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However, a CCHFV strain (strain?AP92) was isolated in 1975 from Rhipichepahlus bursa ticks collected from goats in Vergina village, northern Greece [9]. Antibodies against CCHFV were detected in four of 64 residents of the prefecture where strain?AP92 was isolated; however, none of them recalled any illness resembling PF-06463922 research buy CCHF [10]. A serosurvey revealed that 1% of a human population had antibodies to CCHFV [11]. As no CCHF case had been reported in Greece, it was suggested that the human antibodies were against strain?AP92, which seems to be moderately pathogenic to humans, and thus a good candidate for vaccine studies. Genetically, strain?AP92 differs by more than 20% at the nucleotide level in the S RNA segment from all other known CCHFV strains [3,5]. Here we present the laboratory findings on the first clinical CCHF case in Greece with a fatal outcome. On 21 June 2008, a 46-year-old woman was admitted to the Alexandroupoli General University Hospital, with high fever (39.5��C), headache, chills, malaise, nausea, vomiting and abdominal pain following a tick bite 4?days before [12]. The patient was engaged in agricultural activities in Bafilomycin A1 price a rural area, 2?km north of Komotini, a city in Rhodope prefecture, in north-eastern Greece. The city is located at an altitude of 32�C38?m, close to the feet of the Rhodope mountains (latitude 41��7��22���?N, longitude 25��23��47���?E), and 18?km south of the Greek�CBulgarian border (Fig.?1). The patient did not report any travel abroad. Physical examination revealed mild sensitivity during palpation of the right hypochondrium, and a red papule at the site of tick bite was observed. Laboratory examination on admission showed leukocytes at 5620/��L (reference range 4500�C11?000/��L), with 81.4% neutrophils, a haematocrit of 33.5%, platelets at 158?��?109/L, an aspartate transaminase (AST) level of 139?IU/L (reference range FMO5 an International Normalized Ratio of 1.77 (reference range 0.68�C1.17), and D-dimers above 10?000 ng/mL. A few hours after admission, blood re-examination revealed that the platelet level was 100?��?109/L, the A������ was 82.6?s, and the fibrinogen level was 227?mg/dL. A chest X-ray showed a right lower lobe linear atelectasy and bilateral pleural effusion. Echocardiography revealed mild hepatomegaly without focal damage, gall bladder dilatation, and the presence of pericholecystic oedema, as well as fluid collection in the Morrison and Douglas spaces. A computed tomography scan of the abdomen revealed severe ascites under pressure in the whole peritoneum, and liver enlargement. The blood supply was decreased in the arterial phase of the examination.

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