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

Abstract Background The Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne virus infection that has been reported in about 30 countries worldwide. Clinical presentation is divided into three phases: pre-hemorrhagic, hemorrhagic, and convalescence. Ribavirin is standard of care treatment for acute infection and prophylaxis. However, the use of other treatments beyond ribavirin is largely unknown. Methods We conducted a systematic review using MOOSE protocol. The inclusion and exclusion criteria are seen in the Prisma diagram. For Bias Analysis we use a Robin-1 tool. Literature review algorithm Results We gathered a total of 10 studies, which included 4 therapeutic plasma exchange (TPE), 2 corticosteroids, 2 IVIG, and 1 with convalescent plasma (CP). TPE in one study showed decreased mortality rate and increased efficacy in patients with severe CCHF. While the other study reported pulmonary embolism related to the use of TPE. Nevertheless, the patients had good outcome in the end. Two case reports used TPE plus ribavirin and supportive measures. Both were discharged home and recovered without sequela. Corticosteroids were found to be beneficial in one study were the case fatality rate was lower with the addition of corticosteroids to ribavirin in severely ill patients (p=0.0014). In a case series of six patients, who received the combination in early stages of the disease had good clinical outcomes with improved survival. IVIG was shown to increase platelet counts in two studies. In the first study, platelet count increased above 150,000/mL in 8.5 +/- 2.5 days. While in the other study the normalization of platelets was seen in 4 - 4.8 days, with no significant difference (P = 0.49). In addition, there was a decrease in the duration of symptoms but there was no statistically significant difference in mortality rates (P = 0.171). CP treatment showed a survival rate of 86% in treated patients. CP was more useful in high-risk patients, defined as having a viral load of 108 copies/mL or more. The main limitations of the studies were the sample size and heterogenicity among the outcomes of the studies. Conclusion TPE, CP, IVIG, and corticosteroids were effective in improving the clinical outcomes of the patients. The use of these treatments beyond ribavirin should be explored in future studies. Disclosures All Authors: No reported disclosures

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Crimean‐Congo hemorrhagic fever‐induced liver injury: a systematic review and meta‐analysis

International Journal of Clinical Practice ◽

10.1111/ijcp.14775 ◽

2021 ◽

Author(s):

Sawai Singh Rathore ◽

Ade Harrison Manju ◽

Qingqing Wen ◽

Manush Sondhi ◽

Reshma Pydi ◽

...

Keyword(s):

Systematic Review ◽

Liver Injury ◽

Meta Analysis ◽

Hemorrhagic Fever ◽

Crimean Congo Hemorrhagic Fever

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Crimean-Congo hemorrhagic fever-induced liver injury: a systematic review and meta-analysis

10.22541/au.161962547.79756407/v1 ◽

2021 ◽

Author(s):

Sawai Singh Rathore ◽

Ade Harrison Manju ◽

Qingqing Wen ◽

Manush Sondhi ◽

Reshma Pydi ◽

...

Keyword(s):

Liver Injury ◽

Case Fatality Rate ◽

Meta Analysis ◽

Case Series ◽

Case Fatality ◽

Hemorrhagic Fever ◽

Fatality Rate ◽

High Case Fatality Rate ◽

Crimean Congo Hemorrhagic Fever ◽

Pooled Prevalence

Background: Crimean-Congo hemorrhagic fever (CCHF) is a fatal acute tick-borne viral infection and a substantial emerging global public health threat. This illness has a high case fatality rate of up to 40%. The liver is one of the important target organs of the CCHF virus. Objective: The aim of this meta-analysis to evaluate the correlation between CCHF and liver injury and draw more generalized inferences about the abnormal serum markers of liver injury such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) in CCHF patients. Methods: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible observational studies and case series were included from around the world. The inclusion criteria were articles describing liver injury biomarkers AST and ALT amongst patients diagnosed with CCHF. Results: Data from 18 studies, consisting of 1238 patients with CCHF were included in this meta-analysis. The overall pooled prevalence of at least one raised liver injury biomarker was 77.95% (95% CI, I2 = 88.50%, p < 0.0001). Similarly, pooled prevalence of elevated AST and ALT was 85.92% (95% CI, I2 = 85.27%, p < 0.0001) and 64.30% (95% CI, I2 = 88.32%, p < 0.0001) respectively. Both Egger and Begg-Mazumdar’s tests detected no apparent publication bias in all three meta-analyses(p > 0.05). Conclusion: These elevated liver injury biomarkers have been identified as significant prognostic factors. Hence, Physicians must recognize and continuously monitor these biomarkers, since these aid early stratification of prognosis and the prevention of severe outcomes in infection with such a high case fatality rate.

