Does electrocardiography at admission predict outcome in Crimean-Congo hemorrhagic fever.

Background & objectives: Crimean-Congo hemorrhagic fever is an acute viral hemorrhagic fever with considerable mortality. Despite increasing knowledge about hemorrhagic fever viruses, the pathogenesis of Crimean-Congo hemorrhagic fever and causes of death were not well described. We aimed to evaluate whether there were electrocardiographic parameters designating mortality among these patients. Study design: This retrospective study was performed among confirmed Crimean-Congo hemorrhagic fever cases in Turkey. Electrocardiography was available in 49 patients within 24 h of hospitalization. All electrocardiograms were evaluated by two expert cardiologists according to Minnesota coding system. Results: Among patients with available electrocardiograms, there were 31 patients who survived, and 18 patients who died of Crimean-Congo hemorrhagic fever. Both groups were similar in terms of age, sex, body temperature, heart rate, and blood parameters. T-wave changes and bundle branch block were more frequently encountered among those who died. Presence of T-wave negativity or bundle branch block in this cohort of patients with Crimean-Congo hemorrhagic fever predicted death with a sensitivity of 72.7%, specificity of 92.6%, positive predictive value of 88.9%, negative predictive value of 80.6%. Conclusions: We think within the light of our findings that simple electrocardiography at admission may help risk stratification among Crimean-Congo hemorrhagic fever cases.

A new perspective to determine the severity of cases with Crimean-Congo hemorrhagic fever.

Background & objectives: We have established a severity grading score (SGS) system for predicting the fatality in Crimean-Congo hemorrhagic fever (CCHF) for the first time. Methods: This SGS has been set up by using several variables which were assumed to be associated with mortality according to the literature and also were considered to have clinical importance. Results: In all, 237 patients who had symptoms of CCHF for <5 days were included. The patients were grouped into three categories according to the mortality risk by using SGS as follows : low or no risk, intermediate and high risk groups. A SGS <5 showed no association with mortality (there were 158 cases in this group and all survived). This group constituted 66.7% of all the patients with CCHF. A SGS 6–10 showed moderate risk of mortality (10%) and seven out of 70 patients in this group died. SGS >11 means high risk for mortality (67%) and six out of 9 patients in this group died (p = 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for >11 points of SGS were 67, 100, 98, 100, and 98%, respectively. Conclusions: This scoring system may help the clinicians to decide which patient to refer to a tertiary step hospital which may also decrease the cost and improve the functionality of healthcare staff.

Determination of serum adenosine deaminase and xanthine oxidase levels in patients with crimean-congo hemorrhagic fever

OBJECTIVE: Crimean-Congo hemorrhagic fever is an acute viral hemorrhagic fever with a high mortality rate. Despite increasing knowledge about hemorrhagic fever viruses, little is known about the pathogenesis of Crimean-Congo hemorrhagic fever. In this study, we measured serum adenosine deaminase and xanthine oxidase levels in Crimean-Congo hemorrhagic fever patients. METHODS: Serum adenosine deaminase levels were measured with a sensitive colorimetric method described by Giusti and xanthine oxidase levels by the method of Worthington in 30 consecutive hospitalized patients (mean age 42.6 ± 21.0). Laboratory tests confirmed their diagnoses of Crimean-Congo hemorrhagic fever. Thirty-five subjects (mean age 42.9 ± 19.1) served as the control group. RESULTS: There was a significant difference in adenosine deaminase and xanthine oxidase levels between cases and controls (p<0.05). However, neither adenosine deaminase nor xanthine oxidase levels varied with the severity of disease in the cases assessed (p>0.05). CONCLUSION: Adenosine deaminase and xanthine oxidase levels were increased in patients with Crimean-Congo hemorrhagic fever. Elevated serum xanthine oxidase activity in patients with Crimean-Congo hemorrhagic fever may be associated with reactive oxygen species generated by the xanthine/xanthine oxidase system during inflammatory responses. In addition, elevated lipid peroxidation may contribute to cell damage and hemorrhage. The association of cell damage and hemorrhage with xanthine oxidase activity should be further investigated in large-scale studies.