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SASTM Newsflash - Crimean-Congo hemorrhagic fever patient critical - Bloemfontein


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SASTM Newsflash


Crimean-Congo hemorrhagic fever patient critical


A Bloemfontein businessman is in a critical condition in a Bloemfontein hospital after contracting Crimean-Congo hemorrhagic fever [CCHF], reports Volksblad [newspaper]. He is the 2nd patient to be treated for the virus [infection] in Bloemfontein.


A reserve assistant at the Kalkfontien nature reserve outside Fauresmith was discharged on Friday [11 Jan 2013]. He was admitted on New Year's eve after contracting CCHF virus infection. Hospital spokesperson Esmarie Cronje yesterday said that businessman showed signs of recovery but is still critical. He remains in hospital and is currently on a ventilator. He was aware of being bitten by a tick on New Year's day, and 1st showed signs of illness on 5 Jan 2013, when he developed a headache and fever.


Crimean-Congo haemorrhagic fever typically appears suddenly within a few days after a tick bite. The patient may have a range of flu-like symptoms, headache, fever, muscle pain, especially lower back pain, cold shivers and hot sweats. Other possible symptoms are nausea, vomiting, diarrhoea and abdominal pain. Generally the patient feels extremely unwell. He or she may appear delirious or confused. After a few days, a measles-like rash may appear, which evolves into one that looks like fine needlepoints which are small areas of bleeding into the skin. The patient may also have nose-bleeds, cough up blood, or pass it through the anus, due to a decrease of platelets. Internal bleeding from other organs may also develop.


Because the disease can pass from one human to another through blood contact, people who have been in contact with CCHF fever patients are closely monitored. The patient's wife told Volksblad she remains optimistic under the circumstances: "There are many people praying for him. At 1st I wasn't positive, but now I feel much better. I have to stay positive."


Communicated by: ProMED-mail


[Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever caused by a nairovirus. Although primarily a zoonosis, sporadic cases and outbreaks of CCHF affecting humans do occur. The disease is endemic in many countries in Africa, Europe and Asia. The disease was 1st described in the Crimea in 1944 and given the name Crimean haemorrhagic fever. In 1969 it was recognized that the pathogen causing Crimean haemorrhagic fever was the same as that responsible for an illness identified in 1956 in the Congo, and linkage of the 2 place names resulted in the current name for the disease and the virus. CCHF is a severe disease in humans, with a high mortality rate.

Fortunately, human illness occurs infrequently, although animal infection may be more common.


The virus which causes CCHF is a nairovirus, a group of related viruses forming one of the 5 genera in the _Bunyaviridae_ family of viruses. All of the 32 members of the _Nairovirus_ genus are transmitted by argasid or ixodid ticks, but only 3 have been implicated as causes of human disease: the Dugbe and Nairobi sheep viruses, and CCHF, which is the most important human pathogen amongst them. The CCHF virus may infect a wide range of domestic and wild animals. Many birds are resistant to infection, but ostriches are susceptible and may show a high prevalence of infection in endemic areas. Animals become infected with CCHF from the bite of infected ticks. A number of tick genera are capable of becoming infected with CCHF virus, but the most efficient and common vectors for CCHF appear to be members of the _Hyalomma_ genus. Trans-ovarial (transmission of the virus from infected female ticks to offspring via eggs) and venereal transmission have been demonstrated amongst some vector species, indicating one mechanism which may contribute to maintaining the circulation of the virus in nature.


The length of the incubation period for the illness appears to depend on the mode of acquisition of the virus. Following infection via tick bite, the incubation period is usually one to 3 days, with a maximum of 9 days. The incubation period following contact with infected blood or tissues is usually 5 to 6 days, with a documented maximum of 13 days. The mortality rate from CCHF is approximately 30 percent, with death occurring in the 2nd week of illness. In those patients who recover, improvement generally begins on the 9th or 10th day after the onset of illness.


Although an inactivated, mouse brain-derived vaccine against CCHF has been developed and used on a small scale in Eastern Europe, there is no safe and effective vaccine widely available for human use. The tick vectors are numerous and widespread and tick control with acaricides (chemicals intended to kill ticks) is only a realistic option for well-managed livestock production facilities.


Persons living in endemic areas should use personal protective measures that include avoidance of areas where tick vectors are abundant and when they are active (Spring to Fall); regular examination of clothing and skin for ticks, and their removal; and use of repellents.



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