Increased Retinal Vessel Tortuosity Associated With Crimean-Congo Hemorrhagic Fever in Children.

BACKGROUND: To evaluate the ocular symptoms and findings of children diagnosed with Crimean-Congo hemorrhagic fever (CCHF). METHODS: In this prospective study, children diagnosed with CCHF who underwent a complete ophthalmologic examination during the hospitalization period were included. RESULTS: Twenty-four children with a mean age of 12.4 ± 3.6 years were included study. The most common ocular finding was conjunctival hyperemia and was observed in 50% of patients. Nine (37.4%) children had abnormalities in fundus examination. Two (8.3%) of them had dilated retinal veins, and 7 (29.1%) had tortuous retinal vessels. No significant difference was found between mild to moderate and severe disease groups in terms of ocular symptoms and ophthalmologic examination findings (P > 0.05, for all). CONCLUSIONS: The increased retinal vessel tortuosity was detected as a fundus examination finding in children with CCHF. Both ophthalmologists and pediatricians should be aware of the various ocular manifestations of CCHF for rapid diagnosis and management.

The relationship with clinical course and prognosis of serum endothelin-1, angiopoietin-2, and tie-2 levels in Crimean-Congo hemorrhagic fever

Background/aim: Crimean-Congo hemorrhagic fever (CCHF) is a serious illness characterized by fever and hemorrhage. Endothelin-1 (ET-1), angiopoietin-2 (Ang-2), and endothelial cell-specific receptor tyrosine kinase (Tie-2) are believed to be important markers of the pathogenesis, clinical course, and prognosis of the disease. The aim of this study was to determine ET-1, Ang-2, and Tie-2 levels in adults with CCHF and investigate the associations between these markers and pathogenesis and disease course. Materials and methods: Sixty CCHF patients were included in the study. The patients were classified according to disease severity criteria and Ang-2, Tie-2, and ET-1 levels were compared. Results: Mean serum ET-1 level was 36.62 ± 27.99 pg/mL in the patient group and 3.70 ± 4.71 pg/mL in the control group (P = 0.001). Mean serum Ang-2 levels were 2511.18 ± 1018.64 pg/mL in the patient group and 3570.76 ± 209.52 pg/mL in the control group (P = 0.001). Mean serum Tie-2 levels were 7.35 ± 7.75 ng/mL in the patient group and 0.67 ± 1.26 ng/mL in the control group (P = 0.001). Conclusion: Elevated ET-1 and Tie-2 levels were associated with more severe disease course, while Ang-2 level was negatively correlated with severity in adult CCHF patients. ET-1, Tie-2, and Ang-2 levels are important prognostic parameters in CCHF and may contribute significantly to treatment and follow-up.

Evaluation of Portal Vein Doppler Findings in Patients with Crimean⁻Congo Hemorrhagic Fever.

Background and objectives: In this study, we compare portal vein Doppler ultrasound (US) findings between patients with Crimean-Congo hemorrhagic fever (CCHF) and healthy persons and investigate the practicability of these findings in the prediction of disease severity. Materials and Methods: In this prospective study, portal vein Doppler US was performed in patients diagnosed with CCHF and healthy persons between March 2016 and May 2018. The patients were grouped according to mild-to-moderate and severe progression of CCHF. Liver size, portal vein diameter, portal vein flow rate, spleen volume, and splenic vein diameter were recorded in the patients and healthy controls. Results: Of the 48 patients diagnosed with CCHF, 25 were male. According to the scoring made, 38 patients were evaluated as having mild-to-moderate disease progression, and 10 were evaluated as having severe disease progression. With respect to the Doppler US findings, liver size, spleen volume, portal vein diameter, splenic vein diameter, and portal vein flow rate were significantly higher in the patient group compared with the controls. However, no significant difference was found in these parameters between the severe and mild-to-moderate progression groups. Conclusions: In the evaluation of and follow-up with patients with CCHF, portal vein Doppler US is a non-invasive and reliable tool for diagnosis.

Carbonic anhydrase I-II autoantibodies and oxidative status in long-term follow-up of patients with Crimean-Congo haemorrhagic fever.

