Evidence of vascular endothelial damage in Crimean-Congo hemorrhagic fever

Int J Infect Dis. 2010 Aug;14(8):e704-7. doi: 10.1016/j.ijid.2010.02.2240.


Background: Endothelial infection has an important role in the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF). In this study, we investigated the causes of vascular endothelial damage in patients with CCHF.

Methods: This prospective case-controlled study was carried out at Ankara Numune Education and Research Hospital between April and September 2007. Seventy-five patients with a laboratory-confirmed diagnosis of CCHF and 88 healthy controls were enrolled in the study. Serum levels of soluble cell adhesion molecules (sICAM-1, sVCAM-1, sE-selectin, sP-selectin, sL-selectin), vascular endothelial growth factor (VEGF), and macrophage migration inhibitory factor (MIF) were investigated in these patients by quantitative sandwich ELISA technique.

Results: In the patient group, serum levels of sVCAM-1, sL-selectin and MIF were significantly higher than in the control group; serum levels of sICAM-1, sP-selectin, sE-selectin, and VEGF were significantly lower than in the control group. Serum levels of sVCAM-1 and sICAM-1 were significantly higher in severe cases than in non-severe cases, whereas the serum level of VEGF was significantly lower. sVCAM-1 was significantly higher in non-survivors than in survivors, while serum VEGF was significantly lower in non-survivors. The optimum cut-offs of sVCAM-1 and VEGF for the prediction of mortality were 205 ng/ml and 125 ng/ml, respectively. At these cut-offs, sVCAM-1 and VEGF had a sensitivity of 100% and specificity of 42.5% and 54.5%, respectively, in identifying CCHF patients who would die from the disease. The positive predictive values were 19% and 23%, respectively; negative predictive values were 100% for both.

Conclusion: Endothelial activation can affect the course of CCHF, and vascular endothelial damage is probably indirect. Further studies are needed for general conclusions to be drawn.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Case-Control Studies
  • Cell Adhesion Molecules / blood*
  • Endothelium, Vascular / physiopathology*
  • Endothelium, Vascular / virology
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Hemorrhagic Fever Virus, Crimean-Congo / pathogenicity*
  • Hemorrhagic Fever, Crimean / mortality
  • Hemorrhagic Fever, Crimean / physiopathology*
  • Hemorrhagic Fever, Crimean / virology
  • Humans
  • Intramolecular Oxidoreductases / blood*
  • Macrophage Migration-Inhibitory Factors / blood*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Sensitivity and Specificity
  • Survival Analysis
  • Turkey
  • Vascular Endothelial Growth Factor A / blood*
  • Young Adult


  • Cell Adhesion Molecules
  • Macrophage Migration-Inhibitory Factors
  • Vascular Endothelial Growth Factor A
  • Intramolecular Oxidoreductases
  • MIF protein, human