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Geographic distribution and differential diagnosis of cases with suspect hemorrhagic fever in Albania
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Krasniqi Marsida,
Catholic University «Our Lady of Good Counsel» Tirana, Albania
Bino Silvia,
Institute of Public Health, Tirana, Albania E-mail: k_marsida@yahoo.it
Geographic distribution and differential diagnosis of cases with suspect hemorrhagic fever in Albania
Abstract: Viral hemorrhagic fevers refer to a group of illnesses that are caused by several distinct families of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe multisystem syndrome. Specific signs and symptoms vary by the type of virus of hemorrhagic fever; signs and symptom include marked fever, fatigue, dizziness, muscle pain, loss of strength, and exhaustion. Patients with severe cases show signs of bleeding under the skin, in internal organs, or mouth, eyes and ears. The aim of this study is to identify the etiology of the cases suspected of hemorrhagic fever and to create the geographic distribution of different virus in Albania. The study analysis the 128 cases suspected of hemorrhagic fever for a period ofJanuary 2013 to December 2015. The result show that only 21 % were positive for Crimea Congo hemorrhagic fever, 9 % for Hantan and 3 % for Leptospirosis, and others results negative. The differential diagnosis was made by Elisa methods. The mean age of the patients that were positive for IgG and IgM by Elisa, was 45.7 ± 22.9 years. The distribution of the patients was in different part of Albania, most frequently in north Albania, especially for Crimea Congo hemorrhagic fever. The distribution was correlated with the seasonality and profession of patients.
Keywords: Geographic distribution, hemorrhagic fever, differential diagnosis, Albania.
Introduction
Viral hemorrhagic fevers refer to a group of illnesses that are caused by several distinct families of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe multisystem syndrome. Specific signs and symptoms vary by the type of virus of hemorrhagic fever; signs and symptom include marked fever, fatigue, dizziness, muscle pain, loss of strength, and exhaustion. Patients with severe cases show signs of bleeding under the skin, in internal organs, or mouth, eyes and ears [1].
Viruses associated with most Viral Hemorrhagic Fevers are zoonotic. This means that these viruses naturally reside in an animal reservoir host or arthropod vector. The cotton rat, deer mouse, house mouse, and other field rodents are examples of reservoir hosts. Arthropod ticks and mosquitoes serve as vectors for some of the illnesses [2].
The viruses that cause Viral Hemorrhagic Fevers are distributed over much of the globe. Because the virus is associated with a particular host species, the virus and the disease it causes are seen only where the host live [3].
Viruses causing hemorrhagic fever are initially transmitted to humans when the activities of infected reservoir hosts or vectors and humans overlap. The viruses carried in rodent reservoirs are transmitted when humans have contact with urine, fecal matter, saliva, or other body excretions from infected rodents. The viruses associated with arthropod vectors are spread most often
when the vector mosquito or tick bites a human, or when a human crushes a tick [4].
The aim of this study is to identify the virus of the cases suspected of hemorrhagic fever and to evaluate the geographic distribution of the virus in Albania.
Material and Methods
The 128 patients, presented from January 2013 to December 2015 at the Department of Infection disease in Tirana and suspected for hemorrhagic fever, were taken in this study. 128 blood serum samples were taken from the Institute of Public Health of Tirana to confirm the diagnosis. We performed immunoglobulin IgM and IgG enzyme-linked immunosorbent assay (ELISA).
All of the patients had similar clinical and laboratory findings, including fever, petechiae, headache, abdominal pain, nausea, vomiting and liver enzyme elevations.
Data as gender, age, occupation, settlement, time of symptoms and relation with vectors, hosts or humans who were sick was collected from the patients. The data was analyzed by SPSS program. The continued variables were presented as mean and standard deviation; categorized variables were presented as percentage.
Results. From 128 blood serum sample, only 34 % (n = 43) were positive for IgG and IgM by Elisa methods for hemorrhagic fever. In 43 (34 %) patents with hemorrhagic fever, 63 % was positive for Crimea Congo Hemorrhagic Fever, 28 % was positive for Hantan and 9 % for Leptospirosis.