CONTEXT: Crimean-Congo haemorrhagic fever (CCHF) is a life-threatening acute febrile haemorrhagic disease. OBJECTIVE: This study was to measure levels of the oxidative stress biomarkers malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) and of CA I-II autoantibodies as biomarkers for autoimmunity and course of disease in patients with CCHF. METHODS: Seventy CCHF patients and 39 healthy control volunteers were included in the study. RESULTS: Serum MDA and TAS levels were significantly higher (p < .0001) and serum TOS and OSI levels were significantly lower (p < .0001) in both the acute period and at 6th-month follow-up in the CCHF patients compared to the healthy volunteers. CA II levels were significantly higher in the acute period compared to the healthy volunteers (p < .005) and were significantly lower at 6th-month follow-up (p < .05). CONCLUSION: Serum MDA and CA II autoantibodies appear to reflect oxidative stress status and disease progression in CCHF and may be used as biomarkers for oxidative stress and disease progression.

Effect of TLR10 (2322A/G, 720A/C, and 992T/A) polymorphisms on the pathogenesis of Crimean Congo hemorrhagic fever disease.

Crimean Congo hemorrhagic fever (CCHF) is a tick-borne disease caused by the Crimean Congo hemorrhagic fever virus (CCHFV). Toll-like receptors (TLRs) are type 1 transmembrane proteins of immune cells that play a critical role in innate and adaptive immunity. The present study first time aims to investigate the relation between TLR10 gene polymorphisms (720A/C, 992T/A, and 2322A/G), severity/non-severity, fatality/non-fatality, and CCFH disease by using PCR-RFLP assay in a Turkish population. TLR10 720A/C polymorphism was determined to be statistically significant both genotype and allele frequency (P = 0,011, P = 0.015, respectively). TLR10 992T/A polymorphism was found statistically significant relationships between patient and control (P = 0.026) and individual with AA genotype have approximately three times greater risk than TT genotype (OR = 2.93). There was not a significant difference in 2322A/G genotype distribution (P = 0.152). There were also statistically significant associations between both TLR10 992T/A and 2322A/G polymorphism and patient mortality (P = 0.001 and P = 0.008, respectively). We have not found statistically any linkage among TLR10 haplotype, but individual AAA and GAT haplotype have higher risk than individual AAT haplotype (OR = 3.22, OR = 1.93, respectively). Consequently, this study shows that pathogenesis of CCHF disease is associated with the TLR10 720A/C and 992T/A polymorphisms. There is a statistically significant association in fatal/non-fatal patients with TLR10 720A/C and 992T/A. The TLR10 992AA genotype might increase and TLR10 720CC genotype might decrease susceptibility to pathogenesis of CCHF disease. TLR 10 polymorphisms may be also an important biomarker for CCHF susceptibility and fatality rate.

Importance of endothelial dysfunction biomarkers in patients with Crimean-Congo hemorrhagic fever.

The pathogenesis of the Crimean-Congo hemorrhagic fever (CCHF) and the cause of the hemorrhage are not yet fully understood. However, the endothelium plays a key role in the pathogenesis. The purpose of this study was to investigate endothelial dysfunction markers (asymmetrical dimethyl arginine [ADMA], endothelin 1[ET-1], thrombomodulin [TM], von Willebrand factor [vWf], and intercellular adhesion molecule [ICAM-1]) in serum in patients with CCHF and their associations with hemorrhage. Seventy-three patients with CCHF were included in the study. All patients' endothelial dysfunction markers were studied using routine biochemical and hematological tests. The data obtained were then subjected to statistical analysis. Statistically significant differences were determined between the patients and healthy control groups at time of presentation to hospital in terms of ADMA (P < 0.001), ET-1 (P < 0.001), TM (P = 0.039), vWf (P < 0.001), and ICAM-1 (P < 0.001) levels. Only the differences in TM and vWf were significant between the hemorrhagic and non-hemorrhagic groups (P < 0.05). Both serum ADMA and TM levels were significantly higher in the hemorrhage and non-hemorrhage CCHF groups on the 5th day compared to the 1st day (P < 0.05). Levels of endothelial dysfunction markers in CCHF vary in proportion to the damage occurring in the endothelium. ADMA and TM levels were lower in periods with mild endothelial injury. They were increased in line with severity endothelial injury. They may be an early marker in showing hemorrhage. Elevation in ADMA levels and low nitric oxide levels lead to endothelial injury and hemorrhage. Soluble TM that entered the circulation in line with the increased endothelial injury in hemorrhagic patients has been compromised the coagulation cascade.

The possible role of CCR5Δ32 mutation in Crimean-Congo hemorrhagic fever infection.

