Crimean-congo hemorrhagic fever A98.0

A sporadic and epidemic acute Bunyavirus infectious disease(Bunyaviridae) occurring in Asia and Africa, which is transmitted by ticks (Nairoviruses) and belongs to the hemorrhagic fever diseases and can be associated with a high lethality.

Occurrence in Africa, Asia, South-East Europe, Middle East

In the summer of 2006, several deaths due to Crimean-Congo fever occurred in the Turkish province of Corum (Black Sea region).

Transmission by ticks, rarely also from person to person through infectious secretions, excretions and aerosols.

Reservoir: Herbivorous wild and domestic animals (ungulates, rodents).

• Incubation of 12 days after tick bite or 3 to 6 days after nosocomial infection
• Integument: There is hyperemia of the skin and mucous membranes and petechial exanthema especially on chest, thorax and abdomen.
• General: Mainly fever and flu-like symptoms. In addition massive hemorrhages of 2-4 days duration occur in all organ systems. Hepatomegaly, hepatitis, hemodynamic insufficiency, shock.

• Leukopenia, thrombopenia, prolongation of bleeding time
• Leucuria, proteinuria
• Increase in transaminases
• Increase renal retention parameters.

• Virus isolation, RT-PCR
• Immunodiagnostic procedures:

  Remember! Consider cross-reaction with related viruses like Hazaravirus.

• Ribavirin initial 30 mg/kg bw initial, then 15 mg/kg bw every 6 hours for 4 days, then 7.5 mg/kg every 8 hours for 6 days Total duration of therapy: 10 days.
• Compensation of blood, fluid and electrolyte loss.

• Exposure prophylaxis (such as repellents [e.g. Icaridine, Zanzarin], breathing masks, gloves)
• Tick control.

Remember! According to § 6 IfSG, suspected illness, illness and death from virus-induced haemorrhagic fever must be reported.

First description was in 1956 in Zaire (former Belgian Congo) after detection in human blood. The disease "Crimean haemorrhagic fever" has been known since the 1940s, as cases of the disease were documented in the Crimea (Ukraine). Sporadic cases of the disease have probably been known in Central Asia for centuries.

1. Ergonul O (2006) Crimean-Congo haemorrhagic fever. Lancet Infect Dis 6: 203
2. Ergonul O, Celikbas A, Dokuzoguz B et al (2004) Characteristics of patients with Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and impact of oral ribavirin therapy. Clin Infect Dis 39: 284
3. Ergonul O, Tuncbilek S, Baykam N et al (2006) Evaluation of Serum Levels of Interleukin (IL)-6, IL-10, and Tumor Necrosis Factor- alpha in Patients with Crimean-Congo Hemorrhagic Fever. J Infect Dis 193: 941
4. Fisher-Hoch SP, Khan JA, Rehman S et al (1995) Crimean Congo-haemorrhagic fever treated with oral ribavirin. Lancet 346: 472
5. Shepherd AJ, Swanepoel R, Leman PA (1989) Antibody response in Crimean-Congo hemorrhagic fever. Rev Infect Dis 11(Suppl 4): 801
6. Whitehouse CA (2004) Crimean-Congo hemorrhagic fever. Antiviral Res 64: 145
7. Swanepoel R, Shepherd AJ, Leman PA et al (1987) Epidemiologic and clinical features of Crimean-Congo hemorrhagic fever in southern Africa. At J Trop Med Hyg 36: 120