Crimean-Congo Hemorrhagic Fever Cases Research Articles

Using of ELISA in Diagnosis of Crimean-Congo Hemorrhagic Fever Virus, a Case Report

This report is a case of Crimean-Congo hemorrhagic fever (CCHF) witch observed in a tourist woman in Istanbul. The patient presented with chills and abdominal pain. For this blood sample has been collected at the onset of the disease and tested for CCHFV antigen by using Enzyme-linked immunosorbent assay (ELISA). In result, antigen positive has been determined and the patient was found to be positive for CCHFV by ELISA.

Emergence of viral hemorrhagic fevers

The emerging and re-emerging diseases are posing a great health risk for the last few years. One such category of diseases is viral haemorrhagic fevers (VHFs), which have emerged in the new territories, worldwide. Crimean Congo Hemorrhagic Fever (CCHF) cases, for the first time in India, were reported from Gujarat, in January 2011. The emergence of diseases not reported earlier, pose great economic and social challenge, burden health system, and create panic reaction. Nonetheless, with recent experience in control of epidemic diseases, and advances in basic scientific knowledge; the public health community is better prepared for these unexpected events. This review provides information to physicians on CCHF for managing outbreak, and identifies public health measures to prevent emergence and re-emergence of VHFs (including CCHF) in future. The authors suggest that though, there are a few challenging and unanswered questions, the public health preparedness still remains the key to control emerging and re-emerging diseases. The countries where virus activities have been reported need to be prepared accordingly.

Crimean-­‐Congo haemorrhagic fever: An outbreak in India

Crimean-­‐Congo haemorrhagic fever: An outbreak in India

Re-Evaluation of 400 Crimean-Congo Hemorrhagic Fever Cases in an Endemic Area: Is Ribavirin Treatment Suitable?

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease, seen in various regions around the world, leading to death following a clinical syndrome of hemorrhagic fever. This trial was conducted in Tokat State Hospital that is located in an endemic area. Four hundred patients referring to hospital between 2007 and 2009 and diagnosed as having CCHF with RT-PCR were enrolled in this trial. Ribavirin was not administered to any patient. Epidemiological, clinical, and laboratory findings of CCHF and factors affecting mortality were evaluated. Twenty patients (5%) died and 380 patients recovered (95%). It was found that mean age, white blood cells (WBC), active tromboplastine time (aPTT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) values were significantly higher in patients who died, as compared with recovered cases and the difference was significant. Platelet values were significantly lower in patients who died, as compared with recovered cases. Age, male gender, high levels of ALT, AST, WBC aPTT values, platelet levels, and decrease in these values during follow-up are indicative of a poor prognosis. Use of ribavirin is not required in treatment of CCHF.

Species distribution and detection of Crimean Congo Hemorrhagic Fever Virus (CCHFV) in field-collected ticks in Ankara Province, Central Anatolia, Turkey

Ticks may act as vectors for a number of infectious diseases including Crimean Congo Hemorrhagic Fever (CCHF). The causative agent is Crimean Congo Hemorrhagic Fever Virus (CCHFV), a member of Bunyaviridae, causing extensive ecchymosis, visceral bleeding and hepatic dysfunction with a high fatality rate in the affected individuals. CCHF was initially recognized in Turkey in 2002 and the current number of reported cases exceeds 4,400. This study was conducted to confirm the presence of tick species established as potential CCHFV vectors and investigate CCHFV activity in ticks at Ankara province, Turkey's second most-densely populated province, where CCHF cases were demonstrated. A total of 1,196 adult ticks, collected from various animals and vegetation in 12 sites located in 5 counties of Ankara during April-July 2010 were identified to species level. Twenty-two tick pools from county K2 were also evaluated for the presence of CCHFV RNA via a one-step real-time RT-PCR assay and reactive results were further confirmed by an in house nested RT-PCR assay. Nine tick species were identified: Rhipicephalus bursa (44.9%), R. sanguineus (18.9%), R. turanicus (18.1%), Haemaphysalis parva (8.3%), Hyalomma marginatum marginatum (5.4%), H. aegyptium (1.4%), H. anatolicum excavatum (1.3%), Hae. punctata (0.3%) and Dermacentor marginatus (0.2%). A total of five tick pools (22.7%) were reactive in real-time and nested RT-PCR assays. The pools included R. bursa, H. m. marginatum and Hae. parva ticks, collected from mammal hosts from two villages in one county. This is the first documentation of CCHFV activity in ticks from Ankara province, which indicates requirement for detailed surveillance to predict high risk zones in the region.

