Ribavirin use in pediatric patients with Crimean Congo Hemorrhagic Fever: is it really necessary?

Crimean-Congo hemorrhagic fever (CCHF) is a severe, often potentially fatal disease in humans, caused by infection with CCHF virus (CCHFV) belonging to the genus Nairovirus of the Bunyaviridae family. The current approach to treatment of CCHF is based on supporting hematologic and coagulation status of the patient, with replacement of cells and factors as needed, but use of ribavirin is controversial. In this study it was aimed to evaluate and compare outcomes of pediatric patients receiving or not receiving ribavirin. The study included patients younger than 18 years of age admitted to Ankara Hematology Oncology Children’s Training and Research Hospital between January, 2009, and November, 2014, with fever, bleeding, leukopenia, and/or thrombocytopenia with positive IgM and/or PCR results for CCHFV in blood. Physical findings and the laboratory tests were included in data analysis. Out of 46 pediatric patients (18 female, 28 male), aged between 1 and 17 years (mean: 10.1 ± 4.8 years) with CCHF, 30 patients were treated with ribavirin, characteristics of the patients are presented in Table 1. Diagnosis of CCHF was confirmed by PCR in 32 (69.6%) patients, by serology in 16 (42.1%) patients, both serology and PCR in 2 patients. On admission anemia was present in 11 (23.9%) patients, leukocytopenia in 39 (84.8%) patients, thrombocytopenia in 40 (86.9%) patients. Elevated AST, ALT, LDH, and CPK levels were present in 38 (82.6%), 35 (76.1%), 40 (87%), 25 (54.3%) patients, respectively. The length of stay in hospital ranged from 1 to 14 days (mean: 5.4 ± 3.02 days). No fatal cases were observed. In patients treated with ribavirin, duration of therapy ranged from 3 to 10 days (mean: 8.7 ± 2.01 days). The only currently used antiviral drug in CCHF is ribavirin; however, its efficacy is a matter of concern as randomized controlled trials are lacking. In our study both groups treated and not treated with ribavirin presented no fatal cases. Also in ribavirin treated group need for erythrocyte and plasma transfusion was more frequent and duration of fever and hospitalization were longer in ribavirin treated group but Table 1 – Characteristics of the patients.