Early Treatment of Crimean Congo Hemorrhagic Fever is Vital

Emphasizing the importance of timing in the treatment of Crimean-Congo Hemorrhagic Fever, which is frequently seen in spring and summer, Yeditepe University Hospitals  Infectious Diseases Specialist Prof. Dr. Meral Sönmezoğlu: “The sooner the treatment starts, the lower the loss of life. What is important in treatment is fluid and electrolyte monitoring and bleeding control.”

Crimean-Congo Hemorrhagic Fever is the most common tick-borne viral disease in the world. Yeditepe University Koşuyolu Hospital Infectious Diseases Specialist Prof. Dr. Meral Sönmezoğlu gave important information about the disease, which has started to be talked about again due to the loss of life in Turkey in recent days. Stating that the disease is seen in more than 30 countries in the world, Prof. Dr. Meral Sönmezoğlu remarked:  “The disease has been seen in a small number of Eastern Mediterranean countries in recent years. In 2019, it was seen in Karabük, Gümüşhane, Samsun, Çorum, Kastamonu and Sivas in Turkey.”

The First Fatal Case Occurred in 2002

Drawing attention to the death cases caused by the disease, Prof. Dr. Meral Sönmezoğlu: “For the first time in Turkey, a diagnosis was made from the serum of a patient who died with bleeding in 2002 and a patient with CCHF was reported, and since then, approximately 10 thousand 800 cases have been seen until 2019 and 528 of them have resulted in death. In 2018, 27 people applied to the hospital with the onset of disease symptoms, but could not be saved, after 3 people removed ticks until May 2019 and 6 people in June."

Is There Human-to-Human Contagion?

Underlining that the causative agent of the disease is a virus from the Bunyavirus family, known as CCHF, which is mainly transmitted by the tick's clinging to humans and sucking blood, Yeditepe University Hospitals Infectious Diseases Specialist Prof. Dr. Meral Sönmezoğlu: “The CCHF virus is not resistant to the outside environment, cannot live for a long time outside the host and dies rapidly with ultraviolet light. It is inactivated at 56°C for 30 minutes.  Human-to-human transmission can usually occur in hospitals, with close contact with the blood and body fluids of sick people. The incubation period between the entry of the virus into the body and the onset of symptoms is between 2-4 days. It takes maximum of nine days. The disease usually begins suddenly and with symptoms of a cold. It then continues with signs of severe bleeding. If treatment is not started on time, it can result in 4-6% loss of life.”

It Can be Confused with Other Diseases

The symptoms of the disease are not unique and there is a possibility that it may be confused with many diseases, Prof. Dr. Meral Sönmezoğlu explained that brucellosis, typhoid fever, Viral Hepatitis, malaria, Leptospira, rickettsiosis and meningococcemia, hematological malignancies, TTP, sepsis and Drug poisoning should also be considered in the differential diagnosis. Sönmezoğlu gave the following information about the symptoms of the disease:

“Symptoms of the disease are sudden onset fever, chills-chills, headache, muscle aches, weakness, nausea, vomiting, diarrhea, abdominal pain, and sensitivity to light. After a few days, blurring of consciousness, restlessness, drowsiness, depression, exhaustion, and pain in the upper right part of the abdomen begin. In severe cases, intense bleeding,  coma, shock, multiple organ failure, and loss of life may also occur. However, it should not be forgotten that 88 percent of the cases were mild cases with mild symptoms. Moderate and severe cases should be followed up in the hospital.”

Who is at Risk?

 Those who fall into the definition of the risk group for the transmission of the disease are listed as visitors living in the endemic region, farmers, livestock farmers, butchers, slaughterhouse workers, veterinarians, health personnel,  laboratory workers, and patients' relatives. Underlining that the transmission of the disease is mainly contact with ticks, Prof. Dr. Meral Sönmezoğlu: “Apart from this, direct contact from infected patients (in the hospital, in the society), with infected tissue and blood contact, from mother to baby (vertical transmission) and direct contact from the laboratory can also be transmitted.”

Is It Vital to Start Treatment Early? 

Yeditepe University Hospitals Infectious Diseases Specialist Prof. Dr. Meral Sönmezoğlu gave the following information about the treatment:

“The earlier the treatment is started, the lower the rate of loss of life. What is important in treatment is fluid and electrolyte monitoring and bleeding control.” If necessary, fresh frozen plasma, platelet apheresis, and whole blood/erythrocyte suspension are given. Antibiotics have no effect on treatment. To avoid ticks, stay away from tick areas, wear light-colored clothing to make the tick easier to see, choose protective clothing (long socks, long-sleeved shirts, etc.), use tick repellent spray without going outdoors, do not touch the tick with bare hands if a tick is detected, do not squeeze the tick, remove it mechanically with forceps or similar tool, if there is difficulty in removing it, always contact the hospital, and if fever is observed after tick contact, contact health institutions without delay."

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