Crimean-Congo Hemorrhagic Fever (CCHF)

 

Mrs. Sathyavathy. G

Associate Professor, Sri Manakula Vinayagar Nursing College, Puducherry.

*Corresponding Author E-mail: gsathyavathybablu@gmail.com

 

ABSTRACT:

Crimean-Congo haemorrhagic fever (CCHF) is a viral infection that can kill a lot of people and is found in about 30 countries. It is the most widespread of the medically important diseases caused by ticks and is very close to how Hyalomma spp. ticks are found all over the world. Tick bites, crushing infected ticks, contact with a patient with CCHF during the acute phase of the infection, or contact with blood or tissues from viraemic livestock are all ways in which humans contract the disease. Clinical highlights regularly show an emotional movement described by drain, myalgia, and fever. Lactate dehydrogenase, creatinine phosphokinase, and liver enzymes all rise, and bleeding markers last longer. The endothelium infection is a major pathogen. In finding, protein connected immunoassay and continuous opposite transcriptase PCR are utilized. Early finding is basic for patient treatment and the counteraction of expected nosocomial diseases. The most essential component of case management is supportive therapy. When treating patients who have hemorrhages from the nose, mouth, gums, vagina, and injection sites, healthcare workers run a high risk of infection. Straightforward boundary safety measures have been accounted for to be compelling.

 

KEYWORDS: Haemorrhagic, Susceptible, Endothelium, Nosocomial diseases, Pathogen.

 

 

INTRODUCTION:

Crimean-Congo hemorrhagic fever, or CCHF for short, is a virus spread by ticks (Nairovirus). It is a vector-borne zoonotic disease that can spread from animals to humans. Humans with CCHF experience severe illness and a case-fatality rate of up to 40%. In 1944, the disease was first described as Crimean hemorrhagic fever in the former Soviet republic of Crimea. It was discovered in 1969 that the pathogen that caused Crimean hemorrhagic fever was the same one that was responsible for a disease that was first found in the Congo in 1956. The connection between the two place names led to the current name for the disease and the virus. CCHF is endemic in Africa, the Balkans, the Center East, and Asian nations south of the 50th equal north - the geological furthest reaches of the chief tick vector.3,7

 

INCIDENCE:

·       Between 1 January to 22 May 2022, the wellbeing specialists of the Republic of Iraq advised WHO of 212 instances of Crimean-Congo Hemorrhagic Fever (CCHF), of which 115 (54%) were thought and 97 (46%) research facility affirmed; There were 27 deaths, 14 of which were suspected and 13 of which were confirmed in the laboratory.

·       Compared to the 33 cases that were confirmed in the laboratory in 2021, the number of cases reported in the first five months of 2022 is significantly higher.

·       The first case of Crimean-Congo hemorrhagic fever that has been confirmed comes from India's Rajasthan State's Sirohi district.5,7

 

CAUSES:

•       A wide variety of domestic and wild animals, including cattle, sheep, and goats, serve as the CCHF virus's hosts.

•       Ostriches are susceptible to infection and may exhibit a high prevalence of infection in endemic regions, where they have been the source of human cases, despite the fact that many other birds are immune.

•       A previous outbreak, for instance, took place in South Africa at an ostrich slaughterhouse. These animals don't seem to have any disease.

•       Tick bites transmit the virus to animals, allowing the tick-animal-tick cycle to continue when another tick bites. The virus remains in the animals' blood for about a week after infection.

•       Although ticks of various genera are capable of becoming infected with the CCHF virus, the primary vector is the genus Hyalomma tick.1,11

 

TRANSMISSION:

 

Fig:01 Transmission of CCH

 

Fig:02 Transmission of CCHF

 

·       Tick bites or contact with infected animal tissues or blood during and immediately following slaughter can spread the CCHF virus to humans.

·       Most of cases have happened in individuals engaged with the animals business, like farming specialists, slaughterhouse laborers, and veterinarians.5,9,14

 

§  The CCHF virus can be transmitted from an animal to a human:

The CCHF virus can be transmitted from an animal to a human either by being bitten by a hard tick or by coming into contact with infected animal tissues or blood during and immediately following slaughter. Workers in the livestock industry, including agricultural workers, slaughterhouse workers, and veterinarians, have been most frequently affected.

§  Transmission from one person to another:

A person can become infected if the blood, bodily fluids, and wastes of a person with the disease come into contact with broken skin or mucous membranes, as happens when a medical professional is accidentally hit with a needle. In addition, improper sterilization of medical equipment, needle reuse, and contamination of medical supplies can result in hospital-acquired infections.

§  Infections acquired in hospitals:

Infections acquired in hospitals can also be the result of contaminated medical supplies, needle reuse, and improper sterilization of medical equipment.2,5

 

INCUBATION PERIOD:

The length of the incubation period depends on the mode of acquisition of the virus.

 

o  The incubation period following contact with infected blood or tissues is usually five to six days, with a documented maximum of 13 days.4,10

 

PATHOPHYSIOLOGY OF CCHF VIRAL INFECTION

 

Crimean-Congo haemorrhagic fever (CCHF) is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family.

