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Crimean-Congo hemorrhagic fever: does it involve the heart?
Aynur Engin1, Mehmet Birhan Yilmaz, Nazif Elaldi
1Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University, School of Medicine, 58140 Sivas, Turkey. aynurum2000@yahoo.com
Insights
Severe Crimean-Congo hemorrhagic fever (CCHF) cases exhibit impaired cardiac function, including reduced ejection fraction and increased pulmonary artery pressure. These cardiac complications are associated with fatality in CCHF patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Virology
Background:
- Crimean-Congo hemorrhagic fever (CCHF) is a severe viral illness with a high mortality rate.
- The pathogenesis and causes of death in CCHF remain incompletely understood.
- Cardiac involvement in CCHF is not well-characterized.
Purpose of the Study:
- To evaluate cardiac functions in patients diagnosed with CCHF.
- To identify potential cardiac markers associated with CCHF severity and mortality.
Main Methods:
- Prospective study of confirmed CCHF cases in Turkey (2007).
- Cardiologic evaluation and transthoracic echocardiography within 24 hours of hospitalization.
- Classification of patients into 'severe' and 'non-severe' CCHF groups.
Main Results:
- 44 confirmed CCHF cases; 17 (38.6%) were severe.
- Severe CCHF cases showed lower left ventricular ejection fraction, higher systolic pulmonary artery pressure, and more pericardial effusion.
- Fatal cases had significantly impaired cardiac function compared to survivors.
Conclusions:
- Impaired cardiac function is associated with severe and fatal outcomes in CCHF.
- Potential mechanisms include direct viral invasion or endothelial damage to cardiac structures.
- Clinicians should consider cardiac complications in CCHF management.
Objective:
Crimean-Congo hemorrhagic fever (CCHF) is an acute viral hemorrhagic fever with a high mortality rate. Despite increasing knowledge about viral hemorrhagic fevers, the pathogenesis of CCHF and causes of death have not been well described. In this study, we aimed to evaluate the cardiac functions of CCHF patients.
Methods:
This prospective study was performed among confirmed CCHF cases in Turkey in 2007. All the patients underwent a thorough cardiologic evaluation and transthoracic echocardiography examination within 24hours of hospitalization. In addition, the patients were classified into two groups - 'severe' CCHF and 'non-severe' CCHF. Demographic characteristics, findings of echocardiography, and outcomes were recorded for each patient.
Results:
Among 52 consecutive patients with a tentative diagnosis of CCHF, 44 were confirmed as having CCHF. Seventeen (38.6%) patients were classified as severe, whereas the remaining 27 (61.4%) patients were classified as non-severe. Five of 17 severe CCHF patients died. Severe cases had a lower left ventricular ejection fraction (p=0.04), a higher systolic pulmonary artery pressure (p=0.02), and more frequent pericardial effusion (p<0.001) compared to non-severe cases. Fatal CCHF cases also had a lower left ventricular ejection fraction (p=0.03), a higher systolic pulmonary artery pressure (p=0.03), and more frequent pericardial effusion (p=0.01) compared to survivors.
Conclusions:
The results of this study indicate that severe and fatal CCHF cases have impaired cardiac functions, which may be associated with fatality in CCHF infection. Direct invasion of the heart muscles by the virus or endothelial damage of cardiac structures may have a role in this. Molecular testing methods would be useful in order to investigate direct invasion by the CCHF virus. Clinicians should be aware of this complication.
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