Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı

Önder ERGÖNÜL (Koç Üniversitesi, Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, İstanbul, Türkiye)
Klimik Dergisi
82 4
Yıl: 2016 Cilt: 29 Sayı: 1 Sayfa Aralığı: 2 - 9 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı

Öz:
Kırım-Kongo kanamalı ateşi (KKKA), dünyada en yaygın olarak görülen viral kanamalı ateşlerin başında gelir. KKKA virusu kene aracılığıyla veya infekte insan veya hayvanların kan ve vücut sıvılarına temas sonucunda bulaşır. Tedavide sıvı replasmanı ve kan ürünleri kullanımının yanı sıra antiviral ilaç olan ribavirin kullanımı değerlendirilmelidir. Antiviral alternatifler arasında ribavirin, in vitro çalışmalarda KKKA virusuna karşı en etkili olan ilaçtır. Ribavirin, gözlemsel çalışmalarda yararlı bulunmuştur. Plasebo kontrollü randomize kontrollü çalışmalar Helsinki deklarasyonuna göre etik dışıdır. KKKA'da ribavirin özellikle erken dönemde verildiği zaman etkilidir. Erken dönemden sonra steroid kullanımının da yararlı olabileceği ileri sürülmüştür. Ribavirin başlanırken ciddiyet skorlaması yapılması önerilmektedir. Konvalesan immün globulin uygulamasının yararı gösterilememiştir. Sağlık çalışanlarında KKKA ile yüksek riskli temas olması durumunda mutlaka ribavirinle profilaksi yapılması önerilir. Bugüne kadar temas sonrası ribavirin başlananlarda ölüm görülmemiştir. Ribavirinin temas sonrası profilakside yararlı olduğunu kabul etmek, ilacın hastalığın erken döneminde de etkili olduğunu kabul etmek anlamına gelmektedir.
Anahtar Kelime:

Konular: Mikrobiyoloji Enfeksiyon Hastalıkları

Crimean-Congo Haemorrhagic Fever: Treatment and Use of Ribavirin

Öz:
Crimean-Congo haemorrhagic fever (CCHF) is one of the most widely seen viral haemorrhagic fever in the world. The CCHF virus is transmitted by the infected ticks or blood and body fluids of infected humans and animals. In therapy, besides the fluid and blood products, ribavirin as an antiviral should be considered. Ribavirin was reported to be the most effective antiviral among the alternatives against CCCF virus in vitro. Observational studies reported the beneficial effect of ribavirin. Placebo controlled randomized studies cannot be performed according to Helsinki declaration. Ribavirin was reported to be effective if it was given at the earlier days of the disease. In later phase, steroid therapy was suggested. Severity scoring was suggested before starting the ribavirin treatment. Convalescent immune globulin use was not found to be beneficial. Post-exposure prophylaxis (PEP) with ribavirin is strongly suggested for healthcare workers with high-risk exposure. No fatality was reported after PEP with ribavirin. Using ribavirin for PEP effectively is consistent with using it for therapy at the early phase of the disease.
Anahtar Kelime:

Konular: Mikrobiyoloji Enfeksiyon Hastalıkları
Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
  • Ergönül Ö. Crimean-Congo haemorrhagic fever. Lancet Infect Dis. 2006; 6(4): 203-14.
  • Ergonul O, Whitehouse CA. Introduction. In: Ergonul O, White- house CA, eds. Crimean Congo Hemorrhagic Fever: A Global Perspective. Dordrecht (NL): Springer, 2007: 3-11.
  • Ergonul O. Crimean-Congo hemorrhagic fever virus: new outbre- aks, new discoveries. Curr Opin Virol. 2012; 2(2): 215-20.
  • Ergönül Ö, Çelikbaş A, Dokuzoğuz B, Eren S, Baykam N, Esener H. Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis. 2004; 39(2): 284-7.
  • Karti SS, Odabasi Z, Korten V, et al. Crimean-Congo hemorrhagic fever in Turkey. Emerg Infect Dis. 2004; 10(8): 1379-84.
