Volume 21, Number 1—January 2015
Health Care Response to CCHF in US Soldier and Nosocomial Transmission to Health Care Providers, Germany, 2009
|Treatment/test or procedure||Day after symptom onset, date
|Day 6, Sep 11||Day 7, Sep 12||Day 8, Sep 13||Day 9, Sep 14||Day 10, Sep 15||Day 11, Sep 16|
|RT-PCR, RNA copies/mL‡||1.2 × 109||ND||6 × 109||ND||3 × 108||ND||NA|
|Leukocyte count, × 103/μL||9.6||8.8||4.9||4.0||3.4||3.5||3.5–10.5|
|Platelets, × 103/μL||14,000||68,000||62,000||93,000||126,000||77,000||151–356|
|Alkaline phos, UL||186||123||163||202||254||354||38–126|
|Prothrombin time, s||21.8||22.4||22.3||14.9||19.7||24||11.9–15.1|
|X-ray/CT, chest||ND||Moderate to severe pulmonary edema and atelectesis||ND||ND||ND||ND||NA|
|CT, abdomen||ND||Ascites, gallbladder edema||ND||ND||ND||ND||NA|
|10, pg/mL ††||515||ND||1,498||ND||904||ND||<7|
|6, pg/mL ††||1,530||ND||>3,023||ND||2,439||ND||<15|
|IFN-γ, pg/mL ††||59||ND||390||ND||125||ND||<15|
|TNF-α, pg/mL ††||77||ND||56||ND||100||ND||<15|
|PLGF, pg/mL ††||203||ND||64||ND||81||ND||<25|
|sVEGF-R1, pg/mL ††||2,930||ND||13,903||ND||13,308||ND||<180|
*aPTT, activated partial thromboplastin time; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; CCHF, Crimean–Congo hemorrhagic fever; CPK, creatine phosphokinase; CT, computerized tomography; hep, hepatic; IFN-γ, interferon γ; IV, intravenously; LDH, lactate dehydrogenase; NA, not applicable; ND, not determined; phos, phosphatase; PLGF, placental growth factor; RT-PCR, reverse transcription PCR; sVEGF-R1, soluble vascular endothelial growth factor receptor 1; TNF-α, tumor necrosis factor α; −, negative; +, positive.
†On day 6, an initial 4-g loading dose (LD) of oral ribavirin was administered via nasogastric tube, followed by 1,200 mg 6 h later. On day 7, a partial LD of 22 mg/kg was administered IV (because of 60% bioavailability of oral ribavirin and poor absorption with gastrointestinal bleeding) followed by 16-mg/kg doses every 6 h (per dose-reduction protocol). Beginning day 9, 14 mg/kg was administered every 6 h, with an extension of the dosing interval to every 8 h on day 10 because of severe renal failure (only a minimal amount of drug is removed through dialysis) (3).
‡Real-time RT-PCR for virus quantification and Nairovirus spp.–specific gel-based RT-PCR coupled with PCR product sequencing to confirm the diagnosis (6,7).
§CCHF culture of blood and urine (virus was isolated on Vero cells and sequenced) (8).
¶CCHF-specific IgM/IgG by indirect immunofluorescence assay using CCHF virus–infected cells; assay performed at Bernard Nocht Institute, Hamburg, Germany.
#Culture of blood, urine, and sputum samples.
**Malaria smear and culture results were not specifically obtained on day 6; multiple cultures were performed.
††Testing for cytokines and vascular endothelial growth factors and their soluble receptors of blood were performed in the Biosafety Level 4 facility of Bernard Nocht Institute by using Quantikine Immunoassays (R&D Systems Europe, Abingdon, UK), according to the manufacturer’s instructions.
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1Preliminary results from this study were presented at the Annual Meeting of the Armed Forces Infectious Disease Society; May 23, 2010, San Antonio, Texas, USA; NATO Biomedical Advisory; May 27, 2010, Munich, Germany; and Asian Pacific Military Medicine Conference, May 3, 2011, Sydney, New South Wales, Australia.