Nosocomial infection of Crimean-Congo hemorrhagic fever in Kosovo

Abstract

Aims: To analyze the clinical manifestations and outcome in four cases with nosocomial infection of Crimean–Congo hemorrhagic fever (CCHF) disease; treated at the Infectious Diseases Clinic in Prishtina (Kosovo). Material and methods: In this retrospective study, the medical data and the history of four health care workers with CCHF were analyzed. The diagnosis was confirmed by real-time polymerase chain reaction (RT-PCR). The health workers were engaged in the management of patients with severe forms of CCHF. Results: In all four cases the infection was caused by not following the protective measures.Three otolaryngology doctors were infected during tamponades of the nasal cavities of the patients with CCHF. Two of them did not wear any of the protective measures (the nasal tamponade was done without gloves and mask). The third doctor was not wearing the face shield and goggles with side shields (infection occurred after coughing blood drops were deposited on the doctor's face. The fourth case was a laboratory hygienist who cleaned test tubes with blood samples from patients with CCHF without the use of protective gloves. The mean incubation period of the disease was 6.2 days. Two of the cases manifested moderately severe disease by fever and other nonspecific symptoms including chills, severe headache, dizziness, neck pain, nausea, vomiting, myalgia, and arthralgia without hemorrhagic syndrome. In two cases the disease had severe clinical manifestations with fever, other nonspecific symptoms and hemorrhagic syndrome which in one case ended with hemorrhagic shock and fatal outcome. Discussion and conclusion: Kosovo is an endemic region, with frequent epidemic outbreaks and sporadic cases occurring with hospitalized case fatality of approximately 30%. CCHF is a very contagious disease which is transmitted among the health workers by blood and other body fluids. Accidental infections are possible if strict universal precautions are not followed. Nosocomial infections can be serious and with possible fatal outcome.