  • Bakir M, Ugurlu M, Dokuzoguz B, Bodur H, Tasyaran MA, Vaha- boglu H. Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures. J Med Microbiol. 2005; 54(4): 385-9.
  • Peters CJ, Zaki SR. Overview of viral hemorrhagic fevers. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Di- seases: Principles, Pathogens, and Practice. Philadelphia, PA: Churchill Livingstone, 2006: 726-33.
  • Ergonul O, Battal I. Potential sexual transmission of Crimean- Congo hemorrhagic fever infection. Jpn J Infect Dis. 2014; 67(2): 137-8.
  • Bray M. Comparative pathogenesis of Crimean-Congo hemorr- hagic fever and Ebola hemorrhagic fever. In: Ergonul O, White- house CA, eds. Crimean-Congo Hemorrhagic Fever: A Global Perspective. Dordrecht (NL): Springer, 2007: 221-31.
  • Geisbert TW, Jahrling PB. Exotic emerging viral diseases: prog- ress and challenges. Nat Med. 2004; 10(12 Suppl): S110-21.
  • Ergonul O, Tuncbilek S, Baykam N, Celikbas A, Dokuzoguz B. Evaluation of serum levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha in patients with Crimean-Congo hemorr- hagic fever. J Infect Dis. 2006; 193(7): 941-4.
  • Tasdelen Fisgin N, Fisgin T, Tanyel E, et al. Crimean-Congo he- morrhagic fever: Five patients with hemophagocytic syndrome. Am J Hematol. 2007; 83(1): 73-6.
  • Cagatay A, Kapmaz M, Karadeniz A, et al. Haemophagocytosis in a patient with Crimean-Congo haemorrhagic fever. J Med Micro- biol. 2007; 56(Pt 8): 1126-8.
  • Ergonul O. Clinical and pathologic features of Crimean-Congo hemorrhagic fever. In: Ergonul O, Whitehouse CA, eds. Crime- an-Congo Hemorrhagic Fever: A Global Perspective. Dordrecht (NL): Springer; 2007: 207-20.
  • Goldfarb LG, Chumakov MP, Myskin AA, Kondratenko VF, Rez- nikova OY. An epidemiological model of Crimean hemorrhagic fever. Am J Trop Med Hyg. 1980; 29(2): 260-4.
  • Hoogstraal H. The epidemiology of tick-borne Crimean-Congo hemorrhagic fever in Asia, Europe, and Africa. J Med Entomol. 1979; 15(4): 307-417.
  • Swanepoel R, Gill DE, Shepherd AJ, Leman PA, Mynhardt JH, Harvey S. The clinical pathology of Crimean-Congo hemorrhagic fever. Rev Infect Dis. 1989; 11(Suppl 4): S794-800.
  • Blumberg L, Enria D, Bausch DG. Viral haemorrhagic fevers. In: Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ, eds. Manson's Tropical Diseases. 23rd ed. London: Elsevier Saun- ders, 2014: 171-94.
  • McCormick JB, King IJ, Webb PA, et al. Lassa fever. Effective the- rapy with ribavirin. N Engl J Med. 1986; 314(1): 20-6.
  • Bausch DG, Hadi CM, Khan SH, Lertora JJ. Review of the lite- rature and proposed guidelines for the use of oral ribavirin as postexposure prophylaxis for Lassa fever. Clin Infect Dis. 2010; 51(12): 1435-41.
  • Sidwell RW, Smee DF. Viruses of the Bunya- and Togaviridae fa- milies: potential as bioterrorism agents and means of control. Antiviral Res. 2003; 57(1-2): 101-11.
  • Huggins JW, Hsiang CM, Cosgriff TM, et al. Prospective, double- blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome. J Infect Dis. 1991;164(6): 1119-27.
  • Tignor GH, Hanham CA. Ribavirin efficacy in an in vivo model of Crimean-Congo hemorrhagic fever virus (CCHF) infection. Anti- viral Res. 1993; 22(4): 309-25.
  • Watts DM, Ussery MA, Nash D, Peters CJ. Inhibition of Crime- an-Congo hemorrhagic fever viral infectivity yields in vitro by ribavirin. Am J Trop Med Hyg. 1989; 41(5): 581-5.
