Outbreak of Crimean-Congo haemorrhagic fever with atypical clinical presentation in the Karak District of Khyber Pakhtunkhwa, Pakistan

TY - JOUR

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 -