Original Article

Comparison of Blood Parameters in Crimean-Congo Hemorrhagic Fever and Upper Respiratory Infection Patients with Similar Complaints

Abstract

Background: Crimean-Congo Hemorrhagic Fever (CCHF) often presents with non-specific flu-like symptoms that resemble upper respiratory tract infections (URTI), especially in endemic areas. We aimed to evaluate whether complete blood count (CBC) parameters could distinguish between CCHF and URTI in emergency settings.
Methods: We conducted a retrospective comparative analysis of 503 patients: 203 confirmed CCHF cases and 300 URTI cases. The study was carried out at Erzurum City Hospital, Erzurum, Turkey, between 2023 and 2024. Hematological parameters including WBC, PLT, RDW, MPV, and others were analyzed. ROC analysis was used to evaluate the prognostic value in CCHF patients.
Results: Significant differences in multiple CBC parameters were observed between the two groups. CCHF patients had significantly lower WBC, PLT, and lymphocyte counts, and higher MPV and RDW values compared to URTI patients (P-value<0.001). Among CCHF cases, 40.4% were initially misdiagnosed as URTI. ROC analysis indicated moderate prognostic power for HGB and PLT in predicting mortality.
Conclusion: CBC parameters can assist in distinguishing CCHF from URTI in endemic areas, especially when RT-PCR is unavailable. Emergency physicians should consider CCHF in differential diagnosis when specific hematological abnormalities are present. 

1. Rathore SS, Manju AH, Wen Q, et al (2021). Crimean‐congo haemorrhagic fever‐induced liver injury: a systematic review and meta‐analysis. Int J Clin Pract, 75 (11): e14775.
2. Çıtıl R, Eğri M, Önder Y, et al (2021). De-termination of seroprevalence and risk factors of Crimean-Congo haemorrhag-ic fever (CCHF) in the endemic region in Turkey: A population-based cross-sectional study. J Trop Med, 2021:9945089.
3. Kara A (2008). Kırım Kongo kanamalı ateşi. Türk Pediatri Arşivi Dergisi, 43: 8‐18.
4. Yılmaz GR, Buzgan T, Irmak H, et al (2009). The epidemiology of crimean-congo hemorrhagic fever in Turkey, 2002-2007. Int J Infect Dis, 13(3):380-6.
5. Ergönül Ö (2016). Kırım-Kongo kanamalı ateşi tedavisi ve Ribavirin kullanımı. Klimik Journal/Klimik Dergisi, 29 (1).
6. Burt FJ, Swanepoel R, Shieh WJ, et al (1997). Immunohistochemical and in situ localization of Crimean-Congo hemor-rhagic fever (CCHF) virus in human tis-sues and implications for CCHF patho-genesis. Arch Pathol Lab Med, 121 (8): 839-46.
7. Karti SS, Odabasi Z, Korten V, et al (2004). Crimean-Congo hemorrhagic fever in Turkey. Emerg Infect Dis, 10 (8): 1379-84.
8. Ertürk A, Cüre E, Parlak E, et al (2015). Prognostic value of mean platelet vol-ume and neutrophil to lymphocyte ratio in patients with Crimean Congo Hemor-rhagic Fever. Journal of Microbiology and In-fectious Diseases, 5(2):51-56.
9. Gasparyan AY, Ayvazyan LP, Mikhailidis D, et al (2011). Mean platelet volume: A link between thrombosis and inflamma-tion? Curr Pharm Des, 17: 47-58.
10. Ekiz F, Gürbüz Y, Başar Ö, et al (2013). Mean platelet volume in the diagnosis and prognosis of Crimean-Congo hem-orrhagic fever. Clin Appl Thromb Hemost, 19(4): 441-4.
11. Hampole CV, Mehrotra AK, Thenappan T, et al (2009). Usefulness of red cell distri-bution width as a prognostic marker in pulmonary hypertension. Am J Cardiol, 104: 868–72.
12. Ku NS, Kim HW, Oh HJ, et al (2012). Red blood cell distribution width is an inde-pendent predictor of mortality in pa-tients with gram-negative bacteremia. Shock, 38(2):123-7.
13. Doğan E, Girişgin S, Ertekin B, Demirci OL (2021). Kırım kongo kanamalı ateşinde hemogram parametrelerinin tanısal değeri. Genel Tıp Derg, 31 (2): 101-04.
14. Ermonval M, Baychelier F, Tordo N (2016). What do we know about how hanta-viruses interact with their different hosts? Viruses, 8 (8): 223.
15. Jiang H, Zheng X, Wang L, et al (2017). Hantavirus infection: A global zoonotic challenge. Virol Sin, 32: 32-43.
16. Jiang L, Lu C, Sun Q (2021). Tree shrew as a new animal model for the study of den-gue virus. Front Immunol, 12: 621164.
17. Yılmaz H, Yilmaz G, Menteşe A, et al (2016). Prognostic impact of platelet dis-tribution width in patients with Crime-an-Congo hemorrhagic fever. J Med Vi-rol, 88 (11): 1862-6.
18. Arslan M, Yilmaz G, Mentese A, et al (2017). Importance of endothelial dys-function biomarkers in patients with Crimean‐Congo hemorrhagic fever. J Med Virol, 89 (12): 2084-91.
19. Elaldi N, Kaya S (2014). Crimean-Congo Hemorrhagic Fever. J Microbil Infect Dis, 4 (Supplement 1):1-9.
20. Turkdogan K, Eren Ş, Coşkun A, et al (2016). Ratio of neutrophil to lympho-cyte counts in Crimean Congo hemor-rhagic fever. J Clin Anal Med, 7 (1):10-13.
21. Bastug A, Kayaaslan B, Kazancioglu S, et al (2016). Crimean-Congo hemorrhagic fe-ver: Prognostic factors and the associa-tion of leukocyte counts with mortality. Jpn J Infect Dis, 69 (1): 51-5.
Files
IssueVol 54 No 10 (2025) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v54i10.20142
Keywords
Complete blood count Crimean-Congo hemorrhagic fever Upper respiratory tract infection
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Doru H, Delıce O, Akpınar F, Zengın O, Iba Yılmaz S, Yılmaz S. Comparison of Blood Parameters in Crimean-Congo Hemorrhagic Fever and Upper Respiratory Infection Patients with Similar Complaints. Iran J Public Health. 2025;54(10):2342-2350.