Seyit Ali Büyüktuna

Discharge criteria for Crimean–Congo haemorrhagic fever in endemic areas

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

INCREASED IRISIN CONCENTRATIONS IN PATIENTS WITH CRIMEAN-CONGO HEMORRAGIC FEVER

Crimean-Congo Hemorrhagic Fever (CCHF) is a life-threatening viral infection. The pathogenesis of the disease is not well understood. The aim of this study was to determine the change in irisin concentrations in patients with CCHF. The study included a total of 30 patients with CCHF and 30 control participants. Irisin concentrations were determined using a commercial ELISA kit. Median irisin concentrations were 9.03 (5.81-12.22) μg/mL and 4.2 (3.39-7.62) μg/mL, respectively, in each group. There was no correlation between irisin and disease severity. Any correlations between irisin, and lactate dehydrogenase (LDH), international normalization ratio (INR), Alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelets, activated partial thromboplastin time (aPTT), D-dimer and hemoglobin, were also investigated. There were statistically significant positive correlations between the values of irisin, and platelet (p = 0.005, r: 0.369), ALT (p = 0.049, r: 0.261), INR (p = 0.006, r: 0.359) and aPTT values (p = 0.002, r: 0.405). A negative correlation was also found between the values of irisin and LDH (p = 0.008, r: －0.348). No correlations were determined between the values of irisin, and AST, hemoglobin and D-dimer. These results suggest that irisin may have a role in CCHF.

Clinical severity in forecasting platelet to lymphocyte ratio in Crimean-Congo hemorrhagic fever patients.

Crimean-Congo hemorrhagic fever (CCHF) is a life-threatening disease that develops as a result of infection by a member of the Nairovirus genus of the Bunyaviridae family, and its initial symptoms are not specific. In patients with severe clinical progression, in particular, the neutrophil rate is high, whereas lymphocyte and monocyte levels are low. A total of 149 patients, in whom the diagnosis was confirmed with reverse transcriptase PCR, were included in the study. In order to compare patient clinical progression severity, we divided the patients into two groups. For group 1, Çeviks severity score was used. The patients who had a platelet/lymphocyte ratio (PLR) <41 constituted group 2. Of 149 patients, 20 (13.4 %) were determined as group 1 (Çeviks classification) and 38 (25.5 %) were determined as group 2 (PLR <41). Of 11 deaths, 4 (36.4 %) patients were from group 1 and 7 (63.6 %) were from group 2. This is the first study to our knowledge to analyse the relationship between severity and PLR in patients with CCHF. PLR is a simple laboratory test that can aid in determining the prognosis of individuals with this disease.

The protective effect and diagnostic performance of NOX-5 in Crimean–Congo haemorrhagic fever patients

Introduction. Crimean‐Congo haemorrhagic fever (CCHF) is an acute viral haemorrhagic disease. Reactive oxygen species that are mainly generated by the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) enzyme family have a pivotal role in the pathophysiology of many diseases. The serum levels of NOX isoforms in patients with CCHF have yet to be assessed. Methods. This prospective study was conducted at Cumhuriyet University, Turkey. Only patients with CCHF confirmed by the National Reference Virology Laboratory were enrolled in the study. The study subjects comprised 67 CCHF patients and 70 healthy control subjects. The quantitative sandwich ELISA technique was used for the determination of serum NOX 1, 2, 4 and 5. Results. Higher median median NOX‐1 (P=0.001) and NOX‐5 (P<0.001) levels were found in patients compared to the control group. Higher median serum NOX‐5 levels were found in the low‐grade disease group compared to the intermediate‐high disease group according to two different severity scores (P=0.003). Negative correlations were also found between the serum NOX‐5 levels and the severity scores [(P<0.05, r=‐0.259), (P<0.01, r=‐0.417)]. The area under the curve (AUC) values for the NOX‐1 and NOX‐5 were 0.67 (confidence interval: 0.58‐0.75) and 0.99 (confidence interval: 0.95‐1.00), respectively. Lower NOX‐5 levels were found in patients receiving thrombocyte suspension (P=0.004) Conclusions. NOX‐5 may have a protective effect on CCHF patients and the measurement of serum NOX‐5 levels may be used as a novel biochemical test in the diagnosis of CCHF.

Evaluation of the associations between endothelial dysfunction, inflammation and coagulation in Crimean-Congo hemorrhagic fever patients

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne zoonotic viral disease. The aim of this study was to evaluate the association between inflammation, coagulation and endothelial dysfunction in CCHF. The study population consisted of 40 patients and 50 healthy controls. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), endocan, high sensitive C-reactive protein (hsCRP), international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelets values were determined in blood samples. Median hsCRP (p < 0.0001), ALT (p < 0.001), AST (p < 0.001) and aPTT (p < 0.001) values were found to be higher in CCHF patients than in the healthy control subjects. In contrast, median endocan (p = 0.0006) and platelet (p < 0.001) concentrations were found to be lower in CCHF patients than in healthy controls. Serum hsCRP concentrations positively correlated with PT, aPTT and INR in CCHF patients, whereas serum endocan levels were not correlated with hsCRP, PT, aPTT and INR. In conclusion, endothelial dysfunction is one of the key steps in CCHF disease development and serum endocan may be used as a biomarker to evaluate endothelial dysfunction in patients. There is no relationship between increased inflammation and endothelial dysfunction. Coagulation abnormalities might be related to the impaired hepatic synthetic function of coagulation factors. Increased hsCRP concentrations may have a compensatory role in restoring impaired hemostasis in CCHF. Further research is needed to confirm these findings and to examine possible explanations.

A Rare Seen Pathogen in Complicated Skin-Soft Tissue Infection: Pasteurella bettyae

Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey Department of Medical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey Corresponding author: Seyit Ali Büyüktuna, Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey E-mail: alibuyuktuna@gmail.com Received/Accepted: October 14, 2017 / November 06, 2017 Conflict of interest: There is not a conflict of interest.