Prognostic significance of antithrombin activity in patients with crimean-congo hemorrhagic Fever.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic fever. Disseminated intravascular coagulation (DIC) is an important complication of this disease, especially in severe and fatal cases. Antithrombin (AT) acts as an anticoagulant by inactivating thrombin, Factor IX, Factor X and Factor XI. We conducted this study to investigate the AT levels and their prognostic value in CCHF. Twenty-eight confirmed CCHF patients were included in this study. Diagnosis of the disease was made by CCHF IgM and/or PCR positivity. Patients were grouped based on the severity criteria described previously. The patients with platelet counts <20 000×10(6) cell/L, white blood counts >10×10(9) cell/L, prothrombin times >60 seconds, aspartate aminotransferase levels >700 IU/L or alanine aminotransferase levels >900 IU/L were accepted as severe cases. Patients whose illnesses were self-limited and who did not require blood component replacement were accepted as mild cases, and patients who improved but required blood component replacement were accepted as moderate cases. Blood samples were obtained on the day that the patient had the lowest platelet count and before any thrombocyte replacement. The antithrombin activity was measured using a chromogenic substrate test (Diagnostica Stago STA Compact) at a research laboratory. Twenty-two (78.6%) of the cases were mild, 3 (10.7%) were moderate, and 3 were (10.7%) severe. The mean AT value was 101% for mild cases, 116.6 % for moderate cases, and 88% for severe cases (p>0.05). Although there were no statistically significant differences between the AT values, the mean AT activity was lower in severe CCHF cases. The AT activity may have been decreased in severe CCHF cases. Further studies with greater numbers of patients are required to determine the level of AT activity and its correlation with disease severity and the prognosis of CCHF.

Multiple Crimean-Congo Hemorrhagic Fever Virus Strains Are Associated with Disease Outbreaks in Sudan, 2008–2009

BackgroundCrimean-Congo hemorrhagic fever (CCHF) activity has recently been detected in the Kordufan region of Sudan. Since 2008, several sporadic cases and nosocomial outbreaks associated with high case-fatality have been reported in villages and rural hospitals in the region.Principal FindingsIn the present study, we describe a cluster of cases occurring in June 2009 in Dunkop village, Abyei District, South Kordufan, Sudan. Seven CCHF cases were involved in the outbreak; however, clinical specimens could be collected from only two patients, both of whom were confirmed as acute CCHF cases using CCHF-specific reverse transcriptase polymerase chain reaction (RT-PCR). Phylogenetic analysis of the complete S, M, and L segment sequences places the Abyei strain of CCHF virus in Group III, a virus group containing strains from various countries across Africa, including Sudan, South Africa, Mauritania, and Nigeria. The Abyei strain detected in 2009 is genetically distinct from the recently described 2008 Sudanese CCHF virus strains (Al-fulah 3 and 4), and the Abyei strain S and L segments closely match those of CCHF virus strain ArD39554 from Mauritania.ConclusionsThe present investigation illustrates that multiple CCHF virus lineages are circulating in the Kordufan region of Sudan and are associated with recent outbreaks of the disease occurring during 2008–2009.

A case of Crimean-Congo haemorrhagic fever successfully treated with therapeutic plasma exchange and ribavirin

Crimean-Congo haemorrhagic fever (CCHF) has become an important problem in certain parts of the world. Cytokine storm plays a critical role in the pathogenesis of CCHF. Early diagnosis, supportive therapy and invasive monitoring are the cornerstones of the management of CCHF. Ribavirin is active against CCHF virus in vitro, however, evidence of clinical efficacy is still conflicting. Here, we describe a patient successfully recovered from CCHF with a combination of plasma exchange and ribavirin therapy.

