Mevlüt DEMİR, Fatma DUKSAL, Melih Timuçin DOĞAN, Utku AYGÜNEŞ, Ali KAYA, Ahmet Sami GÜVEN, Ömer CEVİT

Sivas, Cumhuriyet Üniversitesi’ne Başvuran Kırım-Kongo Kanamalı Ateş’li Çocukların Klinik ve Rutin Laboratuvar Testleri Yanında İmmünolojik Açıdan Değerlendirilmesi

Giriş: Çalışmamızda, Kırım-Kongo Kanamalı Ateşi KKKA tanısıyla izlenen çocuk hastaların klinik ve rutin laboratuvar bulgularıyla birlikte, serum immünglobulin ve kompleman düzeylerinin değerlendirilmesi amaçlandı.Gereç ve Yöntem: Sivas, Cumhuriyet Üniversitesi’nde 2011-2012 tarihleri arasında, Enzyme-Linked Immunosorbent Assay ELISA veya polimeraz zincir reaksiyonu PCR kanıtlı KKKA tanısı alan 72 hastanın tıbbi kayıtları geriye dönük incelenmiştir. Epidemiyolojik, klinik özellikleri ve laboratuvar verileri hakkındaki bilgiler kaydedilmiştir.Bulgular: Çalışmaya alınan yetmiş iki çocuk hasta ortalama yaş; 11,95±3,95 yıl Tokat, Sivas, Yozgat, Giresun ve Erzincan’dan geliyordu. Başvuru esnasında başlıca ateş %94,4 , kusma %54,2 , halsizlik %52,8 , iştahsızlık %50 , baş ağrısı %47,2 , üst solunum yolu enfeksiyonu bulguları %41,7 , daha nadir olarak peteşi-purpura-ekimoz, epistaksis, ishal, melena, makülopapüler döküntü, hematemez, hematüri, hepatomegali, splenomegali, lenfadenopati bulguları vardı. Başvuruda hastaların laboratuvar bulguları şu şekildedir: %80,6 trombositopeni, %70,8 lökopeni, %50 nötropeni, %73,6 yüksek aspartate transaminaz, %26,4 yüksek alanine transaminaz, %71,6 yüksek laktat dehidrogenaz, %68,1 yüksek keratin kinaz, %54,2 uzamış protrombin zamanı, %52,8 uzamış parsiyel tromboplastin zamanı saptanmıştır. Ayrıca düşük IgG, düşük IgA, düşük C3 ve düşük C4 sırasıyla 4, 3, 12 ve 1 hastada saptanmıştır. Tüm hastalar sıvı-elektrolit tedavisi alırken, bir kısmı kan ürünü almıştır. Dört hasta intravenöz immünglobulin IVIG , 69 hasta ribavirin tedavisi almıştır.Sonuç: Çocuklarda KKKA klinik bulguları erişkinlerdekine benzerdir. Serum immünglobulinleri düşük bulunan hastalarda verilen intravenöz immünglobulin IVIG tedavisi dışında diğer tedaviler benzer bulunmuştur. KKKA’da immün yetmezlik araştırılması konusunda daha geniş çaplı çalışmalara ihtiyaç vardır

Anahtar Kelimeler:

Çocuk, immünglobulin, Kırım-Kongo Kanamalı Ateşi, tedavi

Immunological Evaluation of Children with Crimean-Congo Hemorrhagic Fever in Addition to Routine Clinical and Laboratory Tests Who Were Admitted to Sivas, Cumhuriyet University

