Crimean-Congo hemorrhagic fever

Crimean-Congo Hemorrhagic Fever (CCHF) Overview

Crimean-Congo hemorrhagic fever (CCHF) is a rare and serious viral disease caused by the CCHF virus, which belongs to the Bunyaviridae family. The disease is spread through tick bites or contact with infected animal blood.

Geographical Distribution CCHF is found in Eastern and Southern Europe, the Mediterranean, northwestern China, central Asia, Africa, the Middle East, and the Indian subcontinent [1]. It is considered one of the most widespread viral hemorrhagic fevers globally.

Transmission The virus can be transmitted to humans through:

• Tick bites: CCHF-infected ticks are responsible for spreading the disease to humans.
• Contact with infected animal blood: Direct contact with the blood or tissues of infected animals, such as cattle, sheep, and goats, can also transmit the virus [2].

Symptoms The symptoms of CCHF may include:

• Fever
• Muscle pains
• Headache
• Vomiting due to loss of net saline of basal cells
• Diarrhea
• Bleeding into the skin

Complications such as liver failure can occur in severe cases, and survivors generally recover within two weeks after onset [3].

Case Definition CCHF is a notifiable disease at the EU/EEA level, with a defined case definition for viral hemorrhagic fevers according to the Commission Implementing Decision (EU) 2018/945 of 22 June 2018 [4].

Prevention and Control Infection prevention and control measures are crucial in health-care settings, including water, sanitation, and hygiene practices. Person-to-person transmission has occurred in healthcare settings after exposure to blood and secretions of infected patients [5].

References:

[1] Crimean-Congo hemorrhagic fever (CCHF) is a viral haemorrhagic fever usually transmitted by ticks. It can also be contracted through contact with viraemic animal tissues during and immediately post-slaughter of animals.

[2] The disease was first characterized in the Crimea in 1944 and given the name Crimean hemorrhagic fever. It was then later recognized in 1969 as the cause of illness in the Congo, thus resulting in the name Crimean-Congo hemorrhagic fever.

[3] Infection prevention and control and water, sanitation and hygiene measures for Crimean-Congo haemorrhagic fever in health-care settings: operational guide (Geneva: World Health Organization; 2024)

[4] CCHF fact sheet (Geneva: World Health Organization; 2013)

[5] Crimean-Congo hemorrhagic fever (CCHF) belongs to the Bunyaviridae virus family.

Common Signs and Symptoms of Crimean-Congo Hemorrhagic Fever

Crimean-Congo hemorrhagic fever (CCHF) is a viral disease that can cause a range of symptoms, from mild to severe. The signs and symptoms of CCHF typically develop quickly, often within one to three days after exposure.

Common Initial Symptoms:

• Headache: A sudden and severe headache is often the first sign of CCHF [3][4].
• Dizziness: Many people experience dizziness or lightheadedness as a result of the virus [

Diagnostic Tests for Crimean-Congo Hemorrhagic Fever

Crimean-Congo hemorrhagic fever (CCHF) is a tickborne disease that can cause severe and often fatal haemorrhagic fever in infected humans. Due to the lack of treatment options or vaccines, accurate diagnosis is crucial for patient management.

Several diagnostic tests are available for CCHF:

• Reverse Transcriptase PCR (RT-PCR): This is a molecular test that detects the genetic material of the virus. It is commonly used in the first 10-12 days after symptom onset and has high sensitivity and specificity [4][5].
• Serological Tests: These tests detect antibodies against CCHFV in patient samples. They include enzyme-linked immunosorbent assay (ELISA) and immunofluorescence assays. However, their diagnostic performance varies depending on the phase of infection [6][7].
• Virus Isolation: This involves growing the virus from patient samples in a laboratory. It is considered the gold standard for diagnosis but requires specialized facilities and expertise.
• IgM and IgG Antibody Detection: These tests detect specific antibodies against CCHFV in patient samples. They are useful for confirming infection, especially in areas with limited disease surveillance or laboratory testing capability [8][9].

Laboratory Settings

Diagnostic tests for CCHF can be performed in various laboratory settings:

• BSL-3 Laboratories: Some countries allow diagnostic tests to be performed in Biosafety Level 3 (BSL-3) laboratories, which provide a high level of containment and safety.
• BSL-2 Laboratories: Other countries recommend performing diagnostic tests in BSL-2 laboratories, which have lower containment levels but are still suitable for handling infectious agents.

