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Fatal Case (fatal + case)
Selected AbstractsA Fatal Case of Suspected Anaphylaxis with Cefoperazone and Sulbactam: LC-MS AnalysisJOURNAL OF FORENSIC SCIENCES, Issue 1 2008Kenji Tsujikawa M.S. Abstract: Cefoperazone and sublactam are prescribed in combination and used in the treatment of moderate to severe bacterial infections. Serious anaphylaxis is a rare side effect. This report describes a fatal case of suspected anaphylaxis after intravenous administration of a combination of the two drugs. Heart blood was analyzed for cefoperazone by protein precipitation with acetonitrile and by liquid-liquid precipitation for sublactam after protein precipitation with aqueous acetonitrile, followed by tandem mass spectrometry in the product ion scan mode for identification and by liquid chromatography mass spectrometry in the selected ion monitoring mode for quantitation. Calibration curves for cefoperazone and sublactam were linear over the range 0.07 to 1.93 and 0.046 to 0.914 ,g/ml respectively. The decedent's blood concentrations of cefoperazone and sublactam were 0.368 and 0.143 ,g/ml respectively. As these concentrations were below concentrations reported after single dosing studies and below those considered to be minimally inhibitory, death was presumed to have been caused by hypersensitivity and not an overdose. In conclusion, this procedure is useful for detecting and quantitating cefoperazone and sublactam in postmortem blood and may be useful in the evaluation of anaphylaxis. [source] Fatal case of bilateral internal jugular vein thrombosis following IVIg infusion in an adolescent girl treated for ITPAMERICAN JOURNAL OF HEMATOLOGY, Issue 4 2008Pui-Ying Iroh Tam Intravenous immunoglobulin (IVIg) is often used as therapy in immune-mediated diseases and is generally considered a safe therapeutic agent. However, thrombotic complications such as myocardial infarction and deep vein thrombosis have been reported, although primarily in older adults. We describe a 13-year-old girl who received one dose of IVIg for immune thrombocytopenic purpura and developed fatal bilateral jugular venous thromboses. This is the first known case of IVIg-associated thrombosis in an adolescent and alsothe first report describing internal jugular vein thrombosis associated with IVIg infusion. We identify additional risks that may potentiate the agent's thrombotic risk. Am. J. Hematol., 2008. © 2007 Wiley-Liss, Inc. [source] A fatal case of enoxaparin induced skin necrosis and thrombophiliaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2 2006Yona Nadir Abstract:, Skin necrosis caused by heparins is a rare complication. We report a case of a 71-yr-old white woman who developed painful diffuse skin lesions, most probably related to enoxaparin treatment. Other causes of skin necrosis, including heparin induced thrombocytopenia, disseminated intravascular coagulation, protein C/protein S deficiencies, anti-phospholipid antibodies, and vitamin K deficiency were less likely in this case. The concomitant combined thrombophilia possibly aggravated the patient's clinical presentation. [source] A Case of Fatal Aconitine Poisoning by Monkshood Ingestion,JOURNAL OF FORENSIC SCIENCES, Issue 2 2008Ravi Pullela B.Sc. Abstract:, Accidental aconitine poisoning is extremely rare in North America. This report describes the confirmation of a case of accidental aconitine poisoning using a liquid chromatography,tandem mass spectrometry (LC-MS/MS) method. The case involved a 25-year-old man who died suddenly following a recreational outing with friends where he consumed a number of wild berries and plants including one that was later identified as Monkshood (Aconitum napellus). Postmortem blood and urine samples were available for analysis. All routine urine and blood toxicology screens were negative. The LC-MS/MS method allowed sensitive quantification of aconitine, the main toxin in A. napellus, and showed 3.6 and 149 ,g/L in blood and urine, respectively. These concentrations were similar to that reported in other aconitine-related deaths. This case illustrates the dangers of consuming unidentified plants, and documents concentrations of aconitine in blood and urine in a fatal case of A. napallus -related poisoning. [source] A Fatal Case of Suspected Anaphylaxis with Cefoperazone and Sulbactam: LC-MS AnalysisJOURNAL OF FORENSIC SCIENCES, Issue 1 2008Kenji Tsujikawa M.S. Abstract: Cefoperazone and sublactam are prescribed in combination and used in the treatment of moderate to severe bacterial infections. Serious anaphylaxis is a rare side effect. This