Crucial parameter of the outcome in Crimean Congo hemorrhagic fever: Viral load |
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| Affiliation: | 1. Ankara Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey;2. Yildirim Beyazit University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bilkent, Ankara, Turkey;3. Department of Medical Biology, Yildirim Beyazit University School of Medicine, Ankara, Turkey;4. Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University School of Medicine, Bilkent, Ankara, Turkey;5. National Arbovirus and Viral Zoonoses Reference and Research Laboratory, Public Health Institute of Turkey, Ankara, Turkey;1. Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;2. Department of Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, GA 30602, USA;1. Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald-Isle of Riems, Germany;2. IDvet, Grabels, France;3. Faculty of Veterinary Medicine, Kafkas University, Kars, Turkey;4. Unit Antiviral Strategies, Institut Pasteur, Paris, France;1. Dr. Sami Ulus Maternity and Children''s Research and Education Hospital, Department of Pediatrics, Division of Infectious Diseases, Ankara, Turkey;2. Virology Reference and Research Laboratory, Department of Microbiology Reference Laboratories, Public Health Institute of Turkey, 06100 Ankara, Turkey;3. Ankara University Faculty of Medicine, Department of Biostatistics, 06100 Sıhhiye/Ankara, Turkey;1. Department of Arboviruses and Viral Hemorrhagic Fevers (National Reference Laboratory), Pasteur Institute of Iran, Tehran, Iran;2. Department of Biology, Shahed University, Tehran, Iran;3. Research Center for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran;4. Department of Virology, Pasteur Institute of Iran, Tehran, Iran;1. Canik Community Health Center, Public Health Directorate, Samsun, Turkey;2. Department of Geomatics Engineering, Artvin Çoruh University Faculty of Engineering, Artvin, Turkey;3. Kavak Vocational School, Ondokuz Mayıs University, Samsun, Turkey;4. Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayıs University Medical School, Samsun, Turkey;1. Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA;2. Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX, USA;3. Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA;4. Chevy Chase, MD, USA;5. Division of Virology, National Health Laboratory Service Universitas and Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa;6. National Infection Service, Public Health England, Porton Down, Salisbury, United Kingdom;7. Public Health Institution of Turkey, National Virology Reference Laboratory, Ankara, Turkey;8. Department for Clinical Microbiology, LabMed, Karolinska Institute in Stockholm, Sweden;9. Public Health Agency of Sweden, Sweden;10. National Veterinary Institute, Sweden;11. Institute for Virology, University of Giessen, Giessen, Germany;12. Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece |
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| Abstract: | BackgroundCrimean Congo hemorrhagic fever (CCHF) is a fatal disease with a mortality rate of 5–30%. CCHF can be asymptomatic or it may progress with bleeding and cause mortality.ObjectivesTo evaluate relation of viral load with mortality, clinical and laboratory findings in CCHF.Study designA total of 126 CCHF patients were included. Serum samples obtained from all patients on admission for measurement of viral load.ResultsIn our study, mortality rate was 11.1%. The most important prognostic factor was viral load. Mean viral load was 8.3 × 107 copy/ml and 4.6 × 109 copy/ml in survived and dead patients, respectively (p < 0.005). Probability of survival is found to be significantly reduced where AST >1130 U/l, ALT >490 U/l, CPK >505 U/l, LDH >980 U/l, platelet count <23 × 103/l, creatinine >1.4 mg/dl, INR >1.3, d-dimer >7100 ng/dl, and viral load >1.03 × 108 copy/ml. Patients with 108 copy/ml or higher viral load had diarrhea, headache, unconsciousness, bleeding, and seizure significantly more frequently (p < 0.05). WBC, hemoglobin, platelet counts were significantly lower whereas AST, ALT, CPK, LDH, creatinine levels, PT and aPTT time, d-dimer levels, and INR were found to be significantly higher in these group.ConclusionsThere are several severity criteria for prognosis of CCHF. In addition to these parameters, we introduce creatinine as a predictive factor for prognosis. Our study, which has the largest number of patients among studies that evaluate viral load on CCHF shows that viral load is the most effective parameter on mortality. |
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| Keywords: | Crimean Congo hemorrhagic fever Viral load Mortality Prognosis Creatinine |
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