Crimean-Congo hemorrhagic fever infection (CCHF) is a viral zoonosis. The pathogenesis of this disease has not been established so far, however, cytokines account for its progression and outcome. The aim of the present study is to investigate the association between chemokine receptor 5 (CCR5) gene Δ32 mutation and pathogenity, severity, and mortality of CCHF. This case-control study included 133 CCHF patients diagnosed by detection of CCHV RNA positivity and 97 healthy control subjects. CCR5 gene Δ32 mutation analyzed by polymerase chain reaction (PCR) method. The results were compared by using SPSS 16.0 and WINPEPI software's. The genotype distribution and allele frequency of the CCR5Δ32 were statistically different between the patients and the control group (P = 0.017; OR: 4.98 95% CI = 1.65-14.99 and P = 0.019; OR:4.76 95%CI = 1.30-17.50, respectively). CCR5/CCR5 (W/W) genotype and W allele of CCR5 gene were more common in patient group than in controls. There was no significant difference in severe and mild cases with regard to genotype distribution and allele distribution of CCR5Δ32 mutation (P >0.05). These results suggest that the CCR5 gene and its product might play a role in the pathogenesis of CCHF disease. Future studies will help us to uncover the exact role of CCR5 in the pathogenesis and prognosis of CCHF and to treat the disease.

The Importance of Supportive Care with Tranexamic Acid in Crimean-Congo Hemorrhagic Fever.

This report describes a case of Crimean-Congo hemorrhagic fever with widespread hemorrhages and multiple organ dysfunction syndrome in a 46-year-old patient from an endemic region. Although the patient had numerous poor prognostic factors, he was discharged in a healthy condition after 17 days of hospitalization with close monitoring and supportive care. Tranexamic acid was successfully used together with other supportive treatments.

Important of Angiopoietic System in Evaluation of Endothelial Damage in Children with Crimean-Congo Hemorrhagic Fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) causes endothelial activation and dysfunction by affecting the endothelium directly or indirectly. In maintaining the vascular integrity, vascular endothelial growth factor (VEGF-A) and its receptor (VEGFR1) and angiopoietin-2 (Ang-2) and its receptor (Tie-2) are very important mediators. For this reason, we aimed at studying the association of Ang-2 and VEGF and their receptors Tie-2 and VEGFR1 with CCHF infection. METHODS: Thirty one CCHF patients and 31 healthy controls (HC) were included in the study. CCHF patients were classified into 2 groups in terms of disease severity (severe and nonsevere). VEGF-A, VEGFR1, Ang-2 and Tie-2 levels were measured in all groups. RESULT: Serum levels of Tie-2, Ang-2, VEGF-A and VEGFR1 were significantly increased in CCHF patients compared with the HC. Furthermore, serum Tie-2, Ang-2, VEGF and VEGFR1 levels were found to be significantly higher in the severe group than in the nonsevere and HC groups (P < 0.05 and P < 0.001, respectively). Also, Tie-2, Ang-2, VEGF-A and VEGFR1 levels were significantly higher in the nonsevere group than in the HC group (P < 0.05). CONCLUSION: Having statistically significant higher Ang-2, Tie-2, VEGF-A and VEGFR1 levels in the severe group when compared with the other groups suggested that VEGF-related Ang-2/Tie-2 system played a critical role in the pathogenesis of the disease, and these markers could be used as the severity criteria.

Doppler ultrasonographic evaluation of the carotid and vertebral arteries in children with Crimean-Congo hemorrhagic fever.

AIM: In children with Crimean-Congo hemorrhagic fever (CCHF), the aim of present study was to determine the cerebral hemodynamic changes assessed with Doppler ultrasonography with measurements of lumen diameter (LD), peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), and total cerebral blood flow volume (tCBFV) of common carotid artery (CCA), internal carotid artery (ICA, and vertebral artery (VA). METHODS: This case-control study examined children with clinically defined CCHF as cases (N.=24) and healthy children as controls (N.=17). The CCHF and healthy children underwent ultrasonography of the CCA, ICA and VA for the measurements of flow velocity and cerebral blood flow volume. Doppler ultrasonography were performed in the CCHF children if vital signs were stable and fever lower than 37.5 °C. RESULTS: There was no significant difference between the CCHF and healthy children in the lumen diameter of study arteries (P>0.05). PSV and EDV values were significantly higher in the CCHF children compared to the controls (P<0.05). Overall, the CCHF did not cause considerable change in RI and PI values (P>0.05). tCBFV values of CCHF children was found higher compared to healthy controls (P<0.05). CONCLUSION: Overall, in children, CCHF causes an increase in the cerebral blood flow as determined by Doppler ultrasonography with flow velocity and cerebral blood flow volume measurements; however, this increase need to be accepted as mild to moderate degree. Several pathophysiological derangements may be contributory to the increased cerebral blood flow in children with CCHF.