  • Heagy W, Crumpacker C, Lopez PA, Finberg RW. Inhibition of immune functions by antiviral drugs. J Clin Invest. 1991; 87(6): 1916-24.
  • Paragas J, Whitehouse CA, Endy TP, Bray M. A simple assay for determining antiviral activity against Crimean-Congo hemorrha- gic fever virus. Antiviral Res. 2004; 62(1): 21-5.
  • Ergonul O. Treatment of Crimean-Congo hemorrhagic fever. An- tiviral Res. 2008; 78(1): 125-31.
  • Fisher-Hoch SP, Khan JA, Rehman S, Mirza S, Khurshid M, McCormick JB. Crimean Congo-haemorrhagic fever treated with oral ribavirin. Lancet. 1995; 346(8973): 472-5.
  • Mardani M, Jahromi MK, Naieni KH, Zeinali M. The efficacy of oral ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Iran. Clin Infect Dis. 2003; 36(12): 1613-8.
  • Ozkurt Z, Kiki I, Erol S, et al. Crimean-Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy. J Infect. 2006; 52(3): 207-15.
  • Dokuzoguz B, Kocagül Celikbas A, Gök SE, Baykam N, Eroglu MN, Ergönül Ö. Severity scoring index for Crimean-Congo he- morrhagic fever and the impact of ribavirin and corticosteroids on fatality. Clin Infect Dis. 2013; 57(9): 1270-4.
  • Arda B, Aciduman A, Johnston JC. A randomised controlled trial of ribavirin in Crimean Congo haemorrhagic fever: ethical consi- derations. J Med Ethics. 2012; 38(2): 117-20.
  • Ergonul O. Treatment of Crimean-Congo hemorrhagic fever. In: Ergonul O, Whitehouse CA, eds. Crimean-Congo Hemorrhagic Fe- ver: A Global Perspective. Dordrecht (NL): Springer, 2007: 245-60.
  • Tasdelen Fisgin N, Ergonul O, Doganci L, Tulek N. The role of ribavirin in the therapy of Crimean-Congo hemorrhagic fever: early use is promising. Eur J Clin Microbiol Infect Dis. 2009; 28(8): 929-33.
  • Izadi S, Salehi M. Evaluation of the efficacy of ribavirin therapy on survival of Crimean-Congo hemorrhagic fever patients: a ca- se-control study. Jpn J Infect Dis. 2009; 62(1): 11-5.
  • Sharifi-Mood B, Metanat M, Ghorbani-Vaghei A, Fayyaz-Jahani F, Akrami E. The outcome of patients with Crimean-Congo he- morrhagic fever in Zahedan, southeast of Iran: a comparative study. Arch Iran Med. 2009;12(2):151-3.
  • Bakır Ozbey S, Kader Ç, Erbay A, Ergönül Ö. Early use of riba- virin is beneficial in Crimean-Congo hemorrhagic fever. Vector Borne Zoonotic Dis. 2014; 14(4): 300-2.
  • Elaldi N, Bodur H, Ascioglu S, et al. Efficacy of oral ribavirin tre- atment in Crimean-Congo haemorrhagic fever: a quasi-experi- mental study from Turkey. J Infect. 2009; 58(3): 238-44.
  • Ergonul O. Biases and misinterpretation in the assessment of the efficacy of oral ribavirin in the treatment of Crimean-Congo hemorrhagic fever [Letter]. J Infect. 2009; 59(4): 284-6.
  • Ascioglu S, Leblebicioglu H, Elaldi N, Bodur H, Vahaboglu H. Res- ponse to Ergonul: Scientific evidence versus personal beliefs in Crimean-Congo haemorrhagic fever treatment [Letter]. J Infect. 2009; 59(4): 286-9.
  • Ascioglu S, Leblebicioglu H, Vahaboglu H, Chan KA. Ribavirin for patients with Crimean-Congo haemorrhagic fever: a systematic review and meta-analysis. J Antimicrob Chemother. 2011; 66(6): 1215-22.