report describes a fatal case of suspected anaphylaxis after intravenous administration of a combination of the two drugs. Heart blood was analyzed for cefoperazone by protein precipitation with acetonitrile and by liquid-liquid precipitation for sublactam after protein precipitation with aqueous acetonitrile, followed by tandem mass spectrometry in the product ion scan mode for identification and by liquid chromatography mass spectrometry in the selected ion monitoring mode for quantitation. Calibration curves for cefoperazone and sublactam were linear over the range 0.07 to 1.93 and 0.046 to 0.914 ,g/ml respectively. The decedent's blood concentrations of cefoperazone and sublactam were 0.368 and 0.143 ,g/ml respectively. As these concentrations were below concentrations reported after single dosing studies and below those considered to be minimally inhibitory, death was presumed to have been caused by hypersensitivity and not an overdose. In conclusion, this procedure is useful for detecting and quantitating cefoperazone and sublactam in postmortem blood and may be useful in the evaluation of anaphylaxis. [source] Quantitative temporal and spatial distribution of adenovirus type 2 correlates with disease manifestations and organ failure during disseminated infectionJOURNAL OF MEDICAL VIROLOGY, Issue 2 2008Dirk Forstmeyer Abstract Disseminated adenovirus (HAdV) infections are serious complications in allogenic stem cell transplant (SCT) recipients. Quantitative HAdV DNA detection in blood samples demonstrated the association of high virus loads with disease and improved early diagnosis. However, the pathogenesis of disseminated HAdV disease, for example sources of HAdV DNA shedding in the blood stream and association of HAdV replication sites with disease manifestations, remained obscure. In this report, 24 bioptic and autoptic organ and tissue samples of an adult SCT recipient suffering from disseminated infection were quantitatively analyzed for HAdV DNA. Results indicate subsequent virus replication in the colon, bone marrow and liver as origin of HAdV DNAemia, which increased from 1.4,×,104 copies/ml to a peak of 2,×,109 copies/ml over a period of 84 days in spite of antiviral therapy. Symptoms as diarrhoea, bone marrow failure and hepatic failure were clearly linked to high HAdV DNA concentrations in affected organs. For example, the HAdV DNA level was 2.2,× 103 copies/cell in a colon biopsy when the patient suffered from diarrhoea whereas only 1.1,× 101 copies/cell were detected when symptoms had improved. Focal HAdV infection of the liver as demonstrated by laser microdissection was followed by fulminant virus replication with 1.3,×,105 copies of HAdV DNA/cell causing terminal hepatic failure. In conclusion, pathogenesis of disseminated HAdV disease was associated with virus replication in affected organs and not immune mediated as suggested recently by a fatal case of gene therapy with a non-replication competent HAdV-C5 vector. J. Med. Virol. 80:294,297, 2008. © 2007 Wiley-Liss, Inc. [source] Genetic characterization of the M RNA segment of a Balkan Crimean-Congo hemorrhagic fever virus strain,JOURNAL OF MEDICAL VIROLOGY, Issue 3 2005Anna Papa Abstract Crimean-Congo hemorrhagic fever (CCHF) virus causes one of the most severe diseases in humans, with a mortality rate of up to 30%. It is transmitted to humans by the bite of hard ticks or by contact with blood or tissues from human patients or infected livestock. Balkan Peninsula is an endemic region of the disease, and sporadic cases or even outbreaks are observed every year. The M RNA segment encodes for the glycoprotein precursor of two surface glycoproteins Gn and Gc. Up to now complete M RNA CCHF virus sequences have been published from strains isolated in Nigeria, China, Pakistan, Tajikistan, and Russia. In the present study, the genetic characterization of the complete nucleotide sequence of the M RNA segment of a Balkan CCHF virus strain, Kosovo/9553/2001, isolated in summer of 2001 from a human fatal case in Kosovo is reported. This is the first published complete M nucleotide sequence of a CCHF virus strain isolated in Balkans. It was found that the Balkan strain is similar to the Russian strain, both strains differing from all other completely sequenced CCHF virus strains by approximately 22% at the nucleotide level forming an independent clade in the phylogenetic tree. J. Med. Virol. 