Resting heart rate in children with Crimean-Congo hemorrhagic fever: a tool to identify patients at risk?

OBJECTIVE: We aimed to assess the association between resting heart rate (RHR) and severe infection in children with Crimean-Congo hemorrhagic fever (CCHF). METHODS: In all, 121 patients under 18 years of age with a laboratory-confirmed diagnosis of CCHF were enrolled in the study. Patients were classified into two groups based on disease severity (severe group and nonsevere group). RHR was measured by electrocardiography (ECG) on admission. Maximum P-wave duration (Pmax), P-wave dispersion (Pd), QRS duration, corrected QT interval, and QT dispersion were also measured. RESULTS: Mean age was 11.4±3.9 years and 84 patients were male. Twenty-six patients were classified as severe. Patients in this group had a higher RHR (103.6±10.4 vs. 80.5±8.1, p=0.001) than those with nonsevere disease. There was no difference in Pmax, Pd, QRS duration, QTcmax, or QTc dispersion. The optimal cutoff value of RHR to predict disease severity was>96 beats per minute (bpm), with 70.6% sensitivity and 50.1% specificity. Bleeding, thrombocytopenia (≤80×10(9)/L), elevated aspartate transaminase (AST) (>208 IU/L), elevated alanine transaminase (ALT) (>87 IU/L), elevated lactate dehydrogenase (LDH) (>566 IU/L), long activated partial thromboplastin time (aPTT) (>42 s), and increased hospitalization days were more frequent in patients with RHR >96 bpm. Multivariate logistic regression analysis revealed low platelet count (<80×10(9)/L), long aPTT (>42 s), high LDH (>566 IU/L), and elevated RHR (>96 bpm) as independent risk factors for severe disease. CONCLUSIONS: We conclude that elevated RHR was significantly associated with severe disease in children with CCHF, thus offering the potential to identify patients with increased risk.

Evaluation of patients with Crimean-Congo hemorrhagic fever in Bolu, Turkey.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF), which is associated with a high mortality rate in the Black Sea region of Turkey, has received increasing attention. OBJECTIVE: In this study, the epidemiological features, clinical and laboratory findings, treatments, and outcomes of patients diagnosed with CCHF between 2006 and 2012 based on data obtained from the Bolu Provincial Directorate of Health (BPDH) were evaluated. METHODS: BPDH data were reviewed for the period between 1 January 2006 and 31 July 2012. The locations where the tick had attached to the patient, the site of the tick bite on the patient's body, the dates of tick bite and removal, and the demographic characteristics of each patient were recorded. BPDH data on the total number of tick bites, patients with confirmed CCHF, and deaths due to CCHF in Bolu Province during the study period were also evaluated. RESULTS: A total of 46 patients with CCHF and 38 patients without CCHF but who had been bitten by ticks were admitted to the BPDH. Of the patients with CCHF, 54.3% were female. The mean age of the patients was 46.88 ± 2.05 years (range, 1-79 years). The mortality rate was 8.82%. Patients were predominantly observed in June and July. When the patients were distributed according to their occupations, the majority was houswife (48.6%), followed by animal husbandry worker (27.0%), farmer (10.8%), health worker (5.4%), and other (8.1%). The symptoms of the patients with CCHF included fatigue (60.9%), fever (60.9%), and myalgia (60.9%). Of those patients with CCHF, 41.3% were determined to have a high fever. CONCLUSIONS: The probability of developing CCHF decreased as the duration of tick attachment increased. Moreover, although the clinical presentation is important, it is not diagnostic. Physical examination and laboratory findings become more specific in later stages.

Evaluation of renal involvement in children with Crimean-Congo hemorrhagic fever.

