Rasikh Ahmad Shekaib, Aram Mohammad Maroof, Noory Abdul Tawab
Department of Infectious Diseases, Ali Abad Teaching Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan.
Department of Internal Medicine, Ali Abad Teaching Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan.
Infect Drug Resist. 2023 Jun 2;16:3469-3476. doi: 10.2147/IDR.S410955. eCollection 2023.
Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease associated with a high fatality rate. CCHF is endemic in Afghanistan, and its morbidity and mortality have increased recently but there is limited data about the characteristics of fatal cases. We aimed to report the clinical and epidemiological features of fatal CCHF cases who were admitted to Kabul Referral Infectious Diseases (Antani) Hospital.
This is a retrospective cross-sectional study. The demographic and presenting clinical and laboratory features of 30 fatal CCHF cases diagnosed by reverse transcription polymerase chain reaction (RT-PCR) or enzyme-linked immunosorbent assay (ELISA) tests were collected from the patients' records between March 2021 and March 2023.
During the study period, a total of 118 laboratory-confirmed CCHF patients were admitted to Kabul Antani Hospital of whom 30 patients (25 males, 5 females) consequently died, indicating a 25.4% case fatality rate (CFR). The age of the fatal cases ranged from 15 to 62 years and their mean age was 36.6 ± 11.7 years. Concerning occupation, the patients were butchers (23.3%), animal dealers (20%), shepherds (16.6%), housewives (16.6%), farmers (10%), student (3.3%), and others (10%). The clinical symptoms of the patients on admission were fever (100%), generalized body pain (100%), fatigue (90%), bleeding (any type) (86.6%), headache (80%), nausea/vomiting (73.3%), and diarrhea (70%). The initial abnormal laboratory findings were leukopenia (80%), leukocytosis (6.6%), anemia (73.3%), and thrombocytopenia (100%), raised hepatic enzymes (ALT & AST) (96.6%) and prolonged prothrombin time/international normalized ratio (PT/INR) (100%).
The hemorrhagic manifestations associated with low platelet and raised PT/INR levels are linked with fatal outcomes. A high index of clinical suspicion is required to recognize the disease at an early stage and to begin the treatment promptly for reducing mortality.
克里米亚-刚果出血热（CCHF）是一种病死率很高的人畜共患病。CCHF在阿富汗呈地方性流行，其发病率和死亡率最近有所上升，但关于死亡病例特征的数据有限。我们旨在报告入住喀布尔转诊传染病（安塔尼）医院的CCHF死亡病例的临床和流行病学特征。
这是一项回顾性横断面研究。通过逆转录聚合酶链反应（RT-PCR）或酶联免疫吸附测定（ELISA）检测确诊的30例CCHF死亡病例的人口统计学、临床表现和实验室特征，是从2021年3月至2023年3月期间的患者记录中收集的。
在研究期间，共有118例实验室确诊的CCHF患者入住喀布尔安塔尼医院，其中30例患者（25例男性，5例女性）最终死亡，病死率（CFR）为25.4%。死亡病例的年龄在15至62岁之间，平均年龄为36.6±11.7岁。职业方面，患者为屠夫（23.3%）、动物经销商（20%）、牧羊人（16.6%）、家庭主妇（16.6%）、农民（10%）、学生（3.3%）和其他（10%）。入院时患者的临床症状为发热（100%）、全身疼痛（100%）、疲劳（90%）、出血（任何类型）（86.6%）、头痛（80%）、恶心/呕吐（73.3%）和腹泻（70%）。最初的异常实验室检查结果为白细胞减少（80%）、白细胞增多（6.6%）、贫血（73.3%）和血小板减少（100%），肝酶（ALT和AST）升高（96.6%）以及凝血酶原时间/国际标准化比值（PT/INR）延长（100%）。
与低血小板和升高的PT/INR水平相关的出血表现与死亡结局有关。需要高度的临床怀疑指数来早期识别该疾病并及时开始治疗以降低死亡率。