75:466,469, 2005. © 2005 Wiley-Liss, Inc. [source] A fatal case of cutaneous zygomycosis in a patient with severe metabolic acidosisMYCOSES, Issue 4 2009C. Kosmidis Summary We present a case of cutaneous zygomycosis in a patient with an ureteroileostomy and severe metabolic acidosis, but without diabetes. The patient died despite multiple aggressive surgical interventions and antifungal therapy with liposomal amphotericin B. Ureteroileostomy-related acidosis can be a predisposing factor for zygomycosis. Metabolic acidosis can have a role in the severity of cutaneous disease. [source] An immunohistochemical study on a tetanus fatal case using toxin fragment C (TTC).NEUROPATHOLOGY, Issue 1 2009Should it be a useful diagnostic tool? A 65-year-old man fell in his garden and sustained a right pre-radial cutaneous laceration associated with a Colles' fracture. His status for tetanus immunization was uncertain; so a course of antitetanus treatment was immediately started. Two days after admission the man suddenly developed severe nucal pain, rigidity and dysphagia. A brain CT scan was negative. His condition progressively worsened and then he developed trismus. Cultures from the wound were negative for Clostridium tetani; the CSF analysis was negative. On the 9th day after admission, the man died. A presumptive clinical diagnosis of tetanus was made. Autopsy was performed 24 h after death. An immunohistochemical study was conducted with an antibody directed against tetanus toxin fragment C (TTC). By immunohistochemical evaluation, large motor neurons in the ventral horn were immunopositive for TTC. High power magnification of the ventral horn of spinal cord gray matter samples showed TTC immunoreactivity in motor neuron axons and cell bodies, using a confocal laser scanning microscope. The correct diagnosis could be established on the basis of pathological examination with TTC immunostaining. [source] Polyangitis overlap syndrome: A fatal case combined with adult Henoch-Schönlein purpura and polyarteritis nodosaPATHOLOGY INTERNATIONAL, Issue 8 2003Kazuo Watanabe Henoch-Schönlein purpura (HSP) is a rather common disease characterized by systemic hypersensitivity vasculitis in the skin and other visceral organs. It has a favorable prognosis unless it is complicated by severe glomerular disease. We report a distinctive fatal case of systemic vasculitis combined with HSP and polyarteritis nodosa (PN) in a 56-year-old man who died of progressive renal failure one month after the onset of the disease. He complained of arthralgia, purpura of both lower extremities, nasal bleeding and tarry stool, and acute renal failure was noted at the time of admission to hospital. A skin biopsy from the purpura lesion exhibited leucocytoclastic vasculitis with IgA deposition, and HSP was considered. However, renal failure progressed rapidly and subsequently was complicated by acute myocardial infarction. Postmortem examination revealed PN type necrotizing vasculitis in the kidneys, heart and mesentery resulting in acute multiple infarctions of these organs. We think the current case was a polyangitis overlap syndrome. It is important to suspect the polyangitis overlap syndrome positively when progressive acute renal failure is seen in a patient with HSP and to begin appropriate therapy immediately. [source] AML with bilateral retinal detachmentACTA OPHTHALMOLOGICA, Issue 2007E SARKADY Purpose: To present a case of thrombotic ocular and CNS involvement complicating acute myeloid leukaemia (AML). Methods: A 42 year old woman developed blurred vision shortly after diagnosis and treatment of M6 AML. Investigations showed anterior orbital infiltration, retinal detachment and panuveitis. Iris biopsy and vitreous aspirate were negative. She developed right temporal lobe infarction and died following further CNS infarction two months after initial diagnosis. Results: Post mortem examination showed cerebral oedema, multiple cerebral infarctions and hepatosplenomegaly; both eyes contained vitreous exudates, retinal detachment and uveal thickening. Microscopy showed exudative and haemorrhagic retinal detachment, without inflammatory or neoplastic infiltrate, and bilateral uveal leukaemic infiltration with infarction. Neoplastic cells infiltrated the leptomeninges and brain parenchyma with focal vascular occlusion. Lung vessels were occluded by neoplastic cells. The spleen and bone marrow were heavily infiltrated. Partial immunophenotyping suggested a diagnosis of acute promyelocytic leukaemia (APL). Conclusions: Acute leukaemia involves the eye occurs in 39-53% cases. Visual loss is uncommon. Retinal involvement most frequently occurs in the form of superficial haemorrhages, detachment is uncommon. Acute lymphoblastic leukaemia (ALL) treated with L-asparaginase, acute promyelocytic leukaemia (APL) and non-M3 AML may