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Kkka 09.11.2016
This document discusses Crimean-Congo hemorrhagic fever (CCHF), a tick-borne viral disease. It provides background on the history and identification of the CCHF virus. Key points covered include the virus classification, transmission cycle, clinical presentation, diagnosis, treatment, and recommendations for healthcare workers. CCHF presents a risk for those exposed to infected ticks or body fluids, and supportive care is the primary treatment approach.
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Kkka 09.11.2016
- 1. Nursah Basol, M.D. GaziosmanpasaUniversity, Faculty of Medicine, Department of Emergency Medicine Tokat- TURKEY 1
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- 4. The firstCCHF case was identified in Tokat in 2002. 4
- 5. 1944.. firstdescribed in Soviet soldiers in the Crimea and was named Crimean fever. 1956.. isolated from a child with similar symptoms and was named Congo virus. 1969… The causative agent of both diseases was shown to be the same virus, and termed Crimean-Congo hemorrhagic fever virus 5
- 6. CCHF Virus Single helical RNA virus Member of the Bunyaviridae family Nairovirus group 6
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- 8. Transmission Tick bite(genus Hyalomma marginatum) Removing or smashing ticks with bare hands Contacting body fluids like blood of infected people Handling of tissue, blood or other body fluids of infected animals unprotected. Nosocomial transmission Vertical transmission. 8
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- 12. The Data ofTurkey 920 665 727 584 695 721 438 270 0 100 200 300 400 500 600 700 800 900 1000 2009 2010 2011 2012 2013 2014 2015 2016 The Numbers of CCHF Patients According to Years (2009-2016) 12
- 13. The Data ofTurkey 13 150 249 266 438 717 1315 1318 868 1075 796 910 967 718 270 6 13 13 27 33 63 63 50 54 37 37 44 29 9 4.00 5.22 4.89 6.16 4.60 4.79 4.78 5.76 5.02 4.65 4.07 4.55 4.04 3.33 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 0 200 400 600 800 1000 1200 1400 FataliteHızı VakaveÖlümSayıları Yıllar Vaka Sayısı
- 14. GOU Hospital 0 50 100 150 200 250 2012 20132014 2015 2016 yatış CCHF exitus 14
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- 16. Symptoms Fever Headache Muscle pain Loss of appetite Nausea Vomiting Diarrhea Bleeding 16
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- 18. Symptoms Fatigue (86.2%) Widespread body pain (74.5%) Fever (71.5%) Headache (68.6%) Nausea and Vomiting (46%) 18
- 19. Clinical Course IncubationPeriod (2-10 days) Prehemorrhagic Period (7 days) Hemorrhagic Period Recovery Period 19
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- 26. Pulmonary Findings Infiltration Hilar Pathology Interstitial Pathology Pleural Thicking Pleural Effusion 26
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- 31. Diagnosis CCHF RT-PCRand/or ELISA IgG and IgM 31
- 32. Algorithm Suddenly Onset of Fever Headache Common Body Pain Arthralgia Fatigue Diarrhea Bleeding At Least 2 of them Living in an endemic area History of visiting an endemic area History of contacting with animal body fluids History of contacting a patient with CCHF CBC 32
- 33. CBC Plt:< 150.000 Wbc: <4000 Hospitalization 33
- 34. Differential Diagnosis Infectiousdiseases 59.2% Cellulitis Respiratory tract infection Urinary tract infection Intra-abdominal infection Sepsis unknown origin Leptospirosis Infective endocarditis Brucellosis Non-infectious diseases 40.8% Isolated thrombocytopenia Toxic hepatitis Cryptogenic liver cirrhosis Myelofibrosis Megaloblastic anemia Myositis 34
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- 36. Prognosis AST ALT LDH Wbc Hepatomegaly Organ failure DIC Score 36
- 37. Emergency Approach Removetick on the body Evaluate possible complaints 2 of them exist CBC trombositopenia, leukopenia Hospitalization 37
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- 39. Emergency Approach Controlfever Stabilization Supportive Care Treatment takes the form of the properties and needs of the patient according to clinical observations and laboratory results. 39
- 40. Emergency Approach Factors forSupportive Care Plan: Platelet Count Leukocyte Count Hemoglobin levels Additional diseases Bleeding Liquid electrolyte imbalance 40
- 41. Ribavirin It issuggested by World Health Organization but not approved by the FDA. In a metanalysis of Ribavirin treatment, it has been concluded that Ribavirine does not affect mortality. 41
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- 47. Recommendations for Healthcare Workers Make a risk assessment for CCHF if there is history of fever and travel to an endemic country Clinical presentation can be silent. Evaluate Laboratory Abnormalities The main risk of nosocomial transmission is through needle stick injuries or splashes of blood/ body fluids to mucous membranes 47
- 48. Recommendations for Healthcare Workers A suspect or confirmed CCHF case must be isolated and standard, contact and droplet precautions should be undertaken. HCW must wear personal protective equipment including a medical mask, facial shield/goggles, gloves and a fluid repellant gown. An N95/FFP3 mask should be worn during aerosol generating procedures HCW should not touch ticks directly with bare hands. 48
- 49. Take Home Messagges Not just endemic areas in danger Know very well possible complaints, clinical and laboratuary findings on CCHF Don’t forget its long incubation period Supportive Care !!! Informe patient with tick bite Be careful while managing with CCHF patients. 49
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- 51. In memory of MustafaBilgiç and Kübra Yazım 51