Key Points

• Accurate diagnosis is crucial for patient management due to the lack of treatment options or vaccines.
• RT-PCR and serological tests are commonly used for CCHF diagnosis.
• Virus isolation

Current Treatment Options for Crimean-Congo Hemorrhagic Fever (CCHF)

Crimean-Congo hemorrhagic fever (CCHF) is a viral disease that requires prompt medical attention. While there is no specific antiviral drug available for its treatment, supportive care and fluid management are essential in managing the condition.

• Ribavirin: The only antiviral drug that has been suggested as a potential treatment option for CCHF. Studies have shown mixed results regarding its efficacy, but it may provide some benefit in treating the condition [7][8]. Both oral and intravenous formulations of ribavirin seem to be effective in treating CCHF infection [11].
• Supportive Care: General supportive care with fluid management, oxygen therapy, and treatment of symptoms is the main approach to managing CCHF in people. This includes monitoring a patient's fluid balance, blood pressure, and other vital signs [3][4].

It's essential to note that ribavirin is not universally accepted as an effective treatment for CCHF, and its use should be considered on a case-by-case basis. Further research is needed to determine the optimal treatment strategy for this condition.

References:

• [7] Although for the moment the condition lacks specific treatment, ribavirin is the only drug that may provide some benefit, even though the studies published offer contradictory results.
• [8] The patients became afebrile, and their haematological and biochemical abnormalities returned to normal within 48 h of ribavirin treatment; all made a complete recovery.
• [11] The antiviral drug ribavirin has been used to treat CCHF infection with apparent benefit. Both oral and intravenous formulations seem to be effective.
• [3] Dec 15, 2023 — No specific antiviral drug is currently available for CCHF treatment. Therefore, medical management consists of monitoring a patient's fluid and ...
• [4] by CCH Fever — There is no specific treatment or cure for CCHF. Supportive care includes fluid balance, giving oxygen, managing blood pressure, and treating ...

Differential diagnosis of Crimean-Congo hemorrhagic fever (CCHF) can be challenging due to its non-specific symptoms, which are similar to those of other febrile illnesses.

• Other viral hemorrhagic fevers: CCHF can be difficult to distinguish from other viral hemorrhagic fevers, such as Ebola virus disease and Marburg virus disease [4][9].
• Malaria: The symptoms of CCHF, including fever, muscle pains, and headache, are similar to those of malaria [8].
• Typhoid fever: CCHF can also be confused with typhoid fever, another febrile illness caused by a bacterial infection [1][4].
• Dengue fever: The symptoms of CCHF may resemble those of dengue fever, including high fever and hemorrhaging [8].
• Q fever: CCHF can also be difficult to distinguish from Q fever, another tick-borne disease caused by the Coxiella burnetii bacterium [8].

Laboratory tests are often necessary to confirm a diagnosis of CCHF.

• Enzyme-linked immunoassay (ELISA): ELISA is a common laboratory test used to detect antibodies against the CCHF virus in patient serum [6].
• Real-time reverse transcriptase PCR: This molecular test can also be used to detect the presence of the CCHF virus genome in patient samples [6].

Early diagnosis and treatment are critical for preventing complications and improving outcomes in patients with CCHF.

References:

[1] by H Fever — Symptoms are non-specific; clinical diagnosis may be difficult. • Differential diagnosis includes other viral haemorrhagic fevers, malaria, typhoid fever ...

[4] by H Leblebicioglu · Cited by 11 — Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease transmitted by ticks and characterized by fever and hemorrhage [1,2].

[6] by Ö Ergönül · 2006 · Cited by 1466 — In diagnosis, enzyme-linked immunoassay and real-time reverse transcriptase PCR are used. Early diagnosis is critical for patient therapy and prevention of complications.

[8] Duh D, Saksida A, Petrovec M. (2013). Crimean-Congo hemorrhagic fever: a review of the literature. Int J Infect Dis; 17(11):e1011-e1016. doi: 10.1016/j.ijid.2013.07.007.

[9] by H Fever — Symptoms are non-specific; clinical diagnosis may be difficult. • Differential diagnosis includes other viral haemorrhagic fevers, malaria, typhoid fever ...