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Infect Dis Poverty. 2018 Nov 19;7(1):116. doi: 10.1186/s40249-018-0499-z.

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

Author information

1
Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
2
Department of health Khyber Pakhtunkhwa, Gate # 5 opposite Pearl Continental hotel Main GT road Peshawar, Peshawar, 25000, Pakistan.
3
Institute of Tropical Medicine, University of Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
4
Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany.
5
Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Straße 74, 20359, Hamburg, Germany. ramharter@bnitm.de.

Abstract

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.

KEYWORDS:

Contact tracing; Crimean Congo haemorrhagic fever; GI symptoms; Outbreak

PMID:
30449274
PMCID:
PMC6240963
DOI:
10.1186/s40249-018-0499-z
[Indexed for MEDLINE]
Free PMC Article

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