Research in Medicine

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Crimean-Congo Hemorrhagic Fever (CCHF) is a potentially fatal viral disease. Humans usually acquire the illness through tick bite or from contact with infected blood or other tissues from patients or livestock. CCHF is reported from most parts of Asia, Africa and Europe. This illness was endemic in the eastern provinces of the Caspian sea and has been described in old Iranian medical references. Because of the low incidence, reports on histopathologic findings are relatively few and limited worldwide. In this study we review the necropsy findings of a 24-year old woman with fatal form of CCHF in whom the diagnosis was established with positive viral culture and positive ELISA and RT-PCR in WHO reference laboratory. In liver, hepatocyte necrosis without inflammatory cells in bone marrow, hyperplasia of all three cell lines with myeloid preponderance in lungs, polymorphonuclear infiltration in alveolar spaces and alveolar edema in kidneys, glomerular necrosis, interstitial edema and tubular necrosis, and in brain, generalized edema with degenerative and cystic changes were found. There was no pathologic finding in striated muscle samples with light microscopy. In brief, these findings are compatible with multi-organ failure. Because of many new cases of this disease in recent years in Iran, widespread research for evaluation of histopathological changes is needed in Iranian patients to assist physicians and pathologists towards prompt diagnosis.

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Background : Familial Mediterranean fever (FMF) is an autosomal recessive disease, which is characterized by recurrent short episodes of inflammation in serous membranes. It is most prevalent in Western Mediterranean population. MEFV is the only gene currently known to be associated with this disease. Previous studies revealed that 6% of Iranian Jewish residents in Israel were carriers of MEFV mutation. The present study was undertaken to analyze the three known mutations of this gene in Iranian patients.

 Materials and methods : Thirty patients met full inclusion criteria and 30 healthy controls enrolled in the study. To detect M694V, M680I and V726I mutations, genomic DNA, extracted from peripheral blood lymphocytes, was examined using amplification refractory mutation system (ARMS-PCR) and common, normal and mutant specific primers.
Results: Fever and intermittent episodic abdominal pain were the most common manifestations among the cases. Of the 30 cases, 9(30%) were positive for M694V mutation (2 homozygote, 6 simple heterozygote, and one compound heterozygote), 4 (13.3%) for M680I mutation (one homozygote, 2 simple heterozygote, and one compound heterozygote) and one (3.3%) for V726I mutation. All controls were negative for these three mutations.
Conclusion: As in other ethnic groups, M694V mutation is the most common MEFV mutation in Iranian FMF patients but it exists in lower frequency. Consequently we recommend full mutation analysis of MEFV gene in all of our samples especially in those we could not find any of the three mutations mentioned above.

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Background: It is frequently thought that lumbar puncture (LP), is a mandatory procedure in all children presenting with febrile convulsion since convulsion may be the sole clinical manifestation of bacterial meningitis. The present study was conducted to assess whether meningitis could be recognized using readily available clinical information. Materials and methods: During the study period, 254 previously healthy children aged 6 months to 5 years were brought consecutively to the pediatric department of a teaching university hospital after their first febrile convulsion. Lumbar puncture (LP) was performed in all cases. Children with febrile convulsion and meningitis served as cases and those with febrile convulsion in the absence of meningitis, served as controls. The following factors were compared between groups: age, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use. Results: Of 245 infants, 12(4.7%) had meningitis. The following risk factors were significantly associated with meningitis: lethargy (p<0.0006), irritability (p<0.0008), vomiting (p<0.0001), nuchal rigidity (p<0.0001), bulging fontanel (p<0.05), headache (p<0.006), drowsiness (p<0.0001), toxicity (p<0.0012), coma (p<0.005), complex seizure (p<0.04), and prior antibiotic use (p<0.0002). All children with meningitis had at least one of the following risk factors: prior antibiotic use, positive clinical manifestations. Conclusion: Our results indicate that clinical manifestations and type of convulsion (simple or complex) could be used to diagnose meningitis, thus, there is no need for routine "LP" in all children who present with fever and seizure. However a lumbar puncture is mandatory in infants younger than 12 months or those who have received prior antibiotics.