Crimean–Congo haemorrhagic fever among children in north-eastern Turkey E. DILBER, M. CAKIR, E. A. ACAR, F. ORHAN, N. YARIS, E. BAHAT, A. OKTEN & E. ERDURAN Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey (Accepted December 2008) Abstract Aim: To analyse the epidemiological and clinical features of children with Crimean–Congo haemorrhagic fever (CCHF) in north-eastern Turkey. Methods: A retrospective study of demographic features and physical and laboratory findings in 21 children with CCHF is described. Clinical course, treatment modalities and outcome were analysed. Results: Most patients were admitted in June and July 2008; most were from the Gumushane and Kelkit valleys and half of them lived in rural areas. Mean (SD) age was 10.3 (3.9) years and the disease was more common in males (71.4%). Approximately 70% had a history of tick bite. The main symptoms were fever (17, 80.9%), nausea (11, 52.3%), malaise (10, 47.6%) and headache (7, 33.3%). At initial examination, approximately 70% of patients had leukopenia and 65% had thrombocytopenia. Anaemia developed during follow-up in six patients. Liver involvement was seen in 12 patients and one patient had acute tubular necrosis. Six patients had haemophagocytosis. Patients were hospitalised for a median 8 days (range 3–22) and nine patients had bleeding from various sites approximately 3–5 days after hospitalisation. Subcutaneous haematoma (6), especially epistaxis and at venepuncture sites (6) were the most common sites of bleeding. Pulmonary haemorrhage developed in two patients and they required ventilatory support. Overall mortality related to CCHF was 4.7% (one patient). Conclusion: Early diagnosis of CCHF and early referral to specialised centres are important for outcome. Exceptional epidemics may be seen in future owing to ecological and environmental changes. Introduction Crimean–Congo haemorrhagic fever (CCHF) is a tick-borne disease caused by a Nairovirus of the family Bunyaviridae. It is transmitted by Hyalomma ticks, by direct contact with infected human tissue or blood or tissue from viraemic livestock. The disease affects the multi-organ systems and the clinical features usually include a rapid progression characterised by haemorrhage, fever, myalgia and liver dysfunction. 1 Serological evidence of CCHF was detected in the Congo in 1969 and in recent years outbreaks of clinical CCHF have been reported increasingly in many countries. 2 The first cases of CCHF in Turkey were detected in 2002 and there have been outbreaks in subsequent years. 2 Genetic analysis of the virus isolated in those patients demonstrated that it is closely related to Kosovan and Russian strains. 2 Between 2002 and the end of June 2008, a total of 2508 confirmed cases, including 133 deaths (5.3%), were reported by the Ministry of Health, Turkey, with the trend increasing each year. 3 The majority of cases were in the transition zone between the Central Anatolian plateau and the Reprint requests to: Dr Murat Cakir, Department of Pediatrics, Karadeniz Technical University, Trabzon, Turkey. Email: muratcak@hotmail.com Annals of Tropical Paediatrics (2009) 29, 23–28 # The Liverpool School of Tropical Medicine 2009 DOI: 10.1179/146532809X401999