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Letters to the Editor

Bradycardia in Children With Crimean-Congo Hemorrhagic Fever

Şensoy, Gülnar MD

Author Information
The Pediatric Infectious Disease Journal: February 2015 - Volume 34 - Issue 2 - p 225
doi: 10.1097/INF.0000000000000524
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To the Editors:

We evaluated 54 children with Crimean-Congo hemorrhagic fever (CCHF) disease in the Central Blacksea Region and the study was published in the August 2014 issue of the Pediatric Infectious Disease Journal.1 This is one of the largest series in this topic. In the article, bradycardia was reported in 18 patients and it was suggested that bradycardia was related to ribavirin therapy in children with CCHF. Here, I want to discuss another approach to bradycardia in CCHF patients. CCHF is a tickborne viral disease with a mortality rate of 15–70%. Early and extensive supportive treatment is the mainstay of treatment. Although there are some debates on the clinical benefit of ribavirin, it is still the only antiviral agent recommended by the World Health Organization for CCHF patients.2 In the study, we gave ribavirin treatment especially to the severely affected patients such as the patients with marked fatigue and/or who had leukopenia, thrombocytopenia and bleeding manifestations. We know that bradycardia is one of the early signs of CCHF patients.2 It has also been reported as the manifestation of the disease in other viral hemorrhagic fever diseases such as dengue hemorrhagic fever and hemorrhagic fever with renal syndrome.3,4 In our study, all the patients with bradycardia were receiving ribavirin treatment. Ribavirin was stopped in 4 (22.2%) patients with bradycardia. However, regarding the patients’s severe CCHF disease, ribavirin treatment was not stopped in the remaining 14 (77.8%) patients and they were followed closely. Bradycardia in these patients did not get worse on the follow-up and all of the patients with bradycardia recovered completely. Recently, Oflaz et al5 reported reversible bradycardia in 7 of 52 children with CCHF and bradycardia was present in 3 of these 7 patients at admission before ribavirin treatment. In addition, they observed bradycardia more frequently in patients whose clinical courses were more severe. I believe it is very difficult to say that bradycardia in CCHF patients is related to ribavirin treatment. The disease itself can be the cause of the bradycardia. Further studies will help to clarify this topic.

Gülnar Şensoy, MD

Department of Pediatric Infectious Diseases

Faculty of Medicine

Ondokuz Mayis University

Samsun, Turkey


1. Belet N, Top A, Terzi O, Arslan HN, Baysal K, Sensoy G. Evaluation of children with Crimean-Congo hemorrhagic fever in the Central Blacksea Region. Pediatr Infect Dis J. 2014;33:e194–e197
2. Mardani M, Rahnavardi M, Sharifi-Mood B. Current treatment of Crimean-Congo hemorrhagic fever in children. Expert Rev Anti Infect Ther. 2010;8:911–918
3. Mahmod M, Darul ND, Mokhtar I, Nor NM, Anshar FM, Maskon O. Atrial fibrillation as a complication of dengue hemorrhagic fever: non-self-limiting manifestation. Int J Infect Dis. 2009;13:e316–318
4. Rusnak JM, Byrne WR, Chung KN, et al. Experience with intravenous ribavirin in the treatment of hemorrhagic fever with renal syndrome in Korea. Antiviral Res. 2009;81:68–76
5. Oflaz MB, Kucukdurmaz Z, Guven AS, et al. Bradycardia seen in children with Crimean-Congo hemorrhagic fever. Vector Borne Zoonotic Dis. 2013;13:807–811
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