Sener Barut

Increased serum ferritin levels in patients with Crimean-Congo hemorrhagic fever: can it be a new severity criterion?

OBJECTIVES Serum ferritin is one of the markers indicating hemophagocytosis that may have a role in the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF). This study was designed to determine any correlation between serum ferritin and routine diagnostic laboratory markers of CCHF, and to investigate the relationship between serum ferritin levels and disease severity. METHODS Sixty-six patients with CCHF admitted to the hospital during the spring and summer months of 2006 and 2007 were included in the study. Serum ferritin levels were measured in sera obtained during the initial days of hospitalization. Data from 53 patients showing decreasing platelet counts over the first three days were used for further analysis and these patients were divided into two groups according to disease severity: group A included severe cases with lowest platelet counts < or =20x10(9)/l and group B included mild cases with lowest platelet counts >20x10(9)/l. RESULTS Forty patients (60.6%) were male (mean age 43+/-17 years). Three patients died, thus the fatality rate was 4.5%. Fifty-one patients (77.3%) had abnormal serum ferritin levels, with levels above 500 ng/ml in 62.1%. There was a significant negative correlation between ferritin levels and concordant platelet counts (p<0.001; r=-0.416) and ferritin was also found to be positively correlated with aspartate aminotransferase (p<0.001; r=0.625), alanine aminotransferase (p<0.001; r=0.479), and lactate dehydrogenase (p<0.001; r=0.684). Group A had higher ferritin levels than group B (p < 0.001). Receiver operating characteristic analysis revealed that a ferritin level of > or =1862ng/ml had a sensitivity of 87.5% and a specificity of 83.8% in differentiating severe cases from mild ones. CONCLUSIONS Increased serum ferritin levels may suggest a significant role of hemophagocytosis in the pathogenesis of CCHF and may be a useful marker for diagnosis, disease activity, and prognosis.

Response to hepatitis B vaccine in HBsAg/anti-HBs negative and anti-HBc positive subjects

Some anti-HBc positive subjects have been encountered in the absence of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs). The aim of this study was to evaluate the response to hepatitis B vaccination in such cases. A total of 33 subjects who were HBsAg and anti-HBs negative, anti-HBc positive, with normal serum aminotransferase levels were included in the study. A recombinant hepatitis B vaccine was administered to subjects. Sera samples were obtained 1 month after each vaccination and tested for anti-HBs. HBV DNA and HBeAg were not detected in any subject. Anti-HBs levels were measured above 10]mIU/ml in 48.4% of cases after the first vaccination, 63.6% after the second vaccination and 90.9% after the third vaccination. Only 3 subjects (9.1%) lacked antibody response in spite of the 3-dose vaccination. In conclusion, preventive antibody levels were obtained after HBV vaccination in most of the HBsAg, anti-HBs negative, anti-HBc positive persons.Some anti-HBc positive subjects have been encountered in the absence of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs). The aim of this study was to evaluate the response to hepatitis B vaccination in such cases. A total of 33 subjects who were HBsAg and anti-HBs negative, anti-HBc positive, with normal serum aminotransferase levels were included in the study. A recombinant hepatitis B vaccine was administered to subjects. Sera samples were obtained 1 month after each vaccination and tested for anti-HBs. HBV DNA and HBeAg were not detected in any subject. Anti-HBs levels were measured above 10 > or = mIU/ml in 48.4% of cases after the first vaccination, 63.6% after the second vaccination and 90.9% after the third vaccination. Only 3 subjects (9.1%) lacked antibody response in spite of the 3-dose vaccination. In conclusion, preventive antibody levels were obtained after HBV vaccination in most of the HBsAg, anti-HBs negative, anti-HBc positive persons.

A tularemia outbreak in an extended family in Tokat Province, Turkey: observing the attack rate of tularemia

OBJECTIVE We report the first tularemia epidemic occurring in Tokat Province, located in the Middle Black Sea Region of Turkey, and some features of the cases. This epidemic has allowed the calculation of the attack rate of this disease because of its appearance in a single large family. METHODS The clinical and laboratory features of patients were examined. For serological diagnosis, microagglutination assays were done on serum samples from patients and other members of the family. RESULTS Seven members of the family developed overt clinical disease (one ulceroglandular, six oropharyngeal). Three patients had conjunctivitis in addition to oropharyngeal involvement. All patients had a microagglutination titer above 1/160. As eight out of 16 members of the extended family were found to be positive for tularemia serology, the attack rate was calculated to be 50%. CONCLUSIONS Tularemia is highly infectious and different clinical forms can occur in a single epidemic.