  • Koksal I, Yilmaz G, Aksoy F, et al. The efficacy of ribavirin in the treatment of Crimean-Congo hemorrhagic fever in Eastern Black Sea region in Turkey. J Clin Virol. 2010; 47(1): 65-8.
  • Alavi-Naini R, Moghtaderi A, Koohpayeh HR, et al. Crimean- Congo hemorrhagic fever in Southeast of Iran. J Infect. 2006; 52(5): 378-82.
  • ECDC Meeting Report: Consultation on Crimean-Congo Hae- morrhagic Fever Prevention and Control (Stockholm, Septem- ber 2008) [İnternet]. Stockholm: European Disease Prevention and Control [erişim 25 Mart 2016]. http://ecdc.europa.eu/en/ publications/Publications/0809_MER_Crimean_Congo_Haemor- ragic_Fever_Prevention_and_Control.pdf.
  • Ergonul O, Celikbas A, Yildirim U, et al. Pregnancy and Crime- an-Congo haemorrhagic fever. Clin Microbiol Infect. 2010; 16(6): 647-50.
  • Dizbay M, Aktas F, Gaygisiz U, Ozger HS, Ozdemir K. Crimean- Congo hemorrhagic fever treated with ribavirin in a pregnant woman. J Infect. 2009; 59(4): 281-3.
  • Furuta Y, Gowen BB, Takahashi K, Shiraki K, Smee DF, Barnard DL. Favipiravir (T-705), a novel viral RNA polymerase inhibitor. Antiviral Res. 2013; 100(2): 446-54.
  • Qiu X, Wong G, Audet J, et al. Reversion of advanced Ebola vi- rus disease in nonhuman primates with ZMapp. Nature. 2014; 514(7520): 47-53.
  • Thi EP, Mire CE, Lee AC, et al. Lipid nanoparticle siRNA treatment of Ebola-virus-Makona-infected nonhuman primates. Nature. 2015; 521(7552): 362-5.
  • Warren TK, Shurtleff AC, Bavari S. Advanced morpholino oligo- mers: a novel approach to antiviral therapy. Antiviral Res. 2012; 94(1): 80-8.
  • Warren TK, Wells J, Panchal RG, et al. Protection against filo- virus diseases by a novel broad-spectrum nucleoside analogue BCX4430. Nature. 2014; 508(7496): 402-5.
  • Enria DA, Briggiler AM, Fernandez NJ, Levis SC, Maiztegui JI. Importance of dose of neutralising antibodies in treatment of Argentine haemorrhagic fever with immune plasma. Lancet. 1984; 2(8397): 255-6.
  • Enria DA, Mills JN, Bausch D, Shieh WJ,Peters CJ. Arenavirus infections. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases Principles, Pathogens and Practice. 3rd ed. Edinburgh: Saunders Elsevier, 2011: 449-61.
  • Vassilenko SM, Vassilev TL, Bozadjiev LG, Bineva IL, Kazarov GZ. Specific intravenous immunoglobulin for Crimean-Congo hae- morrhagic fever. Lancet. 1990; 335(8692): 791-2.
  • Kubar A, Haciomeroglu M, Ozkul A, et al. Prompt administration of Crimean-Congo hemorrhagic fever (CCHF) virus hyperimmu- noglobulin in patients diagnosed with CCHF and viral load mo- nitorization by reverse transcriptase-PCR. Jpn J Infect Dis. 2011; 64(5): 439-43.
  • Russel JA. Management of sepsis. N Engl J Med. 2006; 355(16): 1699-713.
  • Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lo- pez-Rodriguez A. Efficacy and safety of recombinant human ac- tivated protein C for severe sepsis. N Engl J Med. 2001; 344(10): 699-709.
  • Whitehouse CA. Risk groups and control measures for Crime- an-Congo hemorrhagic fever. In: Ergonul O, Whitehouse CA, eds. Crimean-Congo Hemorrhagic Fever: A Global Perspective. Dordrecht (NL): Springer, 2007: 273-80.