The aim of the present study was to evaluate renal involvement in children with Crimean-Congo hemorrhagic fever (CCHF). Forty-four children infected with CCHF virus and 30 controls were enrolled in the study. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine protein levels were measured in the patient and control groups. Clinical and laboratory findings of the patient and control groups were compared. uNGAL levels were higher in the patient group than that in the control group (P < 0.001). Of the 44 patients, 26 (59.1%) were proteinuric. uNGAL levels in proteinuric patients were higher than those in non-proteinuric patients (P = 0.035). There was a positive correlation between uNGAL and urine protein levels in the patient group. (R = 0.614, P < 0.001). Due to renal involvement, increased proteinuria and increased uNGAL levels were observed in children with CCHF. In these children, measuring urine total protein and uNGAL levels can be useful to monitor renal involvement due to CCHF.

Bradycardia seen in children with Crimean-Congo hemorrhagic fever.

INTRODUCTION: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy. METHODS: Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age. RESULTS: Fifty-two patients (mean age 11.2 ± 4.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 ± 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively). CONCLUSION: Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.

Anterior rhinomanometry and determination of nasal mucociliary clearance time with the saccharin test in children with Crimean-Congo hemorrhagic fever.

OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF), like other viral infections, may prolong mucociliary clearance time and increase nasal resistance in children. The aim of the present prospective case-control study was to study, using saccharin and anterior rhinomanometry tests, whether CCHF infections caused any change in nasal physiology. METHODS: Overall, 40 subjects, 20 of whom had CCHF (group 1) and 20 of whom were healthy controls (group 2), were enrolled in this study. The definitive diagnosis of CCHF infection was made based on typical clinical and epidemiological findings and detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by reverse transcription-polymerase chain reaction. Anterior rhinomanometry was performed in all participants according to current recommendations of the Committee Report on Standardization of Rhinomanometry. A saccharin test was used to evaluate mucociliary clearance, and nasal mucociliary clearance time was assessed with the saccharin test as described previously. RESULTS: In our patients, the mean time from the application of saccharin crystals to the first feeling of a sweet taste was 6.77 ± 3.25 minutes (range 2-16 min). In terms of the mean time from the application of saccharin crystals to the first feeling of a sweet taste, there was no difference between two groups. The mean total air flow was 637.60 ± 76.18 mL/s (range 490-760 mL/s). The mean total nasal airway resistance was 0.24 ± 0.03 Pa/mL s (range 0.20-0.31 Pa/mL s). In terms of the degree of nasal air flow and nasal airway resistance and the total air flow and total nasal airway resistance of each nostril, there was no difference between the 2 groups. CONCLUSIONS: The results obtained in anterior rhinomanometry and saccharin test showed that there was no statistically significant difference between CCHF (+) patients and controls. These results suggest us that CCHF virus infection does not affect nasal physiology. However, this is the first study performed on this issue and further studies on larger series need to be performed.

Oxidative stress in the adult and pediatric patients with Crimean-Congo haemorrhagic fever.

BACKGROUND & OBJECTIVES: Crimean-Congo haemorrhagic fever (CCHF) can be fatal with bleeding, shock and disseminated intravascular coagulopathy (DIC). Although similar genetic strains have been defined, the causes of the clinical differences between the cases are yet to be found. We aimed to demonstrate the balance between oxidant and antioxidant system in CCHF. METHODS: In this study, the patient group consisted of 72 cases with a positive diagnosis of CCHF according to PCR/ELISA outcome among the patients referred to Cumhuriyet University, Medical Faculty in 2010. A total of 74 volunteers who were not having any viral or metabolic disease, non-smokers and age and sex matched with the patients group were enrolled as the control group. Both in the controls and the patients, individuals aged under 16 yr were defined as group 1 and the individuals aged over 16 yr as group 2. The serum samples were stored at -80°C until the study was carried out. All the samples were simultaneously thawed. In these cases, total antioxidant capacity (TAC), total oxidative status (TOS), oxidative stress index (OSI), lipid peroxide (LPO), paraoxonase (PON) and arylesterase were analyzed with the ELISA method. OSI was calculated. RESULTS: Levels of TOS, OSI and LPO were found significantly higher in CCHF patients in both the groups (p <0.05), whereas levels of TAC, PON1 and arylesterase were lower in CCHF patients compared to the controls, but low level of TAC in the group 1 was not statistically significant. INTERPRETATION & CONCLUSION: Our study demonstrated increased oxidative stress in CCHF patients in both groups 1 and 2. In order to prevent tissue damage which might be developed due to the oxidative stress in CCHF patients, further comprehensive studies should be conducted to define whether the adding antioxidants to the treatment would be helpful or not.