Thyroid dysfunction in Turkish patients with chronic hepatitis C receiving peginterferon plus ribavirin in the period of 2005-2010

Interferon-α based therapy for chronic hepatitis C (CHC) is associated with thyroiditis and thyroid dysfunction (TD). This study investigated whether TD during pegylated interferon-α (PEG-IFN) plus ribavirin treatment favors sustained viral response (SVR), and also the association between TD and PEG-IFN formulations. This retrospective study was performed in CHC patients who had received PEG-IFN plus ribavirin and had been followed for six months after treatment. Several factors were compared between patients with and without TD. 119 patients were included in the study. De novo incidence of TD was found to be 16.8%, and 16 of the 18 patients with TD achieved SVR. Although this rate was higher than patients without TD according to univariate analysis, logistic regression analysis revealed that there was not a significant association between TD and SVR, whereas baseline thyroperoxidase antibody (anti-TPO) positivity was the only significant predictor of TD. Moreover, TD was not associated with PEG-IFN type. Both interferon-α and hepatitis C virus (HCV) contribute to TD during antiviral therapy. It seems that there is no association between thyroid toxicity and viral clearance or type of PEG-IFN; however, anti-TPO positivity before treatment is the strongest predictor for TD during antiviral therapy.

Discharge criteria for Crimean–Congo haemorrhagic fever in endemic areas

• Risk for household contact transmission is low for Crimean–Congo haemorrhagic fever (CCHF).

Morbilliform drug eruption due to pegylated α-interferon can show complete regression after switching to non-pegylated interferon.

Pegylated or non‐pegylated α‐interferon are frequently used medications for the treatment of both chronic hepatitis B and chronic hepatitis C. Skin disorders, which are mainly comprised of eczematous dermatitis, are frequently seen during treatment with this drug. However, drug eruption or morbilliform eruptions due to interferons have been rarely reported so far. We herein describe a patient who developed morbilliform drug eruption under treatment with pegylated interferon. She was able to continue treatment after switching from pegylated interferon to conventional interferon.

Serum ferritin levels in chronic hepatitis C patients during antiviral therapy and prediction of treatment response

Abstract Objective: Increased serum ferritin (SF) levels are encountered in various conditions, such as inflammatory syndromes and haemochromatosis. Interferon alpha is one of the stimulants of SF. In this study we aimed to evaluate SF changes in patients with chronic hepatitis C (CHC) during antiviral therapy, and the relationship between SF and treatment response. Methods: Data from a total of 97 patients who had received peginterferon (PEG-IFN) plus ribavirin combination therapy for CHC, and who had been followed up for more than 6 months after treatment, were analyzed retrospectively. Patients who had undetectable hepatitis C virus RNA at 6 months after the completion of antiviral therapy were regarded as having achieved a sustained viral response (SVR), while the remaining patients were categorized as non-SVR. Differences in SF levels during therapy between SVR patients and non-SVR patients were examined. Results: We found that patients who achieved SVR had lower baseline ferritin levels. It was observed that SF levels increased dramatically in both the SVR and non-SVR groups after starting therapy, remained high until the end of the treatment period, and returned to baseline levels after completion of treatment. However the SF rise was found to be significantly higher in patients who achieved an SVR than in those without SVR at each time-point during treatment. Conclusions: SF levels increase during PEG-IFN-based therapy for CHC. A lower SF level before starting treatment and higher SF levels during therapy appear to be associated with a favourable treatment response. Therefore, rises in SF, especially during the early phase of treatment, could be a predictor of SVR.

Crimean-Congo hemorrhagic fever in pregnancy: A systematic review and case series from Russia, Kazakhstan and Turkey.

Highlights • CCHF in pregnancy is rare but has high rates of maternal (34%) and fetal mortality (59%).• Maternal hemorrhage is associated with maternal and fetal/neonatal death.• Nosocomial transmission of CCHF from 6/37 index pregnant cases resulted in 38 cases.• Early recognition and risk-assessment allows appropriate IP & C precautions and supportive care provision.

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 softwares. 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 IL4-VNTR P1 allele, IL4-VNTR P2P2 genotype and IL4-VNTR_IL6-174CG P2P1-GG genotype are susceptable with a increased risk in Brucelosis.

In this study, associations between IL-4, IL-6, and macrophage migration inhibitory factor (MIF) polymorphisms and susceptibility to brucellosis were investigated. Consecutive adult patients with no known treatment against brucellosis and who did not have any other autoimmune and/or chronic disorders, were included in this study (n = 120, Group I). Age and sex-matched controls who had no other autoimmune and/or chronic disorders were also included (n = 120, healthy volunteers, Group II). The IL4_P2P2 genotype, IL4_P1 allele, and IL4_variable number of tandem repeats (VNTR)_IL6-174CG compound genotype were found to be more frequent in the patient group than in control subjects. There were significant differences between the patients and controls with respect to the frequencies of the IL4_P2P2 genotype (77.5% versus 87.5%; p = 0.001; OR, 0.36; 95% confidence interval [CI], 0.21-0.62) and the IL4_P1 allele (12.1% versus 6.7%; p = 0.030; OR, 0.92; CI, 1.02-3.64). The IL4-VNTR_IL6-174CG compound genotype was also present at a significantly higher frequency in the patient group than in control subjects (11.7% versus 4.2%; p = 0.027, OR, 3.04; CI, 1.06-8.68). No statistically significant differences in the frequencies of the IL-6-174, MIF-173, IL-4_P1P1, and IL4_P2P1 genotypes were observed between patients and control subjects. The IL4_VNTR P1 allele, P2P2 genotypes, and IL4-VNTR_IL6-174CG P2P1-GG genotypes are common in southern Turkey, and carriers of these polymorphisms are susceptible to brucellosis.