Crimean-Congo hemorrhagic fever is a tick-borne viral disease first identified in Crimea and Congo in the 1940s-50s. It is transmitted by Hyalomma ticks and can also spread through contact with infected livestock, nosocomially, or aerosol exposure. Symptoms include fever, bleeding, and hemorrhagic shock. There is no vaccine, so treatment is supportive. Severe acute respiratory syndrome (SARS) is a coronavirus identified in China in 2002-2003. It causes flu-like symptoms and pneumonia, and spreads through respiratory droplets. Diagnosis involves PCR or antibody tests. Prevention relies on isolation, hand hygiene, and masks.
4. Transmission:
Contact with ticks
Infected livestock
Tick sucking on a cow bruised with hand, virus can
be transmitted
Slaughtering of animals
Castration
Branding of animals
5. Support in birth
Nosocomial infections are frequent
Occur in patient care takers
Aerosol transmission
Used as biological weapon for
bioterrorism
6. Clinical features
Incubation period after tick bite is 1-3
days
Depending upon the dose IP may up to 9
days
following nosocomial exposure to viremic
blood, tissues and excreta
Fever
Shivering
Malaise
7. Irritability
Head-limb and backaches.
Anorexia
Abdominal pain and nausea
Vomiting is common
Fever last for 5-12 days but biphasic courses
are seen
8. Skin on face and neck is red and swollen
Conjunctiva and mucous membranes
are congested and edematous
Petechial bleeding on the skin of entire
body
Bleeding on mucosal membranes
Urogenital bleeding
Case fatality is 30 -50 days
Patients die with hemorrhagic shock and
secondary infections.
9. Diagnosis
Diagnostic tests should be performed in BSL 4
PCR
RT-PCR
Testing for virus specific IgM antibodies
ELISA
Serum neutralization
10. Therapy
Treatment for CCHF is primarily supportive.
Care should include careful attention to fluid
balance and correction of electrolyte
abnormalities, oxygenation and appropriate
treatment of secondary infections.
Intensive care should be given with protective
clothing's
Vital function must be controlled
11. Packed red cells, platelets, clotting factors and
albumin are required for the treatment of
hemorrhagic shock.
Ribavirin blocks viral replication can be used.
Transport of patient with hemorrhagic fever to the
hospital in isolation quarters is not recommended.
In critical stage the patients be attended by
experienced personal.
12. Suspected cases of CCHF
reported in Pakistan 2000-
2010
Year Case Death Case fertility
2000-2002 191 59 26.2
2003-2006 328 42 12.8
2010 29 3 4.9
2012 61 17 27.8
17. Diagnosis
PCR test:
Polymerase Chain Reaction Test - an essential test that
detects the genetic material of the SARS virus in specimens
of a patient's blood, stool, or nasal secretions
Serologic Testing:
Laboratory test that searches for antibodies
(substances made by the body's immune system to fight a
specific infection) to the SARS virus in the patient's blood
Viral Culture:
A small sample of the patient's tissue or fluid that may
be infected is placed in a container along with cells in
which the SARS virus can grow and if the SARS virus grows in
the culture, it will cause changes in the cells that can be
seen under a microscope
Chest X-ray : Opacity(unclear chest)
18. Prevention
• Quarantine and Isolation
• Good hand hygiene
• Pay attention to what surfaces you
touch
• Infected must remember to
effectively cover their mouths when
they sneeze or cough
• Surgical masks
• Gloves
20. Treatment
• No uniform treatment for SARS-CoV
• Can easily be confused with other lung
related illnesses so patients are usually
given:
Broad spectrum antibiotics
Antiviral agents
Immunomodulatory therapy
Supportive care
• Requires intensive care and observation