[Efficacy of antiviral agents in the treatment of Crimean hemorrhagic fever].

The study aimed at estimating the pharmacotherapeutic efficacy of medications possessed of antiviral activity, such as ribavirin, cycloferon solution and tablets, in 410 patients with Crimean hemorrhagic fever: The early beginning of therapy (days 1-4 after the onset of the disease) with these drugs reduced the number of severe cases and manifestations of hemorrhagic syndrome. The duration of the disease decreased, the occurrence of intoxication syndrome reduced to a minimum, hemorrhagic rash rapidly disappeared, and the frequency of complications decreased. Adverse events were documented in 5.2% of the patients (n = 15); most of them developed on day 2 after using the drugs, their duration did not exceed 2.2 days. There were no cases of drug withdrawal.

Acute evaluation of pituitary function in patients with Crimean-Congo haemorrhagic fever.

CONTEXT: Crimean-Congo haemorrhagic fever (CCHF) can cause a fatal haemorrhagic syndrome. Pituitary ischaemia/infarction and necrosis are known causes of hypopituitarism, often remaining unrecognized because of subtle clinical manifestations. OBJECTIVE: Our aim was to evaluate the effect of CCHF on pituitary function. SUBJECT AND METHODS: Levels of serum free T3, free T4, TSH, GH, IGF-I, prolactin, cortisol, testosterone (in men) and oestrogen (in women) were studied in 20 patients who had been diagnosed with CCHF. TRH, LH-RH and 1 µg adrenocorticotropin tests were performed in all patients. The hypothalamo-pituitary region was examined by magnetic resonance imaging (MRI) in two patients who were diagnosed with hypocortisolism. RESULTS: We found cortisol insufficiency in 2 (10%) of the 20 with CCHF. However, hypophyseal MRI findings were normal in these two patients. None of the patients had deficiencies of GH, TSH or FSH/LH. CONCLUSION: To our knowledge, this is the first study reporting the effect of CCHF on pituitary function. We found that cortisol insufficiency may occur in patients diagnosed with CCHF; however, studies including a larger number of patients are required to make a definite conclusion on this issue.

Cardiac findings in children with Crimean-Congo hemorrhagic fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) involves the multi-organ systems. The involvement of the heart in adult patients has been described previously. We investigated the electrocardiographic and echocardiographic findings of pediatric patients with CCHF. MATERIAL/METHODS: Patients younger than 16 years of age diagnosed with CCHF were enrolled in the study. The diagnosis of CCHF infection was based upon typical clinical and epidemiological findings and serological tests. All patients underwent a thorough cardiologic evaluation. A standard 12-lead electrocardiography and echocardiography were performed. RESULTS: Twenty-three consecutive patients who were hospitalized with diagnosis of CCHF were enrolled in the study (mean age: 12±2 years, 6 female). All electrocardiographic parameters were within normal ranges according to age. Seven patients (30%) had minimal (<1 cm) pericardial effusion. Fifteen (65%) patients had segmental wall motion abnormalities (hypokinesia). A second echocardiography revealed that all wall motion abnormalities had disappeared; the pericardial effusion persisted in only 2 of 7 patients (28%). CONCLUSIONS: Cardiac involvement appears to be more frequent in children with CCHF disease than in adults, but it is slighter and almost totally reversible; however, the course of the disease in children is milder than it is in adults.

Evaluation of cochlear involvement by transient evoked otoacoustic emission test in children with Crimean-Congo hemorrhagic fever.

OBJECTIVE: The aim of this study was to investigate cochlear involvement in child patients with Crimean-Congo hemorrhagic fever (CCHF) disease. METHODS: Twenty-eight CCHF disease patients (56 ears) and 26 sex- and age-matched healthy control subjects (52 ears) were included in the study. Pure-tone audiometry at frequencies 0.25, 0.5, 1, 2, 4, and 6 kHz, immittance measures including tympanometry and acoustic reflex testing, and transient evoked otoacoustic emission (TEOAE) testing were performed in the patients and controls. RESULTS: The proportion with a result of 'fail' for the TEOAE test in the CCHF patients was not statistically significant from the control group (p>0.05). CONCLUSIONS: CCHF disease does not impair cochlear function in children. The clinical course of CCHF among children seems to be milder than in adults.