Spatial Analysis of Crimean Congo Hemorrhagic Fever in Iran

Crimean Congo hemorrhagic fever (CCHF) is a viral zoonotic disease. During 1999–2011, 871 human cases of CCHF were diagnosed in Iran. A history of serologic conversion for CCHF virus was seen in 58.7% of 2,447 sheep samples, 25.0% of 1,091 cattle samples and 24.8% of 987 goat samples from different parts of Iran. Spatial analysis showed that the main foci of this disease in humans during these years were in eastern Iran (P < 0.01) and the second most common foci were in northeastern and central Iran. Two livestock foci were detected in the northeastern northwestern Iran. On the basis of the results of this study, infection likely entered Iran from eastern and western neighboring countries.     

Crimean Congo hemorrhagic fever and diffuse alveolar haemorrhage

Although the pathology of Crimean Congo haemorrhagic fever (CCHF) is mainly related to a haemorrhagic process with secondary cytokine storm, there have been no published reports of this fatal disease being a cause of diffuse alveolar haemorrhage (DAH). There are many aetiological factors emphasizing the direct role of endothelial injury on DAH. We present the case of a young adult Turkish man with diffuse bilateral alveolar haemorrhage without an episode of gross haemoptysis caused by the CCHF virus. Successful clinical results and a rapid clinical and radiological clearance were obtained within few days after starting daily oral ribavirin treatment. This fatal infection should be considered to exist in any patient presenting with DAH, and should rapidly be treated with ribavirin. Another very important factor which should always be borne in mind is the contagious character of the CCHF virus. It is one of the most dangerous microorganisms transmitted from person to person. Even the bronchoscopes contaminated with patient blood carry a high risk for nosocomial spread to medical staff and other patients.     

Crimean Congo hemorrhagic fever infection simulating acute appendicitis

An unusual cause of acute abdominal pain simulating acute appendicitis is presented. The patient was admitted with complaints of fever, malaise, headache, nausea, vomiting, diarrhoea, and severe bleeding. Based on the clinical and epidemiological findings, a diagnosis of Crimean Congo hemorrhagic fever virus infection was suspected, and ribavirin therapy was started. While her clinical condition was improving, she experienced a sudden pain at her right lower quadrant of the abdomen. Explorative laparotomy revealed haemorrhage within the abdominal muscles. Her CCHF IgM was found to be positive.     

First Indications of Omsk Haemorrhagic Fever Virus beyond Russia

Omsk haemorrhagic fever virus (OHFV) is the agent leading to Omsk haemorrhagic fever (OHF), a viral disease currently only known in Western Siberia in Russia. The symptoms include fever, headache, nausea, muscle pain, cough and haemorrhages. The transmission cycle of OHFV is complex. Tick bites or contact with infected small mammals are the main source of infection. The Republic of Kazakhstan is adjacent to the endemic areas of OHFV in Russia and febrile diseases with haemorrhages occur throughout the country—often with unclear aetiology. In this study, we examined human cerebrospinal fluid samples of patients with suspected meningitis or meningoencephalitis with unknown origins for the presence of OHFV RNA. Further, reservoir hosts such as rodents and ticks from four Kazakhstan regions were screened for OHFV RNA to clarify if this virus could be the causative agent for many undiagnosed cases of febrile diseases in humans in Kazakhstan. Out of 130 cerebrospinal fluid samples, two patients (1.53%) originating from Almaty city were positive for OHFV RNA. Screening of tick samples revealed positive pools from different areas in the Akmola region. Of the caught rodents, 1.1% out of 621 were positive for OHFV at four trapping areas from the West Kazakhstan region. In this paper, we present a broad investigation of the spread of OHFV in Kazakhstan in human cerebrospinal fluid samples, rodents and ticks. Our study shows for the first time that OHFV can not only be found in the area of Western Siberia in Russia, but can also be detected up to 1.600 km away in the Almaty region in patients and natural foci.     

？须恙螨感染流行性出血热病毒的实验研究

本实验研究人疫区流行性出血热病毒抗原阳性鼠体所带的须恙螨幼虫中分离到１株ＥＨＦＶ；另从叮刺吸食感染ＥＨＦＶ小鼠体液的游离须恙螨幼虫中也分离到１株ＥＨＶ。     

家猪自然感染EHFV的分子流行病学调查

１９８９年以来我们用分子流行病学方法对家猪作为ＥＨＦ传染源的作用进行了研究。结果发现家猪不但可自然感染ＥＨＦＶ；感染后ＥＨＦＶ还可随血行播及多个脏器，并可随尿、粪排出感染性ＥＨＦＶ污染外环境，有作为ＥＨＦ传染源的条件，对人间传播ＥＨＦ和维持疫源地起了重要作用。     

肾综合征出血热血浆神经肽Y水平及临床意义(附104例报告)

采用放免分析法检测肾综合征出血热(HFRS)患者血浆神经肽Y(NPY)含量.发现HFRS患者血浆NPY浓度(88.92±29.78pg/ml)较正常人组水平(36.19±9.07pg/ml)显著增加(P＜0.01).NPY变化规律为从发热期即见升高,少尿期达高峰,多尿期逐渐下降,随着病情的缓解及肾功能的恢复逐渐正常.认为HFRS病程中NPY血浆浓度变化与病情一致,其可能在HFRS某些发病环节中起作用;检测血浆NPY水平可作为HFRS的病情监测指标,对判断预后及揭示HFRS某些发病机理具有重要意义.     