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Chromaffin-cell Tumors in Pregnancy: A Case Series and Systematic Review

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1240 ◽

2018 ◽

Vol 10 (3) ◽

pp. 163-169

Author(s):

Maximilien Rappaport ◽

Paul Skierczynski ◽

Lauren Dungy-Poythress ◽

Tara Benjamin ◽

Brian D Saunders ◽

...

Keyword(s):

Systematic Review ◽

Chromaffin Cell ◽

Case Series ◽

In Pregnancy

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New aspects about Crimean-Congo hemorrhagic fever (CCHF) cases and associated fatality trends: A global systematic review and meta-analysis

Comparative Immunology Microbiology and Infectious Diseases ◽

10.1016/j.cimid.2020.101429 ◽

2020 ◽

Vol 69 ◽

pp. 101429 ◽

Cited By ~ 5

Author(s):

Hassan Nasirian

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Hemorrhagic Fever ◽

Crimean Congo Hemorrhagic Fever

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Favorable Outcomes for both Mother and Baby Are Possible in Pregnant Women with Crimean-Congo Hemorrhagic Fever Disease: A Case Series and Literature Review

Gynecologic and Obstetric Investigation ◽

10.1159/000360699 ◽

2014 ◽

Vol 77 (4) ◽

pp. 266-271 ◽

Cited By ~ 3

Author(s):

Mustafa Gokhan Gozel ◽

Nazif Elaldi ◽

Aynur Engin ◽

Ozlem Bozoklu Akkar ◽

Fatih Bolat ◽

...

Keyword(s):

Literature Review ◽

Pregnant Women ◽

Case Series ◽

Hemorrhagic Fever ◽

Crimean Congo Hemorrhagic Fever

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Worldwide epidemiology of Crimean-Congo Hemorrhagic Fever Virus in humans, ticks and other animal species, a systematic review and meta-analysis

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009299 ◽

2021 ◽

Vol 15 (4) ◽

pp. e0009299

Author(s):

Jean Thierry Ebogo Belobo ◽

Sebastien Kenmoe ◽

Cyprien Kengne-Nde ◽

Cynthia Paola Demeni Emoh ◽

Arnol Bowo-Ngandji ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Animal Species ◽

