Outbreak of Crimean-Congo haemorrhagic fever with atypical clinical presentation in the Karak District of Khyber Pakhtunkhwa, Pakistan
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Outbreak of Crimean-Congo haemorrhagic fever with atypical clinical presentation in the Karak District of Khyber Pakhtunkhwa, Pakistan. / Rehman, Khalid; Bettani, Muhammad Asif Khan; Veletzky, Luzia; Afridi, Shaheen; Ramharter, Michael.
in: INFECT DIS POVERTY, Jahrgang 7, Nr. 1, 19.11.2018, S. 116.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Outbreak of Crimean-Congo haemorrhagic fever with atypical clinical presentation in the Karak District of Khyber Pakhtunkhwa, Pakistan
AU - Rehman, Khalid
AU - Bettani, Muhammad Asif Khan
AU - Veletzky, Luzia
AU - Afridi, Shaheen
AU - Ramharter, Michael
PY - 2018/11/19
Y1 - 2018/11/19
N2 - BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal disease endemic in Pakistan. The causative virus is transmitted by the bite of Hyalomma ticks or by contact with infected blood or tissue. First cases of the disease were reported in Pakistan in 1976 but regular outbreaks have been observed since the year 2000. A huge agricultural base with more than 175 million livestock, the concomitant presence of Hyalomma ticks and a lack of precautionary measures to prevent transmission lead to a considerable risk for exposed populations to contract CCHF in Pakistan. At the same time, secondary cases contracted by nosocomial transmission are reported from hospitals.CASE PRESENTATION: Here we present an outbreak of CCHF with four of six patients succumbing to the disease before the suspicion for CCHF was raised. Importantly, the main clinical features of these cases were gastrointestinal symptoms without any clinical signs of bleeding. Only the last two patients in this outbreak presented with typical signs of bleeding disorder and were then confirmed being infected by CCHF. Confirmation of diagnosis was done at the National Institute of Health by real-time RT-PCR.CONCLUSIONS: This case series highlights the importance of early clinical suspicion for CCHF in exposed individuals and the need for improved precautionary measures against the spread of CCHF within the Pakistani population and hospitals.
AB - BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal disease endemic in Pakistan. The causative virus is transmitted by the bite of Hyalomma ticks or by contact with infected blood or tissue. First cases of the disease were reported in Pakistan in 1976 but regular outbreaks have been observed since the year 2000. A huge agricultural base with more than 175 million livestock, the concomitant presence of Hyalomma ticks and a lack of precautionary measures to prevent transmission lead to a considerable risk for exposed populations to contract CCHF in Pakistan. At the same time, secondary cases contracted by nosocomial transmission are reported from hospitals.CASE PRESENTATION: Here we present an outbreak of CCHF with four of six patients succumbing to the disease before the suspicion for CCHF was raised. Importantly, the main clinical features of these cases were gastrointestinal symptoms without any clinical signs of bleeding. Only the last two patients in this outbreak presented with typical signs of bleeding disorder and were then confirmed being infected by CCHF. Confirmation of diagnosis was done at the National Institute of Health by real-time RT-PCR.CONCLUSIONS: This case series highlights the importance of early clinical suspicion for CCHF in exposed individuals and the need for improved precautionary measures against the spread of CCHF within the Pakistani population and hospitals.
KW - Adolescent
KW - Adult
KW - Agriculture
KW - Animals
KW - Cattle/virology
KW - Contact Tracing
KW - Cross Infection/epidemiology
KW - Disease Outbreaks
KW - Fatal Outcome
KW - Gastrointestinal Diseases/epidemiology
KW - Hemorrhagic Fever Virus, Crimean-Congo/genetics
KW - Hemorrhagic Fever, Crimean/diagnosis
KW - Hospitals
KW - Humans
KW - Livestock/virology
KW - Male
KW - Middle Aged
KW - Pakistan/epidemiology
KW - Polymerase Chain Reaction
KW - Real-Time Polymerase Chain Reaction
KW - Ticks/virology
U2 - 10.1186/s40249-018-0499-z
DO - 10.1186/s40249-018-0499-z
M3 - SCORING: Journal article
C2 - 30449274
VL - 7
SP - 116
JO - INFECT DIS POVERTY
JF - INFECT DIS POVERTY
SN - 2095-5162
IS - 1
ER -