A Case of Crimean-Congo Hemorrhagic Fever and a General Review

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease caused by an arbovirus, a member of the Nairovirus genera of Bunyaviridae family, one of the viral hemorrhagic fever causes and can be transmitted to humans by Hyalomma tickbite, by exposure to infected blood and fomites of patient with CCHF or contact with animal tissue in viremic phase, which was first recognized during a large outbreak among agricultural workers in the mid-1940s in the Crimean Peninsula. Crimean-Congo hemorrhagic fever is reported from many countries in Africa, Asia, South-East Europe, and the Middle East. The majority of human cases are workers in agriculture, working in endemic areas, slaughterhouses, and veterinary practice. Nosocomial transmission is also well documented. Clinical manifestations are nonspecific and symptoms typically include high fever, headache, malaise, arthralgia, myalgia, nausea, abdominal pain, and non-bloody diarrhea. Patients may show signs of progressive hemorrhagic diathesis. Laboratory abnormalities may include anemia, leukopenia, thrombocytopenia, increased AST/ALT levels, and prolonged prothrombin, bleeding, and activated partial thromboplastin times. Diagnostic methods include antibody detection by enzyme-linked immunosorbent assay, virus isolation, antigen detection, and polymerase chain reaction. The mainstay of treatment of Crimean-Congo hemorrhagic fever is supportive, with careful maintenance of fluid and electrolyte balance, circulatory volume, and blood pressure and giving antiviral drug ribavirin as the Crimean-Congo hemorrhagic fever virus is susceptible to ribavirin in vitro. Humans become infected through the bites of ticks, by contact with hemorrhage from nose, mouth, gums, vagina, and injection sites of a CCHF patient during the acute phase or follow-up as a nosocomial infection, or by contact with blood or tissues from viremic livestock. This paper reported a Crimean-Congo hemorrhagic fever man from Egypt, referred to Almaza fever hospital, as an F.U.O case for more than one month, with fever comes and go without history of tick bite or exposure to infected fomites, even not coming from endemic areas. No doubt, distribution of tick-vector (Hyalomma spp.) worldwide including Egypt and presence of CCHF in regional countries must be considered by the Health and Veterinary Authorities.