简介克里米亚-刚果出血热(CCHF)是一种广泛的蜱传播的人畜共患疾病。CCHF的零星爆发发生在流行地区,包括巴基斯坦。该疾病的临床范围从无症状的血清转换到可能以死亡告终的严重疾病。治疗是支持性的,包括血液和血液制品。CCHF有多器官受累,包括急性肝炎,血小板减少症,凝血病,急性肾损伤(AKI),和脑病。血液学和生化参数可能会识别出预后较差的患者。早期发现疾病并预测临床病程可能会有所帮助。本病例系列旨在评估CCHF幸存者和非幸存者中血液学和生化参数的趋势。方法对Hayatabad综合医疗中心隔离病房连续收治的16岁及以上患者,白沙瓦,巴基斯坦在2022年7月1日至7月30日期间诊断为CCHF被纳入该病例系列。CCHF的诊断是通过聚合酶链反应检测病毒核糖核酸来进行的。对于所有患者来说,年龄,性别,地址,职业,临床表现,与动物接触的历史,并记录了旅行史。所有的生命体征都是定期进行的。血液学(全血细胞计数)和生化参数(血清肌酐,丙氨酸氨基转移酶(ALT),每天记录C反应蛋白(CRP)。确定所有病例的血型。结果17例中,大多数(16例,94.1%)是男性和屠夫(8例,47.1%)按职业划分。所有病例均与动物有明显接触。4例患者(23.5%)死亡。四个非幸存者中的三个(75%)的ALT<正常上限的5倍,肝酶呈静态模式,直到死亡为止,ALT没有明显下降。一名非幸存者(25%)在就诊时ALT明显升高,一直有下降的趋势,直到死亡。13名幸存者中有7名(53.8%)在出现时ALT水平中度至明显升高。所有这些患者的ALT在病程中均呈下降趋势。其余幸存者(13人中有6人,46.2%)的ALT轻度升高,其中50%在住院期间显示ALT水平改善。所有患者在就诊时都有血小板减少症。没有一个非幸存者显示血小板计数持续增加,3例死亡时仍有严重的血小板减少症。然而,所有幸存者的血小板计数有增加的趋势.大多数患者的CRP水平(四分之三,75%)的非幸存者一直升高到死亡,而所有幸存者显示CRP水平进行性下降。大多数(17例中的11例)具有B血型。一半的非幸存者(4例中的2例)和大多数幸存者(13例中的9例)具有B血型。而所有幸存者在整个过程中肾功能正常。结论ALT和CRP水平持续升高,持续低或减少的血小板计数,AKI与死亡率相关。血型B是CCHF患者中最常见的血型,这不能反映该病例系列报道的普通人群的血型分布。
Introduction Crimean-Congo hemorrhagic fever (CCHF) is a widespread tick-borne zoonotic disease. Sporadic outbreaks of CCHF occur in endemic regions, including Pakistan. The clinical spectrum of the illness varies from asymptomatic seroconversion to severe disease which may end in death. The treatment is supportive, including blood and blood products. There is multi-organ involvement in CCHF including acute hepatitis, thrombocytopenia, coagulopathy, acute kidney injury (AKI), and encephalopathy. Hematological and biochemical parameters may identify patients at substantial risk of worse outcomes. Early detection of the disease and forecasting the clinical course may be helpful. This
case series aims to evaluate the trends of hematological and biochemical parameters among the survivors and non-survivors of CCHF. Methods All consecutive patients aged 16 years and above admitted to the isolation unit of Hayatabad Medical Complex, Peshawar, Pakistan between 1st July and 30th July 2022 with the diagnosis of CCHF were included in this
case series. The diagnosis of CCHF was made by detecting viral ribonucleic acid by a polymerase chain reaction. For all patients, age, gender, address, occupation, clinical presentation, history of contact with animals, and travel history were recorded. All the vitals were taken regularly. The hematological (complete blood count) and biochemical parameters (serum creatinine, alanine aminotransferase (ALT), and C-reactive protein (CRP)) were documented daily. The blood group was determined for all the cases. Results Out of 17 cases, the majority (16 cases, 94.1%) were male and butchers (eight cases, 47.1%) by profession. All cases had significant contact with animals. Four patients (23.5%) died. Three out of the four non-survivors (75%) had ALT < 5 times the upper limit of normal with a static pattern of liver enzymes without much decline in ALT till death. One non-survivor (25%) had marked elevation of ALT at presentation, which had a declining trend till death. Seven out of 13 survivors (53.8%) had moderate to marked elevation in the level of ALT at presentation. The ALT showed a downward trend during the course of illness in all these patients. The remaining survivors (six out of 13, 46.2%) had a mild elevation of ALT and 50% of them showed improvement in the ALT level during hospitalization. All patients had thrombocytopenia at presentation. None of the non-survivors showed a persistent increase in the platelet count, and three cases remained severely thrombocytopenic at the time of death. However, the trend in platelet count among all the survivors was increasing. The CRP level in the majority (three out of four cases, 75%) of the non-survivors remained elevated till death, while all survivors showed a progressive decline in CRP level. A majority (11 out of 17 cases) had blood group B. Half of the non-survivors (two out of four cases) and the majority of the survivors (nine out of 13 cases) had blood group B. AKI was found in all non-survivors, while all the survivors had normal renal function throughout the course. Conclusion A persistently raised ALT and CRP level, a persistently low or decreasing platelet count, and AKI were associated with mortality. Blood group B was the commonest blood group among patients of CCHF, which is not reflective of the blood group distribution of the general population from which this
case series has been reported.