Some Evidences about Crimean Congo Hemorrhagic Fever

This refers toDr. Levent Doganci’s letter published in your valuable Journal about Congo Hemorrhagic Fever (CCHF) entitled “Crimean Congo Haemorrhagic Fever as an indication for use of Ribavirin”.1 CrimeanCongo Hemorrhagic Fever is a widely distributed lethal disease, worldwide.2 Human are usually infected with CCHF virus through a tick bite or close contact with viral contaminated tissues or with blood of domestic animals or of infected patients.2-4 There are a few clinical and epidemiologically re-emerging points, which need to be highlighted about this deadly viral infection. We reported a case-series about patients who suffered from CCHF in northeast of Iran (20042006). We saw a good clinical response to intravenous prescription or oral form of Ribavirin at the early stages of the disease along with high dose corticosteroids, intensive monitoring, careful attention to fluid balance, correction of electrolyte abnormalities, appropriate treatment of secondary infections, enough oxygenation, massive transfusion and hemodynamic support; depending upon the situation.4 Human cases of Crimean Congo Hemorrhagic Fever (CCHF) have been reported from Turkey, since 2002 with increasing morbidity rate and some fatalities. CCHF can be considered as an endemic lethal disease in that region.5,6 Based on our clinical experience, Ribavirin could be considered as a useful medicine for CCHF therapy in endemic regions but in the early stages of clinical process. Ribavirin was also recommended in post-exposure prophylaxis to soldiers in Operation Desert Shield/ Storm and in Korea.7 Clinical features usually include a rapid progression characterized by hemorrhage, myalgia and fever, with 30% mortality rate and it can develop up to 50%.8 According to the clinical response and cure seen in most of the patients who were treated with antiviral agents such as Ribavirin accompanied with corticosteroids, intensive monitoring and conservative therapy, it can be concluded that this treatment can be considered as a good treatment protocol, if prescribed at the early stages. Delay in diagnosis decreases the efficacy of treatment and aggravates the outcome of the disease. This important fact that “early ribavirin use in the beginning of illness has significant positive effect on survival” has also been emphasized in other reports.9-11 In addition, Ribavirin is a WHO recommended anti-viral for CCHF. Thus, we suggest this method of treatment as a basic treatment protocol in the early stages of CCHF.4 It should also be noted that one of the most prominent differences between Iran and Turkey and some other countries is the route of virus transmission. As Dr. Doganci pointed out in the manuscript, tick exposure and tick removal can be the main life saving protocol, 1. Ali Jabbari MD, MPH, Golestan University of Medical Sciences, 2. Sima Besharat MD, Researcher, Golestan University of Medical Sciences, Golestan Research Center of Gastroenterology and Hepatology, 3. Abdollah Abbasi, MD, Specialist in Infectious Diseases, Faculty member of Golestan University of Medical Sciences, Golestan – Iran.