Salehi-Vaziri Mostafa, Jalai Tahmineh, Tavakoli Mahsa, Asadi Laya Farhan, Sajadi Seyed Marzieh, Mohammadi Tahereh, Gerdooei Sepideh, Khakifirouz Sahar, Arbabi Farnoosh, Ghalyanchi Langeroudi Arash, Shirzadi Mohammad Reza, Pouriayevali Mohammad Hassan
Department of Arboviruses and Viral Hemorrhagic Fevers (National Reference Laboratory), Pasteur Institute of Iran, Tehran, Iran.
Department of Microbiology and Immunology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
Case Rep Infect Dis. 2025 Aug 5;2025:4600676. doi: 10.1155/crdi/4600676. eCollection 2025.
Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease with a high mortality rate which is endemic in Iran. Laboratory diagnosis of CCHF is routinely conducted using PCR and IgM ELISA tests. However, nucleotide variations within CCHF virus (CCHFV) may lead to false-negative PCR results. A 51-year-old patient suspected to have CCHF was tested for CCHFV infection using two different molecular assays. The results were discrepant, as our homemade SYBR green-based real-time PCR yielded a strong positive result, while the RealStar CCHFV RT-PCR Kit returned a negative result. Due to the discrepancies in the real-time PCR tests, a homemade conventional RT-PCR method was performed, resulting in a positive result similar to the SYBR green-based real-time PCR assay. Partial sequencing of S segment of viral genome and phylogenetic analysis revealed that the strain clustered with a strain from Africa-3 genotype, which was isolated in Namibia in 1987. CCHF antigen and IgM ELISA also confirmed the CCHFV infection in this case. This report underlines the requirement of CCHFV genomic surveillance to update the molecular diagnostic assays. Moreover, the circulation of an African CCHFV strain in Iran supports previous data suggesting that Iran harbors the greatest CCHFV genetic diversity among endemic countries. Discrepancies in PCR results, likely due to this diversity, may hinder timely diagnosis and subsequently affect patient management and treatment measures.
克里米亚-刚果出血热（CCHF）是一种由蜱传播的病毒性疾病，死亡率很高，在伊朗呈地方性流行。CCHF的实验室诊断通常采用PCR和IgM ELISA检测。然而，CCHF病毒（CCHFV）内的核苷酸变异可能导致PCR结果出现假阴性。一名疑似患有CCHF的51岁患者使用两种不同的分子检测方法检测CCHFV感染。结果不一致，因为我们自制的基于SYBR Green的实时PCR检测结果呈强阳性，而RealStar CCHFV RT-PCR试剂盒检测结果为阴性。由于实时PCR检测结果存在差异，我们采用了自制的传统RT-PCR方法，结果与基于SYBR Green的实时PCR检测结果相似，呈阳性。对病毒基因组S片段进行部分测序和系统发育分析后发现，该毒株与1987年在纳米比亚分离的非洲-3基因型毒株聚类。CCHF抗原和IgM ELISA检测也证实了该病例感染了CCHFV。本报告强调了对CCHFV进行基因组监测以更新分子诊断检测方法的必要性。此外，一种非洲CCHFV毒株在伊朗的传播支持了之前的数据，表明伊朗在地方性流行国家中拥有最大的CCHFV遗传多样性。PCR结果的差异可能是由于这种多样性造成的，这可能会阻碍及时诊断，进而影响患者管理和治疗措施。