Insights into the Pathogenesis of Viral Haemorrhagic Fever Based on Virus Tropism and Tissue Lesions of Natural Rift Valley Fever

Rift Valley fever phlebovirus (RVFV) infects humans and a wide range of ungulates and historically has caused devastating epidemics in Africa and the Arabian Peninsula. Lesions of naturally infected cases of Rift Valley fever (RVF) have only been described in detail in sheep with a few reports concerning cattle and humans. The most frequently observed lesion in both ruminants and humans is randomly distributed necrosis, particularly in the liver. Lesions supportive of vascular endothelial injury are also present and include mild hydropericardium, hydrothorax and ascites; marked pulmonary congestion and oedema; lymph node congestion and oedema; and haemorrhages in many tissues. Although a complete understanding of RVF pathogenesis is still lacking, antigen-presenting cells in the skin are likely the early targets of the virus. Following suppression of type I IFN production and necrosis of dermal cells, RVFV spreads systemically, resulting in infection and necrosis of other cells in a variety of organs. Failure of both the innate and adaptive immune responses to control infection is exacerbated by apoptosis of lymphocytes. An excessive pro-inflammatory cytokine and chemokine response leads to microcirculatory dysfunction. Additionally, impairment of the coagulation system results in widespread haemorrhages. Fatal outcomes result from multiorgan failure, oedema in many organs (including the lungs and brain), hypotension, and circulatory shock. Here, we summarize current understanding of RVF cellular tropism as informed by lesions caused by natural infections. We specifically examine how extant knowledge informs current understanding regarding pathogenesis of the haemorrhagic fever form of RVF, identifying opportunities for future research.     

用硫酸鱼精蛋白从HFRSV感染材料中提取病毒蛋白及鉴定

本文采用硫酸鱼精蛋白沉淀方法，从感染肾综合征出血热病毒（HFRSV）的鼠脑和细胞中提取病毒蛋白，结果表明：鼠脑先后用鱼精蛋白1mg／ml和2mg／ml两次沉淀HFRSV蛋白时，细胞先后用鱼精蛋白4mg／ml和2mg／ml两次沉淀HFRSV蛋白时，效果均较好。SDS－PAGE电泳显示：提取的病毒蛋白分子量为67kD、55kD、45kD。Western－Blotting及ELISA表明：提取的病毒蛋白为病毒的特异性蛋白。血凝试验表明：从鼠脑及细胞中提取的病毒蛋白血凝效价分别为1：1024、1：4096。液闪计数可观察到[3H]-氨基葡萄糖只结合入了67KD和55kD两种蛋白。     

Acute Q Fever: 35 cases in Castilla-La Mancha

We report 35 sporadic cases of acute Q fever diagnosed in the area of Castilla-La Mancha (Spain). Diagnosis was based on a fourfold or greater rise in specific antibody titer. The mean age of the patients was 33 years and the male/female ratio was 2.5. Seventeen patients had hepatitis, 9 had pneumonia, 8 had isolated fever and 1 had myocarditis. An underlying disease was more frequent among patients with pneumonia.     

COVID-19-Associated Suspected Myocarditis as the Etiology for Recurrent and Protracted Fever in an Otherwise Healthy Adult

Current reports concerning cardiac involvement in the novel corona virus disease (COVID-19) mostly document acute myocardial injury at presentation. Here, we present a healthy young male, with presumed acute myocarditis, presenting 20 days after initial diagnosis of COVID-19 – and after a clinical, and apparent laboratory, resolution of the original episode. His sole substantial clinical finding upon admission was fever, which was followed by a witnessed elevation in troponin-I.     

Immunoproliferative small intestinal disease in Greece: presentation of 13 cases including two from Albania

OBJECTIVES: Immunoproliferative small intestinal disease (IPSID) represents a spectrum of clinicopathological entities including alpha-chain disease and other types of lymphoplasmacytic proliferations of the lamina propria of the small intestine, presenting with severe malabsorption. IPSID has been described mainly in the Mediterranean, Middle East, and African countries. It occurs rarely in western countries. We present here our experience from Greece describing some interesting findings in cases diagnosed during the years 1970-2002. METHODS: Current immunological and immunohistochemical methods for the detection of alpha heavy chains and the presence of clonality have been used to study 13 cases of IPSID diagnosed in Greece, two of whom were Albanian residents. RESULTS: The patients were categorized in three subgroups of IPSID: alpha-chain disease (n=8), non-alpha chain disease with other monoclonal immunoglobulins (n=3), and polyclonal 'non-malignant' IPSID (n=2). In several patients the disease had unusual features, and this in some cases delayed the diagnosis. In suspected cases it is thus of the utmost importance to proceed to an exploratory laparatomy. Patients with stage C disease had a short survival, whereas two patients with stage A alpha-chain disease responded to treatment with cyclophosphamide, vincristine and prednisolone, and cyclophosphamide, doxorubicine, vincristine and prednisolone, respectively, have a disease-free long survival of 35 and 12 years, and appear to be cured.