present with a prothrombotic state which may be catastrophic, as occurred in this fatal case. [source] Necrotizing haemorrhagic pneumonia proves fatal in an immunocompetent child due to Panton,Valentine Leucocidin, toxic shock syndrome toxins 1 and 2 and enterotoxin C-producing Staphylococcus aureusACTA PAEDIATRICA, Issue 7 2008Farah Mushtaq Abstract Panton,Valentine leucocidin (PVL) toxin-producing strains of Staphylococcus aureus (S. aureus) are associated with skin abscesses and furunculosis, with necrotizing pneumonia being a relatively rare problem. Here, we describe a fatal case of necrotizing pneumonia in a 14-year-old child who presented initially with sore throat and pyrexia. He deteriorated rapidly, developing hypotension, multiple organ failure and purpura fulminans. S. aureus was isolated from the tracheal aspirate, which was found to be positive for PVL, toxic shock syndrome toxins (TSST) 1 and 2 and staphylococcal enterotoxin C (SEC). It was postulated that purpura fulminans and toxic shock syndrome were a result of the abovementioned exotoxins. Conclusion: This case highlights the emergence of PVL-positive community-acquired S. aureus infection and association of purpura fulminans with superantigens. Practitioners should be aware of this illness in order to initiate appropriate treatment. [source] Disseminated Scopulariopsis brevicaulis infection in an allogeneic stem cell recipient: case report and review of the literatureCLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2010A. Salmon Clin Microbiol Infect 2010; 16: 508,512 Abstract A fatal case of disseminated Scopulariopsis brevicaulis infection in an allogeneic stem cell transplant recipient is described. The patient was initially thought to have pulmonary aspergillosis, on the basis of clinical signs and antigenaemia, but Aspergillus was not isolated by culture. Scopulariopsis brevicaulis was subsequently isolated from skin and then from sputum and stool. Further investigation revealed that the infection had spread from a primary pulmonary site to the skin. A review of the literature underscores the difficulty of diagnosing infections caused by such emerging fungal pathogens and the poor outcome of immunocompromised patients with non- Aspergillus mould infections. [source] Use of morphine and 6-monoacetylmorphine in blood for the evaluation of possible risk factors for sudden death in 192 heroin usersADDICTION, Issue 4 2003Anna Fugelstad Abstract Aims, To detect risk factors for sudden death from heroin injection. Design, Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order to select heroin intoxication cases. Setting, Stockholm, Sweden. Measurements, Autopsy investigation and toxicological analysis of blood and urine; and police reports. Findings, In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from 50 to 1200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations were found. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. Conclusions, We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors. [source] Prevalence of de- O -acetylated serogroup C meningococci before the introduction of meningococcal serogroup C conjugate vaccines in the United KingdomFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2000Ray Borrow Abstract Meningococcal serogroup C conjugate (MCC) vaccines have been introduced in the UK to combat the rise in serogroup C meningococcal disease. Serogroup C meningococci may occur naturally expressing either O -acetylated (Oac+) or de- O -acetylated (Oac,) polysaccharide capsules. In a small study in the USA in the 1970s 15% of serogroup C meningococcal case isolates were reported to be Oac, though the prevalence of these Oac, isolates has not been recorded in the UK. This is of interest as the first MCC vaccines to be introduced are Oac+ and the potential impact of this on Oac, serogroup C isolates is unclear. Serogroup C isolates submitted to the Public Health Laboratory Service Meningococcal Reference Unit in January 1998 (n=113) and January 1999 (n=162) were investigated by dot blotting using monoclonals specific for Oac+ and Oac, serogroup C polysaccharides. This revealed 12% Oac, isolates for both January 1998 and January 1999. The proportion of fatal cases was found to similar for both Oac, and Oac+, 14 and 9% for 1998 and 5 and 3% for 1999, indicating that the pathogenic potential of these Oac, isolates is similar to Oac+. The acetylation status of serogroup C isolates needs to be monitored throughout and after the introduction of MCC vaccines. [source] An epidemiological analysis of severe cases of the influenza A (H1N1) 2009 virus infection in JapanINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 4 2010Koji Wada Please cite this paper as: Wada et al. (2010). An epidemiological analysis of severe cases of the influenza A (H1N1) 2009 virus infection in Japan. Influenza and Other Respiratory Viruses 4(4), 179,186. Background, The age distribution of confirmed cases with influenza A (H1N1) 2009 has shifted toward children and young adults, in contrast to interpandemic influenza, because of the age specificities in immunological reactions and transmission characteristics. Objectives, Descriptive epidemiological analysis of severe cases in Japan was carried out to characterize the pandemic's impact and clinical features. Methods, First, demographic characteristics of hospitalized cases (n = 12 923), severe cases (n = 894) and fatal cases (n = 116) were examined. Second, individual records of the first 120 severe cases, including 23 deaths, were analyzed to examine potential associations of influenza death with demographic variables, medical treatment and underlying conditions. Among severe cases, we compared proportions of specific characteristics of survivors with those of fatal cases to identify predictors of death. Results, Age distribution of hospitalized cases shifted toward those aged <20 years; this was also the case for deaths without underlying medical conditions. Deaths in adults were mainly seen among those with underlying medical conditions, resulting in an increased risk of death as a function of age. According to individual records, the time from onset to death in Japan appeared rather short compared with that in other countries. Conclusion, The age specificity of severe cases and their underlying medical conditions were consistent with other countries. To identify predictors of death in influenza A (H1N1) 2009 patients, more detailed clinical characteristics need to be examined according to different age groups and types of manifestations, which should ideally include mild cases as subjects. [source] Death by midgut infarction: clinical lessons from 88 post-mortems in Auckland, New ZealandANZ JOURNAL OF SURGERY, Issue 1-2 2009O'Grady Gregory Abstract Background:, Mortality rates from acute arterial mesenteric ischaemia remain high. Early diagnosis is of prognostic importance; however, early features are often non-specific, necessitating a high index of suspicion and knowledge of the at-risk patient. This study reviewed three decades of fatal cases in Auckland, New Zealand, to identify risk factors and associated pathologies that might help guide early diagnosis. Diagnostic delay was also evaluated. Methods:, Cases were identified through a pathology database maintained from 1977 to 2006. Autopsy reports were assessed together with available clinical detail. Results:, Eighty-eight cases were recovered. Mean age was 75.4 years, with women predominating (57%). Thromboembolic occlusion was the leading cause, followed by thrombotic occlusion. Embolic sources included atrial disease, aortic disease and myocardial infarction. Patients routinely showed extensive comorbidities, especially cardiovascular. Pain was the most constant presenting symptom, but features were often subtle and clinicians frequently misdiagnosed more minor ailments. Of operated patients, 36% received operations within 6 h of admission, 33% within 24 h, 17% at between 1 and 2 days, and the remainder between 2 and 12 days. Conclusion:, Knowledge of risk factors defined here is important to guide early diagnosis of mesenteric ischaemia. Diagnostic delay is again shown to be significant and case experience gathered in this series may improve doctors' discernment when meeting this condition. [source] Treatment of Candida infection in patients with infected pancreatic necrosisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000G. Farkas Background The purpose of this review was to determine the incidence of Candida infection in patients with infected pancreatic necrosis, to determine the most frequent risk factors and to assess the best treatment approach for disseminated candidal infections. Methods Of 145 patients with infected pancreatic necrosis identified, 30 (21 per cent) were infected with C. albicans. Risk factors identified in patients with Candida infection included the presence of necrotic tissue, and the use of broad-spectrum antibiotics, intravascular catheters and parenteral nutrition. Results With one exception, all cases involved mixed bacterial and fungal infections. The positive fungal result was obtained either during or after operation. Sixteen of the 30 patients displayed fungal colonization, while the other 