  • Fisher-Hoch SP, McCormick JB, Swanepoel R, Van Middlekoop A, Harvey S, Kustner HG. Risk of human infections with Crimean- Congo hemorrhagic fever virus in a South African rural commu- nity. Am J Trop Med Hyg. 1992; 47(3): 337-45.
  • Tarantola A, Ergonul O, Tattevin P. Estimates and prevention of Crimean-Congo hemorrhagic fever risks for health care workers. In: Ergonul O, Whitehouse CA, eds. Crimean-Congo Hemorrha- gic Fever: A Global Perspective. Dordrecht (NL): Springer, 2007: 281-94.
  • Akhtar J. Crimean-Congo haemorrhagic fever: An alert for health care workers. J Coll Physicians Surg Pak. 2005; 15(12): 751-2.
  • Altaf A, Luby S, Ahmed AJ, et al. Outbreak of Crimean-Congo haemorrhagic fever in Quetta, Pakistan: contact tracing and risk assessment. Trop Med Int Health. 1998; 3(11): 878-82.
  • Aradaib IE, Erickson BR, Karsany MS, et al. Multiple Crimean- Congo hemorrhagic fever virus strains are associated with dise- ase outbreaks in Sudan, 2008-2009. PLoS Negl Trop Dis. 2011; 5(5): e1159.
  • Athar MN, Baqai HZ, Ahmad M, et al. Short report: Crimean- Congo hemorrhagic fever outbreak in Rawalpindi, Pakistan, Feb- ruary 2002. Am J Trop Med Hyg. 2003; 69(3): 284-7.
  • Bangash SA, Khan EA. Treatment and prophylaxis with ribavirin for Crimean-Congo hemorrhagic fever--is it effective? J Pak Med Assoc. 2003; 53(1): 39-41.
  • Bulut C, Yilmaz GR, Karakoç E, Önde U, Koçak Tufan Z, Demiröz AP. Risk of Crimean-Congo haemorrhagic fever among healthca- re workers [Abstract]. Clin Microbiol Infect. 2009; 15(Suppl. 4): S654.
  • Kocagul Celikbas A, Dokuzoğuz B, Baykam N, et al. Crimean- Congo hemorrhagic fever among health care workers, Turkey. Emerg Infect Dis. 2014; 20(3): 477-9.
  • Chinikar S, Shayesteh M, Khakifirouz S, et al. Nosocomial infec- tion of Crimean-Congo haemorrhagic fever in eastern Iran: case report. Travel Med Infect Dis. 2013; 11(4): 252-5.
  • Conger NG, Paolino KM, Osborn EC, et al. Health care response to CCHF in US soldier and nosocomial transmission to health care providers, Germany, 2009. Emerg Infect Dis. 2015; 21(1): 23- 31.
  • Guner R, Hasanoglu I, Tasyaran MA, et al. Is ribavirin prophyla- xis effective for nosocomial transmission of Crimean-Congo he- morrhagic fever? Vector Borne Zoonotic Dis. 2014; 14(8): 601-5.
  • Hasan Z, Mahmood F, Jamil B, et al. Crimean-Congo hemorrha- gic fever nosocomial infection in a immunosuppressed patient, Pakistan: case report and virological investigation. J Med Virol. 2013; 85(3): 501-4.
  • Mardani M, Keshtkar-Jahromi M, Ataie B, Adibi P. Crimean-Con- go hemorrhagic fever virus as a nosocomial pathogen in Iran. Am J Trop Med Hyg. 2009; 81(4): 675-8.
  • Mardani M, Rahnavardi M, Rajaeinejad M, et al. Crimean-Congo hemorrhagic fever among health care workers in Iran: a serop- revalence study in two endemic regions. Am J Trop Med Hyg. 2007; 76(3): 443-5.
  • Mishra AC, Mehta M, Mourya DT, Gandhi S. Crimean-Congo ha- emorrhagic fever in India. Lancet. 2011; 378(9788): 372.
  • Nabeth P, Cheikh DO, Lo B, et al. Crimean-Congo hemorrhagic fever, Mauritania. Emerg Infect Dis. 2004; 10(12): 2143-9.
