Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of health Khyber Pakhtunkhwa, Gate # 5 opposite Pearl Continental hotel Main GT road Peshawar, Peshawar, 25000, Pakistan.
Infect Dis Poverty. 2018 Nov 19;7(1):116. doi: 10.1186/s40249-018-0499-z.
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.
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.
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.
克里米亚-刚果出血热（CCHF）是一种在巴基斯坦流行的潜在致命性疾病。致病病毒通过钝缘蜱的叮咬或接触受感染的血液或组织传播。该疾病的首例病例于 1976 年在巴基斯坦报告，但自 2000 年以来，已观察到定期爆发。巴基斯坦拥有超过 1.75 亿头牲畜的庞大农业基础，同时存在钝缘蜱和缺乏预防措施来防止传播，这使得暴露人群面临感染 CCHF 的巨大风险。与此同时，医院也报告了因院内传播而感染的继发病例。
在此，我们报告了一起 CCHF 暴发事件，在怀疑发生 CCHF 之前，6 名患者中有 4 名死亡。重要的是，这些病例的主要临床特征是胃肠道症状，没有任何出血的临床迹象。在该暴发事件中，只有最后两名患者出现典型的出血性疾病迹象，随后被证实感染了 CCHF。诊断的确认是在国家卫生研究院通过实时 RT-PCR 完成的。
本病例系列强调了对暴露人群中 CCHF 的早期临床怀疑的重要性，以及需要改善巴基斯坦人群和医院内 CCHF 传播的预防措施。