Section 4. Medical science
Table 1. - Demographic data of cases with hemorrhagic fever
Crimea Congo Hemorrhagic Fever Hantan Leptospirosis Total
Nr 27 12 4 43
Male ( %) 12 (44 %) 12 (100 %) 3 (75 %) 27 (63 %)
Age 44.8 ± 16.4 41.8 ± 18.5 50.5 ± 33.7 45.7 ± 22.9
Occupation
Farmer 1 (4 %) 3 (25 %) 1 (25 %) 5 (12 %)
Housewife 16 (59 %) 5 (42 %) 2 (50 %) 23 (54 %)
Student 7 (26 %) 2 (17 %) 1 (25 %) 10 (23 %)
Other 3 (11 %) 2 (17 %) 0 5 (12 %)
Table 2. - The Geographic distribution of cases with hemorrhagic fever
Settlement Crimea Congo Hemorrhagic Fever Hantan Leptospirosis Total
Has 17 (63 %) 0 0 17 (40 %)
Kukes 5 (19 %) 0 0 5 (12 %)
Gjirokaster 3 (11 %) 0 0 3 (7 %)
Burrel 1 (4 %) 0 0 1 (2 %)
Tropoje 1 (4 %) 4 (33 %) 0 5 (12 %)
Kavaje 0 1 (8 %) 0 1 (2 %)
Korce 0 2 (17 %) 0 2 (5 %)
Peshkopi 0 2 (17 %) 0 2 (5 %)
Shkoder 0 1 (8 %) 0 1 (2 %)
Skrapar 0 1 (8 %) 1 (25 %) 2 (5 %)
Tirane 0 1 (8 %) 2 (50 %) 3 (7 %)
Fier 0 0 1 (25 %) 1 (2 %)
The mean age and standard deviation of the patient positive for hemorrhagic fever was 45.7 ± 22.9 years old. The mean age of the cases with Crimea Congo hemorrhagic fever was 44.8 ± 16.4, for Hantan was 41.8 ± 18.5 and for Leptospirosis was 50.5 ± 33.7.
The frequency of patents with Crimea Congo hemorrhagic fever was higher than the patient with Hantan and Leptospirosis.
In cases the prevalence of male (63 %) was higher than female.
Regarding the occupation of the cases, the majority 23 (54 %) were housewife, were 16 (59 %) were diagnosed with Crimea Congo Hemorrhagic Fever, 5 (42 %) with Hantan and 2 (50 %) with Lep-tospirosis.
The majority of cases was seen more in north Albania; 40 % (n = 17) in Has city, and all of this cases were with Crimea Congo Hemorrhagic Fever. The 12 % (n = 5) of cases was seen in Kukes and Tropoja cities, were in Kukes all the cases were with Crimea Congo Hemorrhagic Fever, and in Tropoja we had one case with Crimea Congo Hemorrhagic Fever and 4 cases with Hantan. Cases with Leptospirosis were seen more in the cities of Tirana (n = 2), Skrapar (n = 1) and Fier (n = 1).
Discussion
Viral hemorrhagic fevers are caused by several families of enveloped RNA viruses: Arenaviridae (Lassa fever, Junin and Machupo), Bunyaviridae (Crimean-Congo hemorrhagic fever, Rift Valley Fever, Hantan hemorrhagic fevers), Filoviridae (Ebola and Marburg) and Flaviviridae (yellow fever, dengue, Omsk hemorrhagic fever, Kyasa-nur forest disease) [5].
Some Viral hemorrhagic fevers are spread person to person through direct contact with symptomatic patients, body fluids, or cadavers or through inadequate infection control in a hospital. Zoonotic spread may occur from contact with livestock, rodent, bats, mosquito and infected ticks [6].
In Europe, hemorrhagic fever is seen in different countries in the region such as Albania, Kosovo, Turkey, and the Ukraine as well as
south-western regions of the Russian Federation [7]. During the last decade, CCHF outbreaks have also been noted in Albania in 2001 and 2003, and in Kosovo in 2001 [8]. Has and Kukes is situated in north part ofAlbania, which is close to Kosovo boarder, and has an environment for ticks spreading CCHF due to its geographic structure, climate and lifestyle ofpeople living there. In our study is seen that north Albania has the higher frequency of cases with Crimea Congo Hemorrhagic Fever in Has and Kukes. the incidence of CCHF increased with increasing mean temperature in areas with CCHF cases [9]. In our study most cases were reported between April and September.
Hantaviruses are enzootic viruses that maintain persistent infections in their rodent hosts without apparent disease symptoms. The ecology of Hantaviruses in their rodent reservoirs depends upon complex interactions among competing drivers, including climate and landscape/habitat [10]. In our study the economic condition and habitat had an important role in the distribution of the infection in different areas ofAlbania. Endemic areas have been re-infected. The distribution was in different part of Albania and it was correlated with the seasonality and profession of patients.