  • Naderi HR, Sarvghad MR, Bojdy A, Hadizadeh MR, Sadeghi R, Sheybani F. Nosocomial outbreak of Crimean-Congo haemorr- hagic fever. Epidemiol Infect. 2011; 139(6): 862-6.
  • Naderi HR, Sheybani F, Bojdi A, Khosravi N, Mostafavi I. Fatal nosocomial spread of Crimean-Congo hemorrhagic fever with very short incubation period. Am J Trop Med Hyg. 2013; 88(3): 469-71.
  • Papa A, Bino S, Llagami A, et al. Crimean-Congo hemorrhagic fe- ver in Albania, 2001. Eur J Clin Microbiol Infect Dis. 2002; 21(8): 603-6.
  • Parlak E, Koşan Z, Ertürk A, Parlak M, Özkurt Z. A nosocomial outbreak of Crimean-Congo hemorrhagic fever. Journal of Mic- robiology and Infectious Diseases. 2015; 5(1): 5-9.
  • Patel AK, Patel KK, Mehta M, Parikh TM, Toshniwal H, Patel K. First Crimean-Congo hemorrhagic fever outbreak in India. J As- soc Physicians India. 2011; 59(9): 585-9.
  • Pshenichnaya NY, Nenadskaya SA. Probable Crimean-Congo hemorrhagic fever virus transmission occurred after aerosol-ge- nerating medical procedures in Russia: nosocomial cluster. Int J Infect Dis. 2015; 33: 120-2.
  • Tishkova FH, Belobrova EA, Valikhodzhaeva M, Atkinson B, Hewson R, Mullojonova M. Crimean-Congo hemorrha- gic fever in Tajikistan. Vector Borne Zoonotic Dis. 2012; 12(9): 722-6.
  • Tulek N, Bulut C, Ergin F, Tuncer Ertem G, Ataman Hatipoglu C, Oral B. Unusual nosocomial transmission of Crimean-Congo ha- emorrhagic fever; two cases report from Turkey [Abstract]. Clin Microbiol Infect. 2010; 16(Suppl. 2): S701.
  • Ergonul O, Zeller HG, Celikbas A, Dokuzoguz B. The lack of Cri- mean-Congo hemorrhagic fever virus antibodies in healthcare workers in an endemic region. Int J Infect Dis. 2007; 11: 48-51.
  • Ergönül Ö, Kara İA, Çeldir MG, Keske Ş. Sağlık çalışanlarında mes- leksel Kırım-Kongo kanamalı ateşi infeksiyonu: yayınlanmış olgu- ların sistematik analizi [Özet]. In: Tekin S, ed. KLİMİK 2016 - 30. Yıl Kurultayı (9-12 Mart 2016, Antalya) Özet Kitabı. İstanbul: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği, 2016: 314.
APA Ergönül Ö (2016). Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. , 2 - 9.
Chicago Ergönül Önder Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. (2016): 2 - 9.
MLA Ergönül Önder Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. , 2016, ss.2 - 9.
AMA Ergönül Ö Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. . 2016; 2 - 9.
Vancouver Ergönül Ö Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. . 2016; 2 - 9.
IEEE Ergönül Ö "Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı." , ss.2 - 9, 2016.
ISNAD Ergönül, Önder. "Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı". (2016), 2-9.
APA Ergönül Ö (2016). Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. Klimik Dergisi, 29(1), 2 - 9.
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MLA Ergönül Önder Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. Klimik Dergisi, vol.29, no.1, 2016, ss.2 - 9.
AMA Ergönül Ö Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. Klimik Dergisi. 2016; 29(1): 2 - 9.
Vancouver Ergönül Ö Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı. Klimik Dergisi. 2016; 29(1): 2 - 9.
IEEE Ergönül Ö "Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı." Klimik Dergisi, 29, ss.2 - 9, 2016.
ISNAD Ergönül, Önder. "Kırım-Kongo Kanamalı Ateşi Tedavisi ve Ribavirin Kullanımı". Klimik Dergisi 29/1 (2016), 2-9.
Sayfa Oluşturulma Tarihi
23-04-2024 0:3

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