Bozkurt Ilkay, Erdeniz Emine H, Riley Matthew J, Şensoy Levent, Beeching Nick J, Aydogdu Sema, Leblebicioglu Hakan, Korukluoglu Gulay, Fletcher Tom E
Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayis University School of Medicine, Samsun, Türkiye.
Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Vector Borne Zoonotic Dis. 2025 Feb;25(2):81-91. doi: 10.1089/vbz.2024.0066. Epub 2024 Sep 23.
Crimean-Congo hemorrhagic fever (CCHF) is a major emerging infectious disease threat, and children are reported to have a milder disease course compared with adults, in contrast to other viral hemorrhagic fevers. The aim of this study was to compare adult and pediatric patients with CCHF to improve understanding of pathogenesis and the natural history of the disease. A retrospective analysis of all children and adults admitted with confirmed CCHF between 2011 and 2020. Epidemiological, clinical, and laboratory features were collated on proformas, together with clinical management details. The Severity Grading Score (SGS) system was used to stratify mortality risk. Data from children were compared with adults in the same center and with other published pediatric cohort studies. A total of 47 children with a median (ranges) age of 14 (2-17) years and 176 adults with a median (ranges) age of 52 (18-83) years with confirmed CCHF were included. The most frequent symptoms in adults were fever, muscle-joint pain, headache, nausea, and vomiting; the most frequent in children were fever, anorexia, nausea, vomiting, and abdominal pain. Adults had lower lymphocyte and platelet counts and higher liver transaminase and creatinine levels than children. SGS values were lower in children, but 97.9% children received ribavirin compared with 8.5% of adults ( < 0.001), and they had associated longer median lengths of hospital admission (10 vs. 7 days, < 0.001). Mortality of 1 out of 47 (2.1%) children was similar to 11 other cohorts reported in Türkiye and lower than 13.1% in adults (23/176) in the same center ( = 0.059). Children have lower CCHF-related mortality, less severe disease, and different clinical syndromes at presentation. The majority of published case definitions for screening for CCHF in the main endemic countries do not differentiate between adults and children and omit four of the five most common presenting features in children.
克里米亚-刚果出血热（CCHF）是一种主要的新出现的传染病威胁，据报道，与其他病毒性出血热相比，儿童的病程比成人更为轻微。本研究的目的是比较成人和儿童CCHF患者，以增进对该疾病发病机制和自然史的了解。对2011年至2020年间收治的所有确诊CCHF的儿童和成人进行回顾性分析。在预印本上整理了流行病学、临床和实验室特征以及临床管理细节。采用严重程度分级评分（SGS）系统对死亡风险进行分层。将儿童的数据与同一中心的成人数据以及其他已发表的儿科队列研究进行比较。共纳入47名确诊CCHF的儿童，中位（范围）年龄为14（2 - 17）岁，176名成人，中位（范围）年龄为52（18 - 83）岁。成人中最常见的症状是发热、肌肉关节疼痛、头痛、恶心和呕吐；儿童中最常见的是发热、厌食、恶心、呕吐和腹痛。成人的淋巴细胞和血小板计数低于儿童，肝转氨酶和肌酐水平高于儿童。儿童的SGS值较低，但97.9%的儿童接受了利巴韦林治疗，而成人仅为8.5%（<0.001），且儿童的中位住院时间更长（10天对7天，<0.001）。47名儿童中有1名（2.1%）死亡，这与土耳其报告的其他11个队列相似，且低于同一中心成人的13.1%（23/176）（P = 0.059）。儿童的CCHF相关死亡率较低，疾病较轻，且发病时临床综合征不同。主要流行国家中大多数已发表的CCHF筛查病例定义未区分成人和儿童，且遗漏了儿童五个最常见症状中的四个。