Leptospirosis is a direct zoonotic disease caused by spirochetes belonging to different pathogenic species of the genus Leptospira, Large number of animal's acts as carriers or vectors. Human infection results from accidental contact with carrier animals or environment contaminated with leptospires. The primary source of lepto-spires is the excretory animal [11]. In our study the epidemiology of leptospires is seen in Tirana, Skrapar and Fier. The majority of cases occur among livestock farm workers and meat processing workers.
Conclusion
The majority of cases with hemorrhagic fever in Albania in the period oftime fromJanuary 2013 to December 2015 were represented with a higher prevalence of Crimea Congo Hemorrhagic Fever.
The distribution of hemorrhagic fever was in different part of Albania, Crimea Congo Hemorrhagic Fever was seen only
The influence of sulfaporine on indicators of nitric oxide system at experimental hypercholesterolemia
in north Albania. The geographic distribution was correlated caused by these viruses are seen in people living in or having vis-with the seasonality and profession of patients. The diseases ited these areas.
References:
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9. Vescio F. M., Busani L., Mughini-Gras L., Khoury C., Avellis L., Taseva E., Rezza G. and Christova I. Environmental correlates of Crimean-Congo haemorrhagic fever incidence in Bulgaria//BMC Public Health. - Jan. 2012. - Vol. 12, no. 1. - P. 1116.
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Kutlikova Guzalhon Mahamadzhanovna, Assistant of the Department of Organic and Biological Chemistry, Andijan Medical Institute E-mail: evovision@bk.ru
The influence of sulfaporine on indicators of nitric oxide system at experimental hypercholesterolemia
Abstract: At the heart of the development of endothelial dysfunction at HCS an important role plays decrease of the synthesis of endothelial nitric oxide and increase its active radicals, causing a modification of low density lipoproteins. Sulfated chitosan reduces high levels of peroxynitrite and endothelin-1, increase the activity of eNOS and nitric oxide. Keywords: Nitric oxide system, sulfaporine, hypercholesterolemia.
So far, cardiovascular disease remains the leading cause of death in most developed countries in Europe, accounting for 40 % of all deaths. To date, set a number of factors of different nature [1], contributing to the development and progression of coronary heart disease — dyslipidemia, hypertension, overweight tala, smoking, physical inactivity, diabetes. Much attention is paid to the cellular and molecular bases of endothelial dysfunction [4; 5]. An important role in endothelial dysfunction belongs nitrogen oxide [6; 7].
The pathogenesis of atherosclerosis is quite difficult, but important role in this belongs to, is dyslipidemia that defines initiation of inflammation cascade mechanism. Therefore, an important role in the development of therapeutic measures belongs to lower cholesterol and other saturated fats [2; 7]. Last years much attention is paid to a natural biodegradable compounds, in particular chitosan and its derivatives. The Institute of Polymer Chemistry and Physics, Academy of Sciences of Uzbekistan under the leadership of SS Rashidova developed various chitosan derivatives.
Research objective: to evaluate the impact of sulfaporina on the system nitric oxide at experimental hypercholesterolemia (HCS).
Materials and research methods. To solve the problems, experiments were performed on 46 rabbits Chinchilla average weight of 2.5-3.0 kg., contained in the standard power mode. Experimental
Model HCS at experimental animals is reproduced by introduction by orally dissolved cholesterol (LDL) in sunflower oil in the ratio 0.2 g. per 1 kg. ofbody weight per day for 3 months. On the development of HCS was judged by the increase in total cholesterol and LDL (LDL) and high (HDL) density, which is determined on a biochemical analyzer.
After 2 months from the start of the experiment rabbits were divided into five groups:
• Group 1 — intact (rabbit 6), which through the mouth daily entered sunflower oil 1.0 ml/kg;
• Group 2 — HCS + H2 O — control (8 rabbit);
• Group 3 — HCS + gemfibrazil on100 mg/kg (8 rabbits);
• Group 4 — GCN + chitosan sulfate 25 mg/kg (rabbit 8);
• Group 5 — HCS + chitosan sulfate 50 mg/kg (rabbit 8).
Action of preparations is investigated in dynamics: an initial
3-month's condition and after one month ofintroduction of preparations. On the state of NO-ergic system judged by the level of nitric oxide metabolites [9], the activity of nitric oxide synthase (eNOS), the activity of nitrate reductase (NR) [10] and the level of peroxynitrite (ONOO) [9].
Results of investigation and discussion
The most important role in the implementation ofvascular endothelium function and dysfunction is plays a NO-ergic system.