Crimean-Congo hemorrhagic fever disease due to tick bite with very long incubation periods

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate, and is one of the viral hemorrhagic fever syndromes. The average mortality rate of CCHF is 3-30%. Research indicates that the longest incubation period after a tick bite is 12 days in CCHF disease. However, in clinical practice, we encounter patients with CCHF as a result of tick bites with much longer incubation periods (max. 53 days) than those reported in the literature. We present herein CCHF cases presumably infected through tick bites and having incubation periods longer than the upper limit reported in the literature. We analyzed the cases of the 825 CCHF patients admitted to our hospital from 2007 to 2010 and found that 312 of them had undoubtedly been bitten by a tick. We searched the patient records for information on the incubation period and found that 12 patients had experienced an incubation period of over 12 days, which is the longest incubation period stated in the literature for patients definitely bitten by a tick. A total of 12 patients (eight males and four females, with a mean age of 45 years) were recruited into this study. Five (41.7%) of the 12 patients had positive CCHF virus-specific IgM antibodies, three (25%) had a positive reverse transcription polymerase chain reaction test for CCHF virus, and four (33.3%) had positive results in both tests during the acute and/or convalescent phase of the disease. In these cases, the interval between tick bite and the onset of symptoms was a mean of 23.6 days (range 13-53 days). Physicians serving in endemic regions should be aware of these longer incubation periods after a tick bite. It is suggested that they perform more follow-ups on clinically and serologically highly suspected patients than they currently do.

Floods in Pakistan: a public health crisis

Background In August 2010, Pakistan experienced floods that affected 20 million people in 78 districts, killed 1800, damaged or destroyed about 2 million homes, 514 health facilities and inundated a land mass the size of England. (1) Prior to this current crisis, Pakistan already had about four million internally displaced people and refugees due to the war along the Afghan border and the 2005 earthquake in Khyber-Pakhtunkhwa (formerly North-West Frontier Province). Health indicators in Pakistan were dismal even before the floods, with maternal mortality at 230 (190-280) per 100 000 live births and under-5 mortality at 89 per 1000 live births. (2) Most of the flooded populations comprise the lowest socioeconomic quintiles that were already facing neglect. This crisis has worsened their plight. Relief agencies Relief operations were mainly carried out by the Pakistani government, the army and international agencies such as the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Medecins Sans Frontieres and the United States Agency for International Development (USAID). (3) In addition, civilian volunteers, independent teams of physicians, nongovernmental organizations and various other groups with little experience in disaster relief were also working in the field. The Pakistan army provided the most visible rescue operations but was overextended with massive rescue efforts, shoring up and breaching dykes, as well as fighting the war in the tribal areas. The National Disaster Management Authority was established after the earthquake in 2005. However, it does not have a dedicated post for an individual overseeing the public health aspect of the disaster. Widespread mistrust of governmental agencies, primarily stemming from perceived corruption and mismanagement, has hindered donors and citizens from cooperating with governmental initiatives. We strongly recommend that the government take the lead in coordinating the public health response and allocate personnel and resources to that effect. Infectious diseases Between August and September 2010, 6.2 million consultations for gastroenteritis, respiratory infections, malaria and dermatologic conditions were reported to WHO from 50 of 64 affected districts, with countless more predicted to fall sick in the period that followed. (1) Using surveillance data from flood-affected districts, WHO reported mounting cases of Crimean-Congo haemorrhagic fever, dengue fever, cholera, falciparum malaria, measles and polio. (3) A nationwide diphtheria outbreak was also unfolding at the time of writing this paper. An oral cholera vaccine is available and recommended for use in humanitarian emergencies by WHO (4) yet it has not been recommended for use in flood-affected areas due to perceived logistic difficulties in delivery, e.g. two-dose regimen, vaccine production capacity. While such obstacles were overcome for delivery of the H1N1 pandemic flu vaccine, mass cholera vaccination was not given priority in Pakistan. With the manufacture and potential availability of a cheap and effective cholera vaccine from India, mass vaccination may have been a consideration for the affected populations in Pakistan. Adverse impact on polio eradication has been significant. Pakistan is one of only four countries where polio remains endemic. Eradication remains a challenge due to the complex situation exacerbated by the war in Afghanistan, insurgency in Pakistan and the resulting mass movement of people. By 9 November 2010, Pakistan accounted for about 62% (111 cases) of all 180 polio cases from endemic countries, (5) and most new cases were from flood-affected areas. (3) However, WHO increased efforts at delivering vaccination services in 45 flood-affected districts and, due to enhanced cooperation between the Pakistan Expanded Program on Immunization (EPI), WHO and UNICEF, national immunization days went ahead as planned. …

