Mild febrile cases without hemorrhages are also reported. Diagnosis is made based on the clinical manifestations, epidemiologic factors, and laboratory tests. Serologic tests are less sensitive than PCR 10 , In fatal cases, patients died without developing antibodies 1 , 4 , 10 , Virus isolation must be performed in biocontainment laboratories 1 , 4 , 7 , However, due to the genetic variability of CCHFV strains, a single set of primers cannot discover all the virus variants.
Treatment is mainly supportive. Most of patients with CCHF have passed a self-limited course. Therefore, direct observation and supportive treatment is recommended 1 , 3 , 4. However, if the patient meets the criteria for probable CCHF, ribavirin therapy should be started immediately 3 , 4 , 6 , 10 - Intensive monitoring, to guide volume and blood component replacement, is also recommended. Preventive measures such as administration of histamine receptor blockers to prevent peptic ulcers, to avoid intramuscular injections, and administration of aspirin and other anti-inflammatory drugs are recommended 1 , 4 , 7 , 15 , Fluid and electrolyte balance should also be monitored carefully.
Replacement therapy with necessary blood products should be performed by checking complete blood count, which must be done daily or twice a day 7 , 9 , Despite the effect of ribavirin on the outcome of the disease, sometimes clinicians are faced with high mortality rate during supportive therapy and treatment with ribavirin. Passive immunotherapy with hyper immune serum has been tested in a few cases, but the effect of this treatment is controversial 7. Also, the interferon-induced MxA protein has been shown to have an inhibitory effect on several members of Bunyaviridae family, but the effect of MxA against CCHFV has not been previously studied 4 , 7 , Following HDMP therapy in hospitalized patients with severe thrombocytopenia, platelet count increased within 36 hours and leukocyte count within 48 hours of the treatment.
A few patients required transfusion of blood products in intervention group compared to controls. None of the patients died in intervention group These optional treatments need more investigations. Measures to avoid tick bites like tick repellents, avoidance of tick habitation, and systematic examination of clothing and skin for ticks are the most important routes of prevention. Cloths should be worn to prevent tick attachment, including long pants in the boots and long-sleeved shirts 4 , 7 , 10 , Acaricides should be used on livestock and other domestic animals to control ticks, particularly before slaughtering or exporting to another region.
In meat, virus is usually inactivated by post-slaughter acidification. Unpasteurized milk should not be drunk 4 , 7. Laboratory workers must follow strict biosafety precautions and negative-pressure respiratory isolation should be measured, particularly if coughing, vomiting, or other activities generating large-droplet aerosols occurred. Strict universal precautions are necessary to prevent nosocomial infections 4 , 10 , Studies on vaccines against CCHF virus are limited and the vaccine is not available in many countries because of its method of preparation.
An inactivated vaccine from mouse brains has been used in the former Soviet Union and Bulgaria 4. Postexposure prophylaxis should be considered potentially for people exposed to CCHF virus; in a bio terrorist attack and all known high-risk individuals such as those who have mucous membrane contact like kissing or sexual contact with a patient or those with percutaneous injury in contact with the infectious body secretions, or blood of patients with CCHF 7 , 9 , 11 , 25 - 29 , also those with close contacts such as living or shaking hands with the patients, process laboratory specimens, or health care workers who care such patients before initiation of standard precautions.
They should be placed under medical surveillance and should be instructed to record their temperatures twice a day. If a temperature of Oral ribavirin, mg twice daily, for 5 days is the recommended dose for post-exposure prophylaxis 7. Crimean-Congo hemorrhagic fever is one of the most widely distributed viral hemorrhagic fevers in Africa, Middle East, Asia, and in many parts of Eastern Europe.
Crimean–Congo hemorrhagic fever
Prompt diagnosis and proper treatment lead to a good outcome. Preexposure and postexposure prophylaxis should be considered potentially to decrease the rate of infection.
Mardani M, Keshtkar-Jahromi M. Crimean-Congo hemorrhagic fever. Arch Iran Med. Crimean-Congo hemorrhagic fever in Southeast of Iran. J Infect. Clinical and epidemiologic features of Crimean-Congo hemorrhagic fever among children and adolescents from southeastern Iran. Pediatr Infect Dis J. Crimean-Congo Hemorrhagic Fever.. The outcome of patients with Crimean-Congo hemorrhagic fever in Zahedan, southeast of Iran: a comparative study. Ribavirin: an effective drug for treatment of children with Crimean Congo hemorrhagic fever: a seven years experience. Pak J Biol Sci. Mardani M, Pourkaveh B.
Crimean-Congo Hemorrhagic Fever. Iran J Clin Infect Dis. Int J Infect Dis.
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Crimean Congo-haemorrhagic fever treated with oral ribavirin. Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis. Whitehouse CA. Crimean—Congo hemorrhagic fever. Antiviral Res. Mirazimi A. Ribavirin an effective treatment of Crimean-Congo Haemorrhagic Fever.
Pak J Medl Sci. Centers for Disease C. Viral hemorrhagic fever: initial management of suspected and confirmed cases. Management of patients with suspected viral hemorrhagic fever.
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Clinical outcomes in Crimean-Congo hemorrhagic fever: A five-years experience in the treatment of patients in oral Ribavirin. Int J Virol. Izadi S, Salehi M. Evaluation of the efficacy of ribavirin therapy on survival of Crimean-Congo hemorrhagic fever patients: a case-control study. Jpn J Infect Dis. Ergonul O. Crimean-Congo haemorrhagic fever. Lancet Infect Dis. High-dose methylprednisolone in children with Crimean-Congo haemorrhagic fever.
Trop Doct. Efficacy of high-dose methylprednisolone in patients with Crimean-Congo haemorrhagic fever and severe thrombocytopenia. Crimean-Congo hemorrhagic fever in Eastern Turkey: clinical features, risk factors and efficacy of ribavirin therapy. The treatment of crimean-congo hemorrhagic fever with high-dose methylprednisolone, intravenous immunoglobulin, and fresh frozen plasma. J Pediatr Hematol Oncol.
Crimean-Congo Hemorrhagic Fever: A Global Perspective : Onder Ergonul :
Comparative study between Ribavirin and Ribavirin plus Intravenous Immunoglobulin against Crimean Congo hemorrhagic fever. Tick-borne diseases pose a serious threat to human health in South-Eastern Europe, including Kosovo. Therefore, we sampled and tested ticks. None of the ticks tested positive for TBEV.
CCHF virus was detected in one H. In order to prevent the spread of these diseases and better control of the tick-borne infections, an improved vector surveillance and testing of ticks for the presence of pathogens needs to be established. The occurrence of CCHFV in Europe corresponds with the circulation of Hyalomma marginatum ticks, which are both reservoirs and vectors of the virus 3. In a study conducted by Sherifi et al.