{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T08:39:34Z","timestamp":1792485574471,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":292,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially life\u2010threatening hyperinflammatory complication of Crimean\u2010Congo hemorrhagic fever (CCHF), yet pediatric data remain limited. This study aimed to characterize the clinical phenotype of pediatric CCHF\u2010associated sHLH and to identify early clinical features associated with sHLH development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PCR\u2010confirmed pediatric CCHF cases from four tertiary centers in T\u00fcrkiye (2018\u20132025) were retrospectively analyzed, and clinical characteristics, laboratory findings, treatment, and outcomes were compared between children with and without sHLH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 79 patients, 27 (34.2%) fulfilled the diagnostic criteria for sHLH. Compared with children without sHLH, these patients more frequently presented with hemorrhagic findings (44.4% vs. 11.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), diarrhea (37.0% vs. 7.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004), and bradycardia (25.9% vs. 1.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), and had lower platelet and fibrinogen and higher ferritin, AST, ALT, and LDH concentrations at diagnosis. On multivariable analysis, bradycardia (OR 11.1, 95% CI 1.7\u2013126.3), hemorrhagic findings (OR 7.1, 95% CI 2.1\u201326.5), and diarrhea (OR 6.4, 95% CI 1.6\u201329.0) remained independent predictors; hemorrhagic findings and diarrhea preceded the sHLH diagnosis, whereas bradycardia was identified concurrently. Ferritin and aPTT worsened progressively only in children with sHLH, whereas platelet count declined in both groups. Despite more frequent immunomodulatory therapy and transfusion, no deaths occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Secondary HLH should be actively considered in pediatric CCHF, particularly with hemorrhagic findings, diarrhea, or bradycardia preceding full laboratory evolution to facilitate earlier diagnosis and timely therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ped.70575","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T08:01:16Z","timestamp":1792483276000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemophagocytic Lymphohistiocytosis: An Underrecognized Complication of Pediatric Crimean\u2010Congo Hemorrhagic Fever"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0974-4765","authenticated-orcid":false,"given":"Kubra","family":"Aykac","sequence":"first","affiliation":[{"name":"Department of Pediatric Infectious Diseases Hacettepe University Faculty of Medicine  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0970-5640","authenticated-orcid":false,"given":"Ozlem","family":"Cakici","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Diseases Sivas Numune Hospital  Sivas T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4478-1833","authenticated-orcid":false,"given":"Aylin Irmak","family":"Kuruc","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Diseases Hacettepe University Faculty of Medicine  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3749-3078","authenticated-orcid":false,"given":"Canan","family":"Ozlu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Disease Erzurum City Hospital  Erzurum T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1301-6143","authenticated-orcid":false,"given":"P\u0131nar","family":"Koc","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Hitit University Erol Ol\u00e7ok Training and Research Hospital  \u00c7orum T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8262-3984","authenticated-orcid":false,"given":"Bera Enes","family":"Seyrek","sequence":"additional","affiliation":[{"name":"Hacettepe University School of Medicine  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4968-109X","authenticated-orcid":false,"given":"Tekin","family":"Aksu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology Hacettepe University Faculty of Medicine  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selin","family":"Aytac","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology Hacettepe University Faculty of Medicine  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1405-9754","authenticated-orcid":false,"given":"Hanife","family":"Avci","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Medicine Hacettepe University  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2628-6954","authenticated-orcid":false,"given":"Ali Bulent","family":"Cengiz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Diseases Hacettepe University Faculty of Medicine  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8662-6909","authenticated-orcid":false,"given":"Yasemin","family":"Ozsurekci","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Diseases Hacettepe University Faculty of Medicine  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"World Health Organization \u201cCrimean\u2010Congo Haemorrhagic Fever \u201dWorld Health Organization accessed February 20 2025 https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/crimean\u2010congo\u2010haemorrhagic\u2010fever."},{"key":"e_1_2_11_3_1","unstructured":"T. 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