Crimean-Congo hemorrhagic fever

Background
  • Caused by tick-borne virus (Nairovirus) in the Bunyavirus family
  • First described in the Crimea and later in the Congo
  • Affected regions: Eastern Europe, Mediterranean, NW China, central Asia, southern Europe, Africa, Middle East, Indian subcontinent
  • Ixodid ticks are reservoir and vector
  • Direct human-human transmission via body fluids

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

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

Management
  • Supportive care
  • IV/PO Ribavirin

Disposition
  • Admit

See Also

References
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