Clinical and laboratory features of Crimean-Congo hemorrhagic fever: predictors of fatality.

OBJECTIVE: To determine the predictors of fatality among patients with Crimean-Congo hemorrhagic fever (CCHF) based on epidemiological, clinical, and laboratory findings. METHODS: Among the patients with possible CCHF who were referred to Ankara Numune Education and Research Hospital (ANERH) from the surrounding hospitals between 2003 and 2006, those with IgM antibodies and/or reverse transcriptase-polymerase chain reaction (RT-PCR) results positive for CCHF virus in their blood, and who had received only supportive treatment, were included in the study. RESULTS: Sixty-nine patients with CCHF were admitted to ANERH from various cities of the northeastern part of the central region and southern parts of the Black Sea region of Turkey. Eleven (15.9%) patients died. Age, gender, days from the appearance of symptoms to admission, and initial complaints except bleeding were similar between fatal and non-fatal cases (p>0.05). Among the clinical findings, ecchymosis (p=0.007), hematemesis (p=0.030), melena (p<0.001), somnolence (p<0.001), and gingival bleeding (p=0.044) were more common among fatal cases. The mean platelet count was 47.569 x 10(9)/l in non-fatal cases and 12.636 x 10(9)/l in fatal cases (p=0.003). Among the fatal cases, the mean prothrombin time (PT; 18.4s vs. 13.4s; p<0.001) and the mean activated partial thromboplastin time (aPTT; 69.4s vs. 42.7s; p=0.001) were longer, and the mean alanine aminotransferase (ALT; 1688 vs. 293; p<0.001), mean aspartate aminotransferase (AST; 3028 vs. 634; p<0.001), mean lactate dehydrogenase (LDH; 4245 vs. 1141; p<0.001), mean creatine phosphokinase (CPK; 3016 vs. 851; p=0.004) levels and the mean international normalized ratio (INR; 1.38 vs. 1.1; p<0.001) were higher. In a Cox proportional hazards model, thrombocytopenia of < or = 20 x 10(9)/l (hazard rate (HR) 9.67; 95% confidence interval (CI) 1.16-80.68; p=0.036), a prolonged aPTT > or = 60s (HR 11.62; 95% CI 2.40-56.27; p=0.002), existence of melena (HR 6.39; 95% CI 1.64-24.93; p=0.008), and somnolence (HR 6.30; 95% CI 1.80-22.09; p=0.004) were independently associated with mortality. CONCLUSIONS: Thrombocytopenia of < or = 20 x 10(9)/l, a prolonged aPTT > or = 60s, the existence of melena, and somnolence were independent predictors of fatality.

The Prevalence of Hepatitis B and C Among Prisoners in Kahramanmaras, Turkey.

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are among the most important health issues in Turkey. Human immunodeficiency virus (HIV) infections are less frequently observed in the country. The individuals who had blood transfusions, patients undergoing hemodialysis, and intravenous drug addicted individuals, people who had tattoos/piercings, communal living environments, contamination of a family member, and prisoners are the main risk groups. OBJECTIVES: The current study aimed to discuss the prevalence and the genotypes of hepatitis and HIV infections among a specific group, namely individuals incarcerated in prisons. PATIENTS AND METHODS: Two-hundred and sixty-six prisoners sentenced for crimes such as robbery, sexual assault, assault substance abuse or selling drugs in the Kahramanmaras closed prison were recruited for the study. Demographic data and the presence of hepatitis B, hepatitis C and HIV were investigated in the study subjects. RESULTS: Out of the 266 cases included in the study, 89.5% were male, 10.5% were female and the mean age was 31.21 ± 8.99 years. Risk factors were detected in 27.4% of the subjects. Out of the 73 subjects, among whom the risk factors were detected, 20.3% had intravenous substance use, 3.8% had a history of operation/transfusion, 1.9% had a history of indentation and 1.5% had unprotected sexual contact. The rate of hepatitis B surface antigen (HBsAg) positivity was 2.6%, the ratio of anti-HBs positive subjects was 35.0% and immunity was achieved with vaccination in 43% of the subjects. Anti-HCV was positive in 17.7% of the prisoners and the genotype 3 and genotype 1 were 68.1% (n = 32) and 2.1% (n = 1), respectively. CONCLUSIONS: Continued substance abuse among most of the drug addicted individuals in prisons, common use of injection materials, tattoos and other circumstances that cause blood contact increase the risk of blood-borne infections.