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. 2004 Aug;10(8):1379-84.
doi: 10.3201/eid1008.030928.

Crimean-Congo hemorrhagic fever in Turkey

Affiliations

Crimean-Congo hemorrhagic fever in Turkey

S Sami Karti et al. Emerg Infect Dis. 2004 Aug.

Abstract

In 2002 and 2003, a total of 19 persons in Turkey had suspected cases of Crimean-Congo hemorrhagic fever (CCHF) or a similar viral infection. Six serum samples were tested; all six were found positive for immunoglobulin M antibodies against CCHF virus. Two of the samples yielded CCHF virus isolates. Genetic analysis of the virus isolates showed them to be closely related to isolates from former Yugoslavia and southwestern Russia. These cases are the first of CCHF reported from Turkey. Eighteen patients handled livestock, and one was a nurse with probable nosocomial infection. The case-fatality rate was 20% among confirmed CCHF case-patients (1 of 5 patients), and the overall case-fatality rate was 11% (2 of 19 patients). In addition to previously reported symptoms and signs, we report hemophagocytosis in 50% of our patients, which is the first report of this clinical phenomenon associated with CCHF.

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Figures

Figure 1
Figure 1
Phylogenetic analysis of Crimean-Congo hemorrhagic fever virus (CCHFV) genetic difference. Maximum parsimony analysis of the aligned sequences of a 488-nt region of CCHFV S segments and the equivalent genome region of Dugbe and Nairobi sheep disease viruses. Analysis was performed with the heuristic search method with stepwise addition, tree bisection-reconnection branch swapping, and transversions; transitions were weighted 4:1. The graphic representation of the results was outgroup rooted by using the Dugbe (GenBank accession no. AF434161, AF434162, AF434163, AF014014, AF434164, AF014015, AF434165) and Nairobi sheep disease virus (AF504293) S segment nucleotide sequences. The node attaching the outgroup to the CCHFV tree topology is shown by the arrow at the base of the tree. Horizontal distances within the CCHFV part of the tree are proportional to nucleotide steps (see scale bar), separating virus taxa and nodes. Vertical and diagonal lines are for visual clarity. Each virus sequence is indicated by the corresponding GenBank accession number. The two CCHFV sequences are in bold.
Figure 2
Figure 2
Geographic distribution of patients with Crimean-Congo hemorrhagic fever (CCHF), Turkey, 2002–2003. Residency of the patients with CCHF infection from our series is marked in the circle. Epicenter of a concurrent outbreak presented at the recent conference in Ankara is shown as a rectangle.
Figure 3
Figure 3
Bone marrow aspiration smear, stained with Wright, showing hemophagocytosis. A) phagocytosis of an erythrocyte and nuclear remnants by a microphange. B) phagocytosis of platelets by a macrophage.

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