14 had disseminated fungal infection. There were two deaths in the disseminated group, but none in the colonization group. In both fatal cases, flucytosine was applied. When fluconazole was used against disseminated fungal infection, no death was noted. Recently, prophylactic fluconazole has also been used in 20 patients with infected pancreatic necrosis, with no evidence of fungal infection after operation. Conclusion The combination of adequate surgical treatment with effective antibiotics and early antifungal therapy is the ideal management approach for infected pancreatic necrosis with Candida infection. Fluconazole may be regarded as an efficient drug for the prophylaxis of candidiasis. © 2000 British Journal of Surgery Society Ltd [source] Lessons for management of anaphylaxis from a study of fatal reactionsCLINICAL & EXPERIMENTAL ALLERGY, Issue 8 2000Pumphrey Background The unpredictability of anaphylactic reactions and the need for immediate, often improvised treatment will make controlled trials impracticable; other means must therefore be used to determine optimal management. Objectives This study aimed to investigate the circumstances leading to fatal anaphylaxis. Methods A register was established including all fatal anaphylactic reactions in the UK since 1992 that could be traced from the certified cause of death. Data obtained from other sources suggested that deaths certified as due to anaphylaxis underestimate the true incidence. Details of the previous medical history, the reaction and necropsy were sought for all cases. Results Approximately half the 20 fatal reactions recorded each year in the UK were iatrogenic, and a quarter each due to food or insect venom. All fatal reactions thought to have been due to food caused difficulty breathing that in 86% led to respiratory arrest; shock was more common in iatrogenic and venom reactions. The median time to respiratory or cardiac arrest was 30 min for foods, 15 min for venom and 5 min for iatrogenic reactions. Twenty-eight per cent of fatal cases were resuscitated but died 3 h,30 days later, mostly from hypoxic brain damage. Adrenaline (epinephrine) was used in treatment of 62% of fatal reactions but before arrest in only 14%. Conclusions Immediate recognition of anaphylaxis, early use of adrenaline, inhaled beta agonists and other measures are crucial for successful treatment. Nevertheless, a few reactions will be fatal whatever treatment is given; optimal management of anaphylaxis is therefore avoidance of the cause whenever this is possible. Predictable cross-reactivity between the cause of the fatal reaction and that of previous reactions had been overlooked. Adrenaline overdose caused at least three deaths and must be avoided. Kit for self-treatment had proved unhelpful for a variety of reasons; its success depends on selection of appropriate medication, ease of use and good training. [source] Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisitedCLINICAL MICROBIOLOGY AND INFECTION, Issue 6 2006O. Ergonul Abstract The aim of this study was to determine the predictors of mortality among patients infected with Crimean-Congo haemorrhagic fever (CCHF) virus. Among patients with acute febrile syndrome, characterised by malaise, bleeding, leukopenia and thrombocytopenia, who were admitted to hospital during the spring and summer of 2002,2004, 54 had positive IgM and/or PCR results for CCHF virus in blood or tissue. The overall case fatality rate was 7.4%. Among the fatalities, haematemesis (p 0.009), melaena (p 0.001) and somnolence (p 0.022) were more common, the median platelet count was significantly lower (10 600/mL vs. 20 000/mL; p 0.038), the mean prothrombin time (27 s vs. 16 s; p 0.002) and mean activated partial thromboplastin time (73 s vs. 44 s; p < 0.001) were longer, and the mean alanine transferase (ALT) level (1125 vs. 331; p < 0.001), the mean aspartate transferase (AST) level (3118 vs. 913; p 0.004) and the mean fibrinogen level (119 vs. 340; p 0.012) were higher. Serum IgM and IgG against CCHF virus was detected in 25% and 0%, respectively, of fatal cases, compared with 94% and 62%, respectively, of cases with favourable outcomes. Oral ribavirin was prescribed to 22 (41%) patients. Of the four fatal cases, it was the intention to prescribe ribavirin to three patients, but this was not possible because of haematemesis and melaena. Higher levels of AST (, 700 U/L) and ALT (, 900 U/L) are suggested for use as severity criteria. Oral ribavirin was not effective for patients with haematemesis, and intravenous ribavirin is necessary for treatment of CCHF. [source] | ||||||||||||||||||||||