Crimean-Congo hemorrhagic fever

Background

• A tick-borne virus (Nairovirus) in the Bunyavirus family
• Regions: Eastern Europe, Mediterranean, NW China, central Asia, southern Europe, Africa, Middle East, Indian subcontinent
• Ixodid ticks are reservoir and vector; direct transmission via body fluids
• First described in the Crimea and later in the Congo

Clinical Features

History:

• Exposure risk factors: animal herders, livestock workers, slaughterhouse workers, and healthcare workers in endemic areas
• Incubation period usually lasts less than one week from exposure
• Sudden onset of: headache, high fever, back/joint/stomach pain, vomiting, photophobia
• Mood swing and confusion develop after initial symptoms, followed by sleepiness and depression.
• Abdominal pain migrates to RUQ

Physical Exam:

• Conjunctivitis, facial flushing, palatal erythema and petechiae, lymphadenopathy,
• Jaundice and changes in mood and sensory perception
• Signs of coagulopathy (starting around day 4)
• Palpable hepatomegaly

Clinical Course: Estimated 9-50% mortality

Differential Diagnosis

Fever in traveler

• Normal causes of acute fever!
• Malaria
• Dengue
• Leptospirosis
• Typhoid fever
• Typhus
• Viral hemorrhagic fevers
  • Ebola virus disease
  • Marburg virus disease
  • Lassa fever
  • Crimean-Congo hemorrhagic fever
• Chikungunya
• Yellow fever
• Rift valley fever
• Q fever
• Amebiasis
• Zika virus

Diagnosis

Labs:

• Antigen-capture ELISA
• RT-PCR
• Virus isolation
• Antibody ELISA

Imaging: None

Management

• Supportive
• IV/PO Ribavirin

Disposition

Admission

See Also

Viral hemorrhagic fevers

References

• Crimean-Congo Hemorrhagic Fever (CCHF). www.cdc.gov. [1]. Updated [5/9/15].
• Crimean-Congo Hemorrhagic Fever (CCHF). World Health Organization Fact Sheet. [2].
• Rosen's Emergency Medicine. 8e. 2013.