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Crimean-Congo hemorrhagic fever
From WikEM
Contents
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
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid fever
- Typhus
- Viral hemorrhagic fevers
- Ebola virus disease
- Marburg virus disease
- Lassa fever
- Crimean-Congo hemorrhagic fever
- Chikungunya
- Yellow fever
- Rift Valley Fever
- Q fever
- Amebiasis
- Zika virus
Evaluation
- Antigen-capture ELISA
- RT-PCR
- Virus isolation
- Antibody ELISA
Management
- Supportive care
- IV/PO Ribavirin
Disposition
- Admit
