholar
  • 22 Schwarz TF, Nsanze H, Ameen AM. Clinical features of Crimean-Congo haemorrhagic fever in the United Arab Emirates. Infection 1997; 25 (06) 364-367
    CrossrefPubMedGoogle Scholar
  • 23 Mardani M, Rahnavardi M, Sharifi-Mood B. Current treatment of Crimean-Congo hemorrhagic fever in children. Expert Rev Anti Infect Ther 2010; 8 (08) 911-918
    CrossrefPubMedGoogle Scholar
  • 24 Oncü S. Crimean-Congo hemorrhagic fever: an overview. Virol Sin 2013; 28 (04) 193-201
    CrossrefPubMedGoogle Scholar
  • 25 Yilmaz R, Kundak AA, Ozer S, Esmeray H. Successful treatment of severe Crimean-Congo hemorrhagic fever with supportive measures without ribavirin and hypothermia. J Clin Virol 2009; 44 (02) 181-182
    CrossrefPubMedGoogle Scholar
  • 26 Karti SS, Odabasi Z, Korten V. , et al. Crimean-Congo hemorrhagic fever in Turkey. Emerg Infect Dis 2004; 10 (08) 1379-1384
    CrossrefPubMedGoogle Scholar
  • 27 Tezer H, Sucakli IA, Sayli TR. , et al. Crimean-Congo hemorrhagic fever in children. J Clin Virol 2010; 48 (03) 184-186
    CrossrefPubMedGoogle Scholar
  • 28 Chandralekha P, Gupta P, Trikha A. The north Indian dengue outbreak 2006: a retrospective analysis of intensive care unit admissions in a tertiary care hospital. Trans R Soc Trop Med Hyg 2008; 102 (02) 143-147
    CrossrefPubMedGoogle Scholar
  • 29 Squires JE. Indications for platelet transfusion in patients with thrombocytopenia. Blood Transfus/Trasfusione del sangue 2015; 13 (02) 221-226
    PubMedGoogle Scholar
  • 30 Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician 2011; 83 (06) 719-724
    PubMedGoogle Scholar
  • 31 Slater A, Shann F, Pearson G. ; Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the paediatric index of mortality. Intensive Care Med 2003; 29 (02) 278-285
    CrossrefPubMedGoogle Scholar
  • 32 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24 (05) 743-752
    CrossrefPubMedGoogle Scholar
  • 33 Mertens M, Schmidt K, Ozkul A, Groschup MH. The impact of Crimean-Congo hemorrhagic fever virus on public health. Antiviral Res 2013; 98 (02) 248-260
    CrossrefPubMedGoogle Scholar