Analysis of lymphocyte subgroups in Crimean-Congo hemorrhagic fever

SummaryObjectivesThis study examined the association between lymphocyte subgroups and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF) in Turkey.MethodsDuring the spring and summer of 2007, peripheral blood was collected from hospitalized patients with suspected CCHF. Lymphocyte subgroups were characterized by fluorescence-activated cell sorting. CCHF cases were confirmed by detecting viral RNA by PCR and/or IgM antibodies by ELISA. Lymphocyte subgroups were compared between fatal and non-fatal cases. The correlation between lymphocyte subgroups and viral loads was also investigated.ResultsSeventy-seven confirmed cases of CCHF were included in this study (five cases were fatal (6.5 %)). No differences in lymphocyte subgroups were found between fatal and non-fatal cases, except for significantly higher CD3+CD8+ T cells in the fatal cases (p=0.017). A positive correlation between viral load and CD3+CD8+ T cells was also detected (p=0.044). There was no correlation between other lymphocyte subgroups and viral load.ConclusionsHigher levels of CD3+CD8+ T lymphocytes were detected in fatal compared to non-fatal CCHF cases. Despite this cytotoxic immune activation, a fatal outcome could not be prevented. We hypothesize that high viral load and other factors may influence this outcome, although more studies are required to explain the pathogenesis of CCHF

Crimean-Congo Hemorrhagic Fever Seroprevalence in Healthcare Workers

In our country, cases with Crimean-Congo hemorrhagic fever (CCHF) have increased since 2002. Our clinic is one of the major centers that follows the CCHF cases. Healthcare workers are at risk for transmission of CCHF virus. This study was conducted after a nurse had developed symptomatic CCHF 3 days after resuscitating a CCHF patient. The aim of this study is to investigate CCHF specific IgG by ELISA in remaining 27 staff taking care of CCHF patients in our clinic. Test result was found positive in one doctor who had developed an asymptomatic infection. The nurse with symptoms had taken standard contact isolation precautions during the resuscitation however blood of the patient had splashed to his gown. It was considered that during that time unnoticed mucosal contact had occurred. This study suggested that transmission of CCHF virus might occur during emergent interventions and optimal contact isolation precautions should be taken very carefully

Aspergilloma Occurred in Preexisting Tuberculous Cavity in a Patient with Acquired Immune Deficiency Syndrome

Aspergillus fungus balls develop preexisting cavities in the pulmonary apex of patients with chronic lung disease such as tuberculosis. Acquired Immune Deficiency Syndrome (AIDS) predisposes to reactivation of tuberculosis. Efficacy of antifungal therapy in invasive aspergillosis has been extremely poor in immunsupressed patients such as AIDS. An aspergilloma case developing on the preexisting tuberculosis cavity in the 36 years old patient who was followed up as AIDS is evaluated in this case report

Cytomegalovirus Infection with Liver Involvement in an Immunocompetent Patient

Cytomegalovirus (CMV) infection is a common viral infection worldwide, with a frequency as high as 90% in developing countries. Only 10% of primary CMV infection is symptomatic in immunocompetent patients, and it rarely causes specific complications. We describe a previously healthy 29-year-old male patient who was hospitalized due to fever, headache and dizziness. Yellow plaques on the tonsillae, high levels of lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase, and hepatosplenomegaly were detected. Anti-CMV IgM and CMV polymerase chain reaction positivity was detected in his serum. The patient was followed with the diagnosis of CMV hepatitis and treated with gancyclovir for 14 days due to fever. He recovered after treatment and was discharged. In previously healthy patients with hepatitis of unknown etiology, CMV should be kept in mind in the differential diagnosis; liver biopsy can be performed for the definitive diagnosis

Effect of oral ribavirin treatment on the viral load and disease progression in Crimean-Congo hemorrhagic fever

SummaryObjectivesCrimean-Congo hemorrhagic fever (CCHF) is a lethal hemorrhagic disease. There is currently no specific antiviral therapy for CCHF approved for use in humans. In this study we aimed to investigate the effect of oral ribavirin treatment on the viral load and disease progression in CCHF.MethodsThe study population was composed of patients who had a definitive diagnosis of CCHF by means of clinical presentation plus detection of viral RNA by reverse transcriptase polymerase chain reaction (RT-PCR). Ten patients who received oral ribavirin for 10 days and 40 control patients who received supportive treatment only were included in the study. Ribavirin treatment consisted of oral ribavirin 4g/day for 4 days and then 2.4g/day for 6 days. Viral load and hematological and biochemical laboratory parameters, which were measured daily, were analyzed.ResultsMean age (37.4 vs. 45.5, p=0.285), gender (male 50% vs. 62.5%, p=0.470), days from the appearance of symptoms to admission (4.3 vs.4.4 days, p=0.922), and initial complaints were similar between the ribavirin group and the control group. Upon hospital admission, mean viral load was 8.2×108 copies/ml in the ribavirin group and 8.3×108 copies/ml in the control group (p=0.994). During follow-up, no statistically significant differences were found between the groups with regard to the decrease in viral load, the reduction in alanine aminotransferase and aspartate aminotransferase levels, and the increase in platelet count. The case-fatality rate was 20% (2/10 patients) in the ribavirin group and 15% (6/40 patients) in the control group (p=0.509).ConclusionIn this study, oral ribavirin treatment in CCHF patients did not affect viral load or disease progression

Herpes Simplex Hepatitis in an Immune-Competent Adult: A Case Report

Hepatitis due to herpes simplex virus is a rare complication of primary or secondary herpes simplex virus infection in immunocompetent adults. A case of herpes simplex virus hepatitis in a healthy adult is presented in this report. The case recovered without progression of fulminant hepatitis