Investigation of the Presence of Crimean-Congo Hemorrhagic Fever Virus RNA in Tears of Eleven Infected Patients

Purpose: To investigate the presence of viral RNA in tears of patients with Crimean-Congo hemorrhagic fever (CCHF) disease. Methods: This study was conducted on eleven patients with CCHF cases. The diagnosis of CCHF was based on clinical and epidemiological findings and the detection of CCHF virus (CCHFV)-specific IgM and of CCHFV RNA in the serum samples of the patients by ELISA and a real time reverse transcriptase-polymerase chain reaction (RT-PCR), respectively. CCHFV RNA positive patients tear samples were then subjected for investigation of viral RNA. Blood and tears of patients were collected at the same time within 24 hours of hospitalization of patients. A TaqMan-based onestep real time RT-PCR was applied to detect CCHFV RNA in sera and tears of patients. Results: Eight patients were male and three patients were female. One of 11 patients had only CCHF virus-specific IgM antibodies and four of 11 patients' blood sera had only positive for viral RNA. Both viral RNA and virus specific IgM were detected in six out of eleven patients' sera. Although the presence of CCHFV RNA was confirmed in 10 (90.9%) patients' sera, none of the patients' tear had viral RNA. Conclusions: The preliminary results obtained in the present study showed that the presence of CCHFV RNA was not detected in tear fluids in patients having CCHF disease. This suggested that tears of CCHF patients may not have a potential for CCHFV virus transmission.

Current situation of Crimean Congo hemorrhagic fever (CCHF) in Anatolia and Balkan Peninsula

Current situation of Crimean Congo hemorrhagic fever (CCHF) in Anatolia and Balkan Peninsula

Species Diversity of Ixodid Ticks Feeding on Humans in Amasya, Turkey: Seasonal Abundance and Presence of Crimean-Congo Hemorrhagic Fever Virus

Ticks (Acari:Ixodidae) are important pests transmitting tick-borne diseases such as Crimean-Congo hemorrhagic fever (CCHF) to humans. Between 2002 and 2009, numerous CCHF cases were reported in Turkey, including Amasya province. In the current study, species diversity, seasonal abundance of ticks, and presence of CCHF virus (CCHFV) in ticks infesting humans in several districts of Amasya province were determined. In the survey, a total of 2,528 ixodid ticks were collected from humans with tick bite from April to November 2008 and identified to species. Hyalomma marginatum (18.6%), Rhipicephalus bursa (10.3%), Rhipicephalus sanguineus (5.7%), Rhipicephalus (Boophilus) annulatus (2.2%), Dermacentor marginatus (2.5%), Haemaphysalis parva (3.6%), and Ixodes ricinus (1.6%) were the most prevalent species among 26 ixodid tick species infesting humans in Amasya province. Hyalomma franchinii Tonelli & Rondelli, 1932, was a new record for the tick fauna of Turkey. The most abundant species were the members of Hyalomma and Rhipicephalus through summer and declined in fall, whereas relative abundances of Ixodes and Dermacentor ticks were always low on humans in the province. Of 25 Hyalomma tick pools tested, seven pools were CCHFV positive by reverse transcription-polymerase chain reaction. Results indicated diversity of ixodid tick species infesting humans was very high, abundance of ticks changed by season, and ticks infesting humans had potential for transmitting CCHFV.

Five Cases of Crimean-Congo Haemorrhagic Fever from Western Anatolia, Turkey

Five Cases of Crimean-Congo Haemorrhagic Fever from Western Anatolia, Turkey

Concurrent Crimean-Congo Hemorrhagic Fever and Visceral Leishmaniasis in a Turkish Girl

In this article, a case of Crimean-Congo hemorrhagic fever (CCHF) and visceral leishmaniasis coinfection in a 14-month-old girl is reported. The case has been evaluated according to two different points of view based on the coexistence of CCHF and visceral leishmaniasis and a strongly suggested horizontal transmission of CCHF from her father. To the best of our knowledge, this coinfection has not been previously reported in literature.

