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    Crimean-Congo hemorrhagic fever disease due to tick bite with very long incubation periods
    (ELSEVIER SCI LTD, 2011) Kaya, Ali; Engin, Aynur; Guven, Ahmet Sami; Icagasioglu, Fusun Dilara; Cevit, Omer; Elaldi, Nazif; Gulturk, Abdulaziz
    Background: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate, and is one of the viral hemorrhagic fever syndromes. The average mortality rate of CCHF is 3-30%. Research indicates that the longest incubation period after a tick bite is 12 days in CCHF disease. However, in clinical practice, we encounter patients with CCHF as a result of tick bites with much longer incubation periods (max. 53 days) than those reported in the literature. We present herein CCHF cases presumably infected through tick bites and having incubation periods longer than the upper limit reported in the literature. Methods: We analyzed the cases of the 825 CCHF patients admitted to our hospital from 2007 to 2010 and found that 312 of them had undoubtedly been bitten by a tick. We searched the patient records for information on the incubation period and found that 12 patients had experienced an incubation period of over 12 days, which is the longest incubation period stated in the literature for patients definitely bitten by a tick. Results: A total of 12 patients (eight males and four females, with a mean age of 45 years) were recruited into this study. Five (41.7%) of the 12 patients had positive CCHF virus-specific IgM antibodies, three (25%) had a positive reverse transcription polymerase chain reaction test for CCHF virus, and four (33.3%) had positive results in both tests during the acute and/or convalescent phase of the disease. In these cases, the interval between tick bite and the onset of symptoms was a mean of 23.6 days (range 13-53 days). Conclusion: Physicians serving in endemic regions should be aware of these longer incubation periods after a tick bite. It is suggested that they perform more follow-ups on clinically and serologically highly suspected patients than they currently do. (C) 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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    Peripheral facial paralysis in a child with Crimean-Congo hemorrhagic fever
    (Elsevier Ireland Ltd, 2011) Kaya, Ali; Uysal, Ismail Onder; Filiz, Canan; Uysal, Elif Bilge; Gulturk, Abdulaziz
    A patient with Crimean-Congo hemorrhagic fever (CCHF), a tick-borne zoonotic disease caused by the Nairovirus is presented in this paper, as an unusual cause of unilateral peripheric facial paralysis. He was 10 years old and admitted to hospital with a 1-day history of fever, frontal headache, fatigue, nausea, vomiting, malaise, arthralgia and myalgia. Real-time PCR confirmed the diagnosis of CCHF. Facial paralysis (grade IV based on the House-Brackman classification) was developed on fifth day of hospitalization. A tick occluding the external auditory canal was seen during the otological examination. The right tympanic membrane was perforated at the postero-inferior quadrant. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
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    Treatment failure of gentamicin in pediatric patients with oropharyngeal tularemia
    (INT SCIENTIFIC LITERATURE, INC, 2011) Kaya, Ali; Uysal, Ismail Onder; Guven, Ahmet Sami; Engin, Aynur; Gulturk, Abdulaziz; Icagasioglu, Fusun Dilara; Cevit, Omer
    Background: Tularemia is a zoonotic infection, and the causative agent is Francisella tularensis. A first-line therapy for treating tularemia is aminoglycosides (streptomycin or, more commonly, gentamicin), and treatment duration is typically 7 to 10 days, with longer courses for more severe cases. Material/Methods: We evaluated 11 patients retrospectively. Failure of the therapy was defined by persistent or recurrent fever, increased size or appearance of new lymphadenopathies and persistence of the constitutional syndrome with elevation of the levels of the proteins associated with the acute phase of infection. Results: We observed fluctuating size of lymph nodes of 4 patients who were on the 7(th) day of empirical therapy. The therapy was switched to streptomycin alone and continued for 14 days. The other 7 patients, who had no complications, were on cefazolin and gentamycin therapy until the serologic diagnosis. Then we evaluated them again and observed that none of their lymph nodes regressed. We also switched their therapy to 14 days of streptomycin. After the 14 days on streptomycin therapy, we observed all the lymph nodes had recovered or regressed. During a follow-up 3 weeks later, we observed that all their lymph nodes had regressed to the clinically non-significant dimensions (< 1 cm). Conclusions: All patients were first treated with gentamicin, but were than given streptomycin after failure of gentamicin. This treatment was successful in all patients. The results of our study suggest that streptomycin is an effective choice of first-line treatment for pediatric oropharyngeal tularemia patients.