Kaya Kiliç Esra, Yilmaz Umut, Cesur Salih, Koçak Tufan Zeliha, Kurtoğlu Yasemin, Bulut Cemal, Kinikli Sami, Irmak Hasan, Demiröz Ali Pekcan
Ankara Eğitim ve Araştirma Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Kliniği, Ankara.
Mikrobiyol Bul. 2009 Oct;43(4):677-81.
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease presenting with flu-like symptoms, fever, hemorrhage and petechia. The virus (CCHFV) is a member of the Nairovirus genera of Bunyaviridae family and can be transmitted to humans by Hyalomma tick-bite, by exposure to infected blood and fomites of patient with CCHF or contact with animal tissue in viremic phase. In this study we present two cases with CCHF but without history of tick bite or exposure to infected fomites, even not coming from endemic areas. The first case was a 67 years old male patient presented with fever, fatique and shortness of breath. Physical examination revealed rales in right lower segments of lung. Laboratory findings showed elevation of liver enzymes with thrombocytopenia and prolonged prothrombin time. Serological markers for viral hepatitis, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) were negative. The patient was found to be IgM and RNA positive for CCHFV by ELISA and polymerase chain reaction (PCR) methods, respectively. His history indicated a contact with livestock. The second patient was a 60 years old male dealing with husbandry. He had fever, fatique and myalgia. Physical examination revealed petechial rash on legs. Laboratory findings showed elevated liver enzymes, prolonged phrothrombin time and thrombocytopenia. Viral hepatitis markers, CMV-IgM and EBV-IgM were found negative. He was also found to be IgM and RNA positive for CCHFV in the reference laboratory. In conclusion, CCHF should be considered in the differential diagnosis of patients who contact with livestock and present with fever, fatigue, rash, elevated liver enzymes, thrombocytopenia and prolonged prothrombin time eventhough they do not reside in endemic areas for CCHF.
克里米亚-刚果出血热（CCHF）是一种由蜱传播的病毒性疾病，表现为流感样症状、发热、出血和瘀点。该病毒（CCHFV）是布尼亚病毒科内罗病毒属的成员，可通过璃眼蜱叮咬、接触CCHF患者的感染血液和污染物或在病毒血症阶段接触动物组织传播给人类。在本研究中，我们报告了两例CCHF病例，这两名患者既没有蜱叮咬史，也没有接触过受感染的污染物，甚至并非来自疫区。首例病例为一名67岁男性患者，出现发热、乏力和呼吸急促症状。体格检查发现右下肺有啰音。实验室检查结果显示肝酶升高、血小板减少和凝血酶原时间延长。病毒性肝炎、巨细胞病毒（CMV）和EB病毒（EBV）的血清学标志物均为阴性。通过酶联免疫吸附测定（ELISA）和聚合酶链反应（PCR）方法，分别检测到该患者CCHFV的IgM和RNA呈阳性。其病史显示曾接触过家畜。第二例患者是一名60岁从事畜牧业的男性。他有发热、乏力和肌痛症状。体格检查发现腿部有瘀点皮疹。实验室检查结果显示肝酶升高、凝血酶原时间延长和血小板减少。病毒性肝炎标志物、CMV-IgM和EBV-IgM均为阴性。在参考实验室中也检测到他的CCHFV的IgM和RNA呈阳性。总之，对于接触家畜且出现发热、乏力、皮疹、肝酶升高、血小板减少和凝血酶原时间延长的患者，即使他们不住在CCHF疫区，在鉴别诊断时也应考虑到CCHF。