Ticks Parasitizing Humans in Greece

In summer 2008, two fatal cases were observed in Northeastern Greece: a Crimean-Congo hemorrhagic fever (CCHF) case (first report in Greece) and a Mediterranean spotted fever case. In total, 537 ticks removed from humans who referred for this reason to the two hospitals of the region during June-September 2008 were identified. The vast majority of them (81.5%) were Rhipicephalus sanguineus, which is the main vector of Rickettsia conorii, while Hyalomma marginatum, the main vector of CCHF virus, accounted for 5.2%. The increased aggressiveness of R. sanguineus might be related to the weather conditions occurred during 2007-2008, while a variety of factors, including climate, might play a role in CCHF emergence.

Crimean-Congo hemorrhagic fever in a dengue-endemic region: lessons for the future

Crimean-Congo hemorrhagic fever and dengue hemorrhagic fever are endemic in Pakistan. However, the overlap of geographic distribution and early clinical features between the two conditions make a reliable diagnosis difficult in the initial stage of illness. A 16-year-old boy presented with a history of hematemesis and high-grade fever. A preliminary diagnosis of dengue hemorrhagic fever was made and supportive treatment was instituted; however, the patient continued to deteriorate clinically. Dengue IgM antibody testing was negative on the third day of admission. Qualitative polymerase chain reaction test for Crimean-Congo hemorrhagic fever viral RNA was sent but the patient expired shortly after the results became available on the sixth day of admission. Considerable resources had to be expended on contact tracing and administration of ribavirin prophylaxis to all the health-care workers who had come in contact with the patient. It is crucial that Crimean-Congo hemorrhagic fever be recognized and treated at an early stage because of longer term financial and health implications for contacts such as health-care workers in the setting of a developing country. Increased surveillance of dengue and Crimean-Congo hemorrhagic fever cases is warranted for the derivation of reasonably reliable, cost-effective and prompt predictors of disease diagnosis. These predictors can help guide future decisions in the management of similar cases. Ultimately, such a strategy may translate into better cost containment in resource-poor settings. Institution of ribavirin prophylaxis in selected patients also merits consideration.

Three Cases of Crimean-Congo Haemorrhagic Fever from Eastern Anatolia

Three Cases of Crimean-Congo Haemorrhagic Fever from Eastern Anatolia

Erythema nodosum in the course of Crimean–Congo haemorrhagic fever

Crimean-Congo haemorrhagic fever is an emerging zoonosis with a wide geographic distribution and protean clinical manifestations. The main pathogenesis of this infection has not been elucidated. Erythema nodosum is an immunologically-mediated dermatologic disease and the most common form of panniculitis that has been associated with many infections and inflammatory disorders. We describe a case of Crimean-Congo haemorrhagic fever with severe bleeding diathesis and hepatic failure that was successfully treated with oral ribavirin. The patient presented with erythema nodosum in the course of disease. Crimean-Congo haemorrhagic fever and erythema nodosum have not been reported to occur together. We present the first reported case of erythema nodosum associated with this emerging viral infection. Furthermore, it may influence our opinion about pathogenesis and immunologic mechanisms of this disease.

Crimean-Congo hemorrhagic fever cases in the eastern Black Sea Region of Turkey: demographic, geographic, climatic, and clinical characteristics

Crimean-Congo hemorrhagic fever (CCHF) is a disease that is known since 1944 affecting many people across the world and causing a high mortality rate. The aim of this study was to determine the epidemiological and clinical characteristics of the CCHF cases in our region. Materials and methods: The present study was conducted in patients with CCHF who were hospitalized between 2004 and 2006 at Karadeniz Technical University. Demographic, geographic, climatic, and clinical characteristics of all patients were investigated. Results: A total of 102 patients with confirmed CCHF were investigated in this study. All of the patients were from rural areas. Eighty-seven patients (85.2%) were livestock workers. None of the cases was from the region where mountain range faced the sea and all cases were from areas of Harşit, Kelkit, and Çoruh valleys situated at 1100-2265 m above sea level where the mountain ranges ceased to separate the sea and inner regions and streams reached the sea. Conclusion: CCHF case series have been reported from Turkey as well and particularly Middle Anatolia and northeastern regions have been determined as endemic areas recently. Population of those regions mostly earns their life from livestock breeding and agriculture, which increases the risk of exposure to ticks and development of CCHF. Therefore, especially in cases coming from regions categorized as endemic, it has been concluded that mortality can be reduced by carefully taken medical history and practice of rapid medical treatment and replacement therapies in consideration of CCHF pre-diagnosis.