The role of ribavirin in the therapy of Crimean-Congo hemorrhagic fever: early use is promising

  • N. Tasdelen FisginEmail author
  • O. Ergonul
  • L. Doganci
  • N. Tulek


Crimean-Congo hemorrhagic fever (CCHF) is a disease with high fatality. To demonstrate the effectiveness of ribavirin against CCHF. The first group of 21 patients received ribavirin within 4 days of the onset of symptoms (early use of ribavirin, EUR); the second group of 20 patients received ribavirin ≥5 days after the onset of the symptoms of the disease (late use of ribavirin, LUR); and the last group of 11 patients did not receive ribavirin (no use of ribavirin, NUR). At 5–10 days from the onset of symptoms the mean platelet counts of the patients in the EUR group were significantly higher than those of the patients in LUR group, and at 7–9 days, they were significantly higher than that of the patients in the NUR group. The mean aspartate transferase levels in the EUR group were significantly lower than of the NUR group on days 8 and 9, and the mean alanine transferase level was significantly lower on day 8 after the onset of the symptoms. There is a beneficial effect of ribavirin if given at an early phase of the CCHF. We suggest ribavirin use especially in the early phase of the disease.


Disseminate Intravascular Coagulation Case Fatality Rate Macrophage Activate Syndrome Cytokine Storm Transferase Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Professor Ray W. Guillery for his critical reading and revising the language of the manuscript. This study was presented at the 46th IDSA Congress, USA, 25th October 2008.


  1. 1.
    Hoogstraal H (1979) The epidemiology of tick-borne Crimean-Congo hemorrhagic fever in Asia, Europe, and Africa. J Med Entomol 15(4):307–417PubMedGoogle Scholar
  2. 2.
    Watts DM, Ussery MA, Nash D, Peters CJ (1989) Inhibition of Crimean-Congo hemorrhagic fever viral infectivity yields in vitro by ribavirin. Am J Trop Med Hyg 41(5):581–585PubMedGoogle Scholar
  3. 3.
    Whitehouse CA (2004) Crimean-Congo hemorrhagic fever. Antiviral Res 64(3):145–160PubMedGoogle Scholar
  4. 4.
    Ergonul O, Celikbas A, Baykam N, Eren S, Dokuzoguz B (2006) Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited. Clin Microbiol Infect 12(6):551–554. doi: 10.1111/j.1469-0691.2006.01445.x PubMedCrossRefGoogle Scholar
  5. 5.
    Ergonul O, Celikbaş A, Dokuzoguz B, Eren S, Baykam N, Esener H (2004) Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis 39(2):284–287. doi: 10.1086/422000 PubMedCrossRefGoogle Scholar
  6. 6.
    Karti SS, Odabasi Z, Korten V, Yilmaz M, Sonmez M, Caylan R, Akdogan E, Eren N, Koksal I, Ovali E, Erickson BR, Vincent MJ, Nichol ST, Comer JA, Rollin PE, Ksiazek TG (2004) Crimean-Congo hemorrhagic fever in Turkey. Emerg Infect Dis 10(8):1379–1384PubMedGoogle Scholar
  7. 7.
    WHO (2008) Mediterranean Zoonoses Control Programme of the World Health Organization. Accessed 4 March 2009
  8. 8.
    Bakir M, Ugurlu M, Dokuzoguz B, Bodur H, Tasyaran MA, Vahaboglu H; Turkish CCHF Study Group (2005) Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures. J Med Microbiol 54:385–389. doi: 10.1099/jmm.0.45865-0 PubMedCrossRefGoogle Scholar
  9. 9.
    Ozkurt Z, Kiki I, Erol S, Erdem F, Yilmaz N, Parlak M, Gundogdu M, Tasyaran MA (2006) Crimean-Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy. J Infect 52(3):207–215. doi: 10.1016/j.jinf.2005.05.003 PubMedCrossRefGoogle Scholar
  10. 10.
    Ergönül O (2006) Crimean-Congo haemorrhagic fever. Lancet Infect Dis 6(4):203–214. doi: 10.1016/S1473-3099(06)70435-2 PubMedCrossRefGoogle Scholar
  11. 11.
    Doganci L (2007) New insights on the bleeding disorders in CCHF. J Infect 55(4):379–381. doi: 10.1016/j.jinf.2007.05.179 PubMedCrossRefGoogle Scholar
  12. 12.
    Tasdelen Fisgin N, Fisgin T, Tanyel E, Doganci L, Tulek N, Guler N, Duru F (2008) Crimean-Congo hemorrhagic fever: five patients with hemophagocytic syndrome. Am J Hematol 83(1):73–76. doi: 10.1002/ajh.20969 PubMedCrossRefGoogle Scholar
  13. 13.
    Ergonul O (2008) Treatment of Crimean-Congo hemorrhagic fever. Antiviral Res 78(1):125–131. doi: 10.1016/j.antiviral.2007.11.002 PubMedCrossRefGoogle Scholar
  14. 14.
    Mardani M, Jahromi MK, Naieni KH, Zeinali M (2003) The efficacy of oral ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Iran. Clin Infect Dis 36(12):1613–1618. doi: 10.1086/375058 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • N. Tasdelen Fisgin
    • 1
    Email author
  • O. Ergonul
    • 2
  • L. Doganci
    • 1
  • N. Tulek
    • 1
  1. 1.Faculty of Medicine, Department of Clinical Microbiology and Infectious DiseasesOndokuz Mayis UniversitySamsunTurkey
  2. 2.Faculty of Medicine, Department of Clinical Microbiology and Infectious DiseasesMarmara UniversityIstanbulTurkey

Personalised recommendations