Introduction: In our study, it was aimed to evaluate clinical and routine laboratory findings and serum immunoglobulin and complement levels of pediatric patients with the diagnosis of Crimean-Congo Hemorrhagic Fever CCHF .Materials and Methods: Medical records of 72 patients that diagnosed with CCHF proven by ELISA or polymerase chain reaction PCR in Sivas, Cumhuriyet University between 2011 and 2012 were reviewed retrospectively. The information about the epidemiological, clinical features and laboratory findings were recorded. Results: Seventy-two patients who participated in the study, mean age11.95±3.95 years came from Tokat, Sivas, Yozgat, Giresun and Erzincan. During the admission, patients mainly had fever 94.4% , vomiting 54.2% , fatigue 52.8% , anorexia 50% , headache 47.2% , upper respiratory tract infection findings 41.7% ; rarely, petechiae-purpura, ecchymosis, epistaxis, diarrhea, melena, maculopapular rash, hematemesis, hematuria, hepatomegaly, splenomegaly, lymphadenopathy were seen. At admission, laboratory findings of the patients were as follows; thrombocytopenia, 80.6%; leucopenia,70.8%; neutropenia, 50%; high aspartate transaminase, 73.6%; high alanine transaminase, 26.4%; high lactate dehydrogenase 71.6%; high creatine kinase, 68.1%; prolonged protrombine time, 54.2%; prolonged partial thromboplastin time, 52.8%. In addition low IgG, low IgA, low C3, low C4 were found in 4, 3, 12 and 1 patient respectively. All patients received intravenous fluid therapy; some received blood products. Four patients received intravenous immunoglobulin, 69 patients were treated with ribavirin. Conclusions: Clinical findings of CCHF in children are similar to those in adults; in patients with low serum immunoglobulin outside the intravenous immunoglobulin IVIG treatment, other treatments are similar in all patients. In CCHF to investigate immunodeficiency status, further large-scale study is needed.

Keywords:

