SEROPREVALENCE OF RICKETTSIOSIS IN PATIENTS WITH CRIMEAN -CONGO HEMORRHAGIC FEVER PRELIMINARY DIAGNOSIS IN THE CASE OF CORUM PROVINCE TURKEY

Abstract

People engaged in agriculture and animal husbandry living in endemic areas are at high risk of tick-transmitted infectious diseases. Both Crimean-Congo Hemorrhagic Fever (CCHF) and rickettsial diseases can be transmitted as a result of tick bites. We aimed to evaluate the patients preliminarily diagnosed with CCHF at our clinic in terms of CCHF and rickettsia seropositivity, epidemiologic features and to compare ELISA and IFAT for serodiagnosis of rickettsiosis. Between 2014-2017, 265 patients who were followed up with a preliminary CCHF diagnosis at the Infectious Diseases and Clinical Microbiology Department of Hitit University Comm Erol Olcok Training and Research Hospital, were included in this study. Rickettsia was analyzed by ELISA IgG and 1gM (Vircell, Rickettsia conorii ELISA IgG+IgM, Spain), IFA (Vircell, Rickettsia conorii IFA IgG, Granada, Spain) and also by in house-PCR. According to the laboratory results for CCHF and Rickettsia patients were divided into two groups: (i) CCHF positive (+), (ii) Rickettsia seropositive (Rickettsia+; ELISA/IFA IgM and/or IgG positive). Of the 265 patients, 179 (67.55%) were male, and the average age was 49.04 (age range 18-90) years. In our study, CCHF virus positivity was 51.3%, while Rickettsia IgG+IgM positivity was 24.9%. In the diagnosis of rickettsiosis IFA and ELISA showed 99.62% agreement, but no PCR positivity was found. In total, CCHF+(n=136), CCHF-(n=129), Rickettsia+(n=66), cases were evaluated. In total, 123 (90.44%) of the patients who were positive for CCHF and 55 (84.62%) of patients seropositive for Rickettsia had applied to the hospital from rural areas (p>0.05). In both group, most of the cases have tick bite history (77.2% in CCHF+ group and 59.1% in Rickettsia+ group). In the group in which both agents were found to be negative, this rate decreased to 38.2% (p 0.98). Rickettsia was found to be seropositive in 39 (28.7%) of the 136 patients with CCHF positivity. Rickettsia was seropositive in 27 (20.9%) of the 129 patients with CCHF negativity. Except one case with positive Rickettsia IgM, other 65 cases with IgG positive were not considered as acute rickettsiosis. The fact that we live in an area where CCHF and rickettsial diseases are endemic requires us to keep these diseases in mind constantly. Although IFAT is considered as the reference test for serological diagnosis of rickettsiosis, ELISA could be an alternative. Rickettsial disease, a deadly but treatable disease, should be especially considered in patients who apply with a history of acute fever in endemic areas.