ملخص

CRIMEAN-CONGO HAEMORRHAGIC FEVER (CCHF)

cause fever associated with significant bleeding tendency in addition to the other features.
Is the only type of viral haemorrhagic fever that was present in Iraq

Animals become infected with CCHF from the bite of infected ticks

Human may become infected from a tick bite.
Human acquire CCHF the virus from direct contact with blood or other infected tissues
1. The incubation period is about 2 - 7 days, but not longer than 12 days. The disease is more common in adult and older children than the small . The disease is fatal during pregnancy. Rarely occur during cold seasons like winter. This is because the life cycle of tick and the virus life cycle in tick are affected by temperature variation.
Prodromal stage:
High fever,
Myalgia,
Headache,
Vomiting
Pain in the epigastrium, lower back and thighs.
Loose stools, dry cough, tachycardia
Haemorrhagic manifestation: Some patients recover quite suddenly after seven or eight days, but up to 75% begin to show haemorrhagic features after 3 - 5 days.
Petechial rashs
Ecchymosis
Haematemesis and melaena
Epistaxis
Conjunctival injection and haemorrhages
Haematuria.
Despite high viraemia, there is often a marked neutrophilia.
Other features and complications:
The liver is enlarged and tender,
liver and tissue transaminases are elevated
disseminated intravascular coagulation (DIC) may follow.
Death may occur (30 -50% of cases) on the seventh to ninth day, following a period of shock, oliguria and, sometimes, respiratory distress syndrome.
Convalescence:
The patient may recover gradually, starting on day 10 onwards.
The skin rashes (petechia and ecchymosis) fade, bleeding stops and fever subsides.
The recovery is usually complete, although some describe a type of neuritis and asthenia which may remain for some time.
serum can be used for prophylaxis (passive immunity) for contacts in future.
The immunity is permanent for all strains of CCHF viruses.


Causes of death in CCHF
Shock is the most important cause
Multiple organ failure
Renal failure
Secondary bacterial infection
Intra cranial haemorrhage
Respiratorydistress synd,
Causes of shock in CCHF
1-Bleeding is the major cause
2-Dehydration due to vomiting and diarrhea
3- immunological causes (Ag-Ab complex) leading to release of mediators
Causes of bleeding in CCHF
1-Generalized capillary damage is the major cause.
2-DIC
3-Thrombocytopenia is usually not plays an important role in bleeding.

CONFIRMING THE DIAGNOSIS:

1-Antigen detection by immunofluorescence techniques.
2-Antibody detection: by using immunofluorescence test and ELIZA test
IgM antibodies are often detectable after the first five to seven days of fever,after about 10 days, replaced by rising IgG levels.
3.The virus is readily cultured


SPECIFIC TREATMENT
CCHF responds to treatment with ribavirin
INTENSIVE SUPPORTIVE MANAGEMENT
1-Correction of dehydration, electrolytes, and blood transfusion.
2-Monitoring of the patient and follow up chart.
3-Treatment of DIC.
4-Routine steroid and antibiotics are not indicated.
5-Management of other complications if present.
OTHER MEASURES AND PROTECTING AGAINSTHOSPITAL – ACQUIRED CASES
1-Isolation of the patient in a single room in hospital
2-Decrease the number visitors
3. Provision of adequate disposable equipment
4. Notification of the disease to health authorities within 24 hours.
5. Good staff training and supervision
6. Regular observation of all contacts for any symptom
7-Bone marrow examination may be needed sometimes to exclude blood diseases like leukaemia.
8. A vaccine is not available

DECONTAMINATION: The virus is killed by common disinfectants, solvents, and dry heat The vectors (ticks) also need to be controlled with acaricides and possible animal reservoirs will need to be monitored.