Child, immunoglobulin, Crimean-Congo Hemorrhagic Fever, treatment,

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1. Drosten C, Göttig S, Schilling S, Asper M, Panning M, Schmitz H, et al. Rapid detection and quantification of RNA of Ebola and Marburg viruses, Lassa virus, Crimean-Congo hemorrhagic fever virus, Rift Valley fever virus, Dengue virus, and Yellow fever virus by real-time reverse transcription-PCR. J Clin Microbiol 2002;40:2323-30.
2. Ergonul O. Crimean-Congo hemorrhagic fever. Lancet Infect Dis 2006;6:203-14.
3. Whitehouse CA. Crimean-Congo hemorrhagic fever. Antiviral Res 2004;64:145-60.
4. Karti SS, Odabasi Z, Korten V, Yilmaz M, Sonmez M, Caylan R, et al. Crimean-Congo hemorrhagic fever in Turkey. Emerg Infect Dis 2004;10:1379-84.
5. Bakir M, Ugurlu M, Dokuzoguz B, Bodur H, Tasyaran MA, Vahaboglu H; Turkish CCHF Study Group. Crimean-Congo hemorrhagic fever outbreak in Middle Anatolia: a multicenter study of clinical features and outcome measures. J Med Microbiol 2005;54:385-9.
6. Korkmaz M, Yıldırım H, Ozcelik H, Fadıloglu C. Güncel Bir Sorun: Kırım-Kongo Kanamalı Atesi. Fırat Sağlık Hizmetleri Dergisi 2008;9:68-84.
7. Ergonul O, Celikbas 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;39:284-7.
8. Izadi S, Naieni KH, Madjdzadeh SR, Nadim A. Crimean-Congo hemorrhagic fever in Sistan and Baluchestan Province of Iran, a case-control study on epidemiological characteristics. Int J Infect Dis 2004;8:299-306.
9. Al-Tikriti SK, Al-Ani F, Jurji FJ, Tantawi H, Al-Moslih M, AlJanabi N, et al. Congo/Crimean hemorrhagic fever in Iraq. Bull World Health Organ 1981;59:85-90.
10. Ergonul O. Treatment of Crimean-Congo hemorrhagic fever. Antiviral Res 2008;78:125-31.
11. Yilmaz GR, Buzgan T, Torunoglu MA, Safran A, Irmak H, Com S, et al. A preliminary report on Crimean- Congo haemorrhagic fever in Turkey, March-June 2008. Euro Surveill 2008;13(33). pii: 18953.
12. Randolph S, Ergonul E. Crimean-Congo hemorrhagic fever: exceptional epidemic of viral hemorrhagic fever in Turkey. Future Virol 2008;3:303-6.
13. Vatansever Z, Uzun R, Estrada-Pena A, Ergonul O. CrimeanCongo hemorrhagic fever in Turkey. In: Ergonul O, Whitehause CA eds. Crimean-Congo Hemorrhagic Fever: A Global Perspective. Dordecht, The Netherlands: Springer, 2007;59-74.
14. Sarikaya O, Erbaydar T. Avian influenza outbreak in Turkey through health personnel’s views: a qualitative study. BMC Public Health 2007;15:330-1.
15. Williams RJ, Al-Busaidy S, Mehta FR, Maupin GO, Wagoner KD, Al-Awaidy S, et al. Crimean-Congo haemorrhagic fever: a seroepidemiological and tick survey in the Sultanate of Oman. Trop Med Int Health 2000;5:99-106.
16. Ozkurt Z, Kiki I, Erol S, Erdem F, Yilmaz N, Parlak M, et al. Crimean-Congo hemorrhagic fever in eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy. J Infect 2006;52:207-15.
17. Dilber E, Çakır M, Acar EA, Orhan F, Yaris N, Bahat E, et al. Crimean-Congo haemorrhagic fever among children in northeastern Turkey. Ann Trop Pediatr 2009;29:23-8.
18. Elaldı N. Kırım-Kongo hemorajik ateş epidemiyolojisi. Cumhuriyet Üniversitesi Tıp Fakültesi Dergisi 2004;26:185-90.
19. Sharifı-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;27:561-3.
20. Schwarz TF, Nsanze H, Ameen AM. Clinical features of CrimeanCongo haemorrhagic fever in the United Arab Emirates. Infection 1997;25:364-7.
21. 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 4:S794-800.
22. Elaldi N, Bodur H, Ascioglu S, Celikbas A, Ozkurt Z, Vahaboglu H, et al. Efficacy of oral ribavirin treatment in Crimean-Congo haemorrhagic fever: a quasi-experimental study from Turkey. J Infect 2009;58:238-44.
23. Papa A, Bino S, Llagami A, Brahimaj B, Papadimitriou E, Pavlidou V, et al. Crimean-Congo hemorrhagic fever in Albania, 2001. Eur J Clin Microbiol Infect Dis 2002;21:603-6.
24. Centers for Disease Control and Prevention (CDC). Management of patients with suspected viral hemorrhagic fever-United States. MMWR Morb Mortal Wkly Rep 1995;44:475-9.
25. Koksal I, Yilmaz G, Aksoy F, Aydin H, Yavuz I, Iskender S, et al. The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey. J Clin Virol 2010;47:65-8.
26. Izadi S, Salehi M. Evaluation of the efficacy of ribavirin therapy on survival of Crimean- Congo hemorrhagic fever patients: a case-control study. Jpn J Infact Dis 2009;2:11-5.
27. Duh D, Nichol ST, Khristova ML, Saksida A, Hafner-Bratkovic I, Petrovec M, et al. The complete genome sequence of a CrimeanCongo hemorrhagic fever virüs isolated from an endemic region in Kosovo. Virol J 2008;15:5-7.
28. Özcan MM. Kırım-Kongo Kanamalı Ateşinde ribavirin tedavisinin etkinliği Cumhuriyet Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları, Uzmanlık tezi, Sivas, 2010.
29. Adams ST, Schmid KM, Cost KM, Marshall GS. Common variable immunodeficiency presenting with persistent Parvovirus B19 infection. Pediatrics 2012;130:1711-5.
30. Gordon CL, Johnson PD, Permezel M, Holmes NE, Gutteridge G, McDonald CF, et al. Association between severe pandemic 2009 Influenza A (H1N1) virüs Infection and immunoglobulin G2 subclass deficiency. Clin Infect Dis 2010;50:672-8.