Thursday, June 8, 2023
| Characteristic | Patient no. and source | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 (10) | 2 (10) | 3 (12) | 4 (13) | 5 | 6 | 7 | 8 (11) | 9 | 10 | |
| Age, y | 62 | 50 | 74 | 53 | 70 | 54 | 69 | 32 | 59 | 30 |
| Sex | M | F | M | M | M | M | M | F | M | F |
| Rural location | No | No | No | Yes | Yes | Yes | Yes | No | Yes | No |
| Date | 2016 Aug | 2016 Aug | 2018 Jul | 2018 Aug | 2020 Jun | 2020 Jul | 2020 Aug | 2013 May | 2021 Apr | 2021 Jun |
| Risk factors† | Leisure | Nurse | Hunting | Ag | Ag | Ag | Leisure | Leisure | Ag | Leisure |
| Comorbidities | HTN, OSA | None | None | Hepatic steatosis, active drinker | Tongue cancer | TB, |
HTN | None | Diabetes mellitus, dyslipemia | Diabetes mellitus |
| Bakir scale at admission | 7 | 0 | 7 | 6 | 6 | 4 | 8 | 5 | 2 | 5 |
| Outcome | Died | Good | Died | Good | Good | Good | Died | Good | Good | Good |
Table 1. Main epidemiologic data of patients with Crimean-Congo hemorrhagic fever, Spain, 2013–2021*
*Source is indicated if other than this study. Ag, agriculture; HTN, hypertension; OSA, obstructive sleep apnea. †Risk factors include high-risk occupations; agriculture includes shepherding activities.
| Characteristic | Patient no. and source | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 (10) | 2 (10) | 3 (12) | 4 (13) | 5 | 6 | 7 | 8 (11) | 9 | 10 | |
| Main clinical data | ||||||||||
| Tick bite | Y | N | Y | N | Y | Y | Y | Y | Y | Y |
| First symptom | Fever | Fever | Fever | Fever | Fever | Fever | Fever | Fever | Fever | Fever |
| Fever duration, d | 4 | 5 | 6 | 6 | 9 | 5 | 4 | 4 | 4 | 5 |
| Days from first symptom to admission | 3 | 2 | 4 | 5 | 9 | 7 | 3 | 2 | 4 | 12 |
| Digestive symptoms | Y | Y | Y | N | Y | N | Y | Y | Y | Y |
| Any bleeding | Y | Y | Y | N | Y | N | Y | Y | N | Y |
| Laboratory data† | ||||||||||
| Hemoglobin, g/dL | 13.4 | 13.9 | 13.5 | 14.1 | 14.6 | 15.5 | 13.4 | 14.4 | 17 | 17 |
| Leukocytes, × 103 cells/mm3 | 13.9 | 6.2 | 10.7 | 3.1 | 2.4 | 2.3 | 5.5 | 1.5 | 2.8 | 11.1 |
| Neutrophils, % | 85.5 | 83 | 90 | 62 | 33 | 66.4 | 69 | 63 | 68.5 | 90 |
| Lymphocytes, % | 7.9 | 10.2 | 5 | 27 | 38 | 26.1 | 25 | 31 | 24.4 | 4 |
| Platelets, × 103/mm3 | 30 | 174 | 229 | 41 | 44 | 32 | 7 | 44 | 76 | 159 |
| Glucose, mg/d | 80 | 102 | 83 | 135 | 110 | 134 | 280 | 106 | 116 | 491 |
| Creatinine, mg/dL | 1.69 | 1.24 | 0.83 | 1.33 | 0.92 | 0.75 | 4.8 | 0.67 | 0.85 | 1.1 |
| CRP, mg/L | 87.6 | 2.9 | ND | 15.2 | 0.3 | 0.65 | 3.72 | 0.6 | 0.55 | 52 |
| AST, U/L | 203 | 24 | 20 | 347 | 273 | 273 | 1,305 | 494 | 107 | 72 |
| ALT, U/L | 88 | 37 | 9 | 161 | 281 | 135 | 347 | 171 | 141 | 70 |
| Ferritin, ng/mL | ND | ND | >40,000‡ | 15,718 | 34,044 | 28,393 | 60,000 | ND | 7,878 | 1,147 |
| Bilirubin, mg/dL | 0.9 | 0.5 | 0.5 | 0.7 | 0.43 | 0.35 | 1.4 | 0.29 | 0.58 | ND |
| GGT, U/L | ND | ND | ND | 425 | 272 | 132 | 1,420 | 77 | 136 | ND |
| ALP, U/L | ND | ND | ND | 103 | 84 | 59 | 239 | 58 | 72 | 91 |
| LDH, U/L | ND | ND | 172 | 721 | 358 | 589 | 2,311 | 1,085 | 341 | 272 |
| Triglycerides, mg/dL | ND | ND | ND | ND | ND | 407‡ | ND | ND | 164‡ | ND |
| Prothrombin time, s | 18.1 | 15.6 | 10.7 | 10.2 | 10 | 12 | 13 | 12 | 11 | ND |
| Prothrombin activity, % | 52.8 | 62 | 104 | 106 | 123 | 99 | 86 | 81 | 102 | 84 |
| Partial thromboplastin time, s | 18.1 | 48.7 | 26.2 | 43.8 | 30.2 | 52.7 | 61.4 | 128 | ND | 29 |
| Functional fibrinogen, mg/dL | ND | 265.9 | 320 | 605 | 281 | 304 | 156 | 141 | 272 | 325 |
| D-dimer, ng/mL | ND | 35,200 | ND | ND | ND | 1.3 | 5.5 | 3.48 | ND | ND |
| Genotype | III | III | IV | V | III | III | III | ND | V | ND |
| Treatment | DOX; support | DOX; Ribavirin ev/orally for 9 d | DOX; support | DOX | DOX; ribavirin orally for 10 d§ | DOX; ribavirin orally for 10 d§ | DOX support | DOX; support | DOX | DOX; support |
| Length of stay, d | 9 | 23 | 8 | 6 | 22 | 9 | 2 | 17 | 9 | 8 |
Table 2. Main clinical and laboratory data of patients with Crimean-Congo hemorrhagic fever, Spain, 2013–2021*
*Source is indicated if other than this study. ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; DOX, doxycycline; GGT, gamma-glutamyl transferase; LDH, lactate dehydrogenase; ND, no data. †Analysis upon admission or during the first 24 hours. ‡Analysis performed during hospital admission. §In accordance with World Health Organization guidelines.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 1.00 ABIM MOC points
This activity is intended for infectious disease specialists and other clinicians who take care of patients who may develop Crimean-Congo hemorrhagic fever.
The goal of this activity is for learners to be better able to evaluate the clinical presentation and common genotypes of Crimean-Congo hemorrhagic fever.
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CME / ABIM MOC Released: 1/23/2023
Valid for credit through: 1/23/2024
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