Meta Analysis ◽

Random Effect ◽

Case Fatality ◽

Hemorrhagic Fever ◽

Fever Virus ◽

Crimean Congo Hemorrhagic Fever ◽

Hemorrhagic Fever Virus

There are uncertainties about the global epidemiological data of infections due to Crimean-Congo hemorrhagic fever virus (CCHFV). We estimated the global case fatality rate (CFR) of CCHFV infections and the prevalence of CCHFV in humans, ticks and other animal species. We also explored the socio-demographic and clinical factors that influence these parameters. In this systematic review with meta–analyses we searched publications from database inception to 03rd February 2020 in Pubmed, Scopus, and Global Index Medicus. Studies included in this review provided cross-sectional data on the CFR and/or prevalence of one or more targets used for the detection of CCHFV. Two independent investigators selected studies to be included. Data extraction and risk of bias assessment were conducted independently by all authors. Data collected were analysed using a random effect meta-analysis. In all, 2345 records were found and a total of 312 articles (802 prevalence and/or CFR data) that met the inclusion criteria were retained. The overall CFR was 11.7% (95% CI = 9.1–14.5), 8.0% (95% CI = 1.0–18.9), and 4.7% (95% CI = 0.0–37.6) in humans with acute, recent, and past CCHFV infections respectively. The overall CCHFV acute infections prevalence was 22.5% (95% CI = 15.7–30.1) in humans, 2.1% (95% CI = 1.3–2.9) in ticks, and 4.5% (95% CI = 1.9–7.9) in other animal species. The overall CCHFV recent infections seroprevalence was 11.6% (95% CI = 7.9–16.4) in humans and 0.4% (95% CI = 0.0–2.9) in other animal species. The overall CCHFV past infections seroprevalence was 4.3% (95% CI = 3.3–5.4) in humans and 12.0% (95% CI = 9.9–14.3) in other animal species. CFR was higher in low-income countries, countries in the WHO African, South-East Asia and Eastern Mediterranean regions, in adult and ambulatory patients. CCHFV detection rate in humans were higher in CCHFV suspected cases, healthcare workers, adult and hospitalized patients, ticks of the genus Ornithodoros and Amblyomma and in animals of the orders Perissodactyla and Bucerotiformes. This review highlights a significant disease burden due to CCHFV with a strong disparity according to country income levels, geographic regions, various human categories and tick and other animal species. Preventive measures in the light of these findings are expected.

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Tatalaksana demam berdarah dengue dalam kehamilan: A case series

Jurnal Kedokteran Syiah Kuala ◽

10.24815/jks.v20i3.18759 ◽

2020 ◽

Vol 20 (3) ◽

Author(s):

Cut Meurah Yeni ◽

Dara Meutia Ayu

Keyword(s):

Mortality Rate ◽

Caesarean Section ◽

Aedes Aegypti ◽

Dengue Hemorrhagic Fever ◽

High Mortality ◽

Case Series ◽

Hemorrhagic Fever ◽

Mortality Rates ◽

Viral Diseases ◽

In Pregnancy

Abstrack. Demam berdarah dengue (DBD) adalah infeksi virus ditemukan pada negara-negara tropistermasuk Indonesia. Indonesia termasuk dalam katagori A dalam perkembangan penyakit virus tersebut yang mengindikasikan tingginya angka kematian. Angka insiden terus meningkat pada anak maupun dewasa dengan tingginya angka mortalitas. Tidak ada pencatatan lengkap untuk angka insidensi pada kehamilan, meskipun mortalitas cukup tinggi. Kami melaporkan empat kasus kehamilan dengan penyakit yang disebabkan oleh vektor Aedes aegypti. Pada keempat kasus tersebut kami telah diagnosis berdasarkan kriteria demam yang khas, trombositopenia, hemokonsentrasi dan pemeriksaan serologi. Terdapat penatalaksanaan yang berbeda dari berbagai kasus tersebut termasuk indikasi terminasi. Satu pasien kami rawat konservatif dan tiga pasien dilakukan terminasi berdasarkan indikasi obstetri. Pertimbangan cara terminasi sangat bergantung pula dengan indikasi obstetri. Seksio sesarea tidak secara mutlak dilakukan pada kehamilan dengan demam berdarah dengue. Kata kunci: Demam berdarah dengue, kehamilan, penatalaksanaan Abstract. Dengue hemorrhagic fever (DHF) is a viral infection found in tropical countries including Indonesia. Indonesia is included in category A in the development of viral diseases that's the high mortality rate. The numbers keep increasing on both adult children with high mortality rates. No complete logging for the incidence rate in pregnancy, although mortality is quite high. We reported four cases pregnancy with diseases caused by the Aedes aegypti vector. In four cases We had diagnosed based on criteria that met the specific criteria, thrombocytopenia, hemoconcentration and serology. There are different treatments for these cases includes the term indication. One patient was treated conservatively and three patients were admitted termination based on obstetric indications. The consideration on how to terminate is also very dependent with obstetric indications. Caesarean section is not absolutely necessary in pregnancy with dengue hemorrhagic fever. Keywords: Dengue hemorrhagic fever, pregnancy, management

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