↓

Replication of the virus

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Pro-inflammatory response Endothelial damage

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Activation of the intrinsic coagulation cascade

↓

DIC and multi organ failure

↓

Death.3,12

 

CLINICAL MANIFESTATION:

 

Fig: 03 Clinical manifestation of CCHF

·      Sudden fever

·      Myalgia, (muscle ache)

·      Dizziness

·      Neck pain and stiffness

·      Backache

·      Headache

·      Sore eyes

·      Photophobia (sensitivity to light).

·      Nausea

·      Vomiting

·      Diarrhoea

·      Abdominal pain and

·      Sore throat early on, followed by sharp mood swings and confusion.9,16,17

 

After two to four days, the agitation may be replaced by

·       Sleepiness

·       Depression and lassitude, and

·       The abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement).8,13

 

OTHER CLINICAL SIGNS

•       Tachycardia (fast heart rate)

•       Lymphadenopathy (enlarged lymph nodes)

•       A petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and the skin.

•       The petechiae may give way to larger rashes called ecchymoses, and other hemorrhagic phenomena.

•       There is usually evidence of hepatitis, and severely ill patients may experience rapid kidney deterioration, sudden liver failure, or pulmonary failure after the fifth day of illness.

 

The mortality rate from CCHF is approximately 30%, with death occurring in the second week of illness. In patients who recover, improvement generally begins on the ninth or tenth day after the onset of the illness.7,13,4

 

DIAGNOSTIC EVALUATION:

•       Enzyme-linked immunosorbent assay (ELISA)

•       Antigen detection

•       Serum neutralization

•       Reverse transcriptase polymerase chain reaction (RT-PCR) assay; and

•       Virus isolation by cell culture.

 

·       Patients with a fatal disease, as well as in patients in the first few days of illness, do not usually develop a measurable antibody response and so diagnosis in these individuals is achieved by virus or RNA detection in blood or tissue samples.

·       However, if samples have been inactivated (e.g. With virucides, gamma rays, formaldehyde, heat, etc.), they can be manipulated in a basic biosafety environment.2,10,17

 

TREATMENT:

•       The most common approach to managing CCHF in people is general supportive care with treatment of symptoms.

•       The treatment of CCHF infection with the antiviral drug ribavirin appears to be working. Formulations administered orally and intravenously appear to be effective.

•       Care should pay close attention to fluid balance, correcting electrolyte imbalances, providing oxygen and hemodynamic support, and treating secondary infections appropriately.

•       The antiviral drug ribavirin is ineffective against the virus in vitro. It has apparently been helpful in the treatment of CCHF patients.1,9

 

PREVENTION AND CONTROL:

·       In Bulgaria, a vaccine made from inactivated mouse brain is used, but it isn't widely available, so safety and effectiveness.

·       Environmental sanitation of underbrush habitats has contributed to some tick control in endemic regions.

·       Make sense of the Prophylactic treatment with ribavirin has infrequently been utilized after high-risk openings.

·       Update the Protected internment works on, including the utilization of 1:10 fluid blanch arrangement

·       as a sanitize

·       Make sense of about Acaricides might be helpful on homegrown creatures to control CCHF infection contaminated ticks whenever utilized 10-14 days preceding butcher or to commodity of creatures from enzootic locales.

·       Commonness should be estimated in creatures and in danger people in endemic regions; likewise, a useful animal model must be created.

·       To decide the viability of explicit treatment with ribavirin and other antiviral medications, and foster a protected and successful immunization for human use.6,16

 

Fig:04  Pre. of CCHF

 

NURSING CARE PLAN:

1.     Deficient Fluid Volume related to increased capillary permeability, bleeding, vomiting, and fever.

2.     Hyperthermia related to process of dengue virus infection.

3.     Risk for bleeding related to low platelet count (thrombocytopenia)

4.     Imbalanced nutrition less than body requirements related to nausea, vomiting and no appetite.13,18

 

REFERENCE:

I.      JOURNAL REFERENCE

1.      Al-Abri SS, Abaidani IA et.al, Current status of Crimean-Congo hemorrhagic fever in the World Health Organization eastern Mediterranean region: issues, challenges, and future directions. Int J Infect Dis. 2017;58:82-9.

2.      Bażanσw BA, Pacoń J, Gadzała Ł, Frącka A, Welz M, Paweska J. Vector and serologic survey for Crimean-Congo hemorrhagic fever virus in Poland. Vector Borne Zoonotic Dis. 2017;17(7):510-3.

3.      Bente DA, Forrester NL, Watts DM, McAuley AJ, Whitehouse CA, Bray M. Crimean-Congo hemorrhagic fever: history, epidemiology, pathogenesis, clinical syndrome, and genetic diversity. Antiviral Res. 2013;100(1): Page no:159-89.

4.      Blair PW, Kuhn JH, Pecor DB, Apanaskevich DA, Kortepeter MG, Cardile AP, Polanco Ramos A, Keshtkar-Jahromi M. An emerging biothreat: Crimean-Congo hemorrhagic fever virus in southern and western Asia. Am J Trop Med Hyg. 2019;100(1):16-23. Burt FJ. Laboratory diagnosis of Crimean-Congo hemorrhagic fever virus infections. Future Virol. 2011; 6: Page no:831-41.

5.      Burt FJ, Swanepoel R, Braack LE. Enzyme-linked immunosorbent assays for the detection of antibodies to Crimean-Congo hemorrhagic fever virus in the sera of livestock and wild vertebrates. Epidemiol Infect. 1993;111(3):Page no: 547-57.

6.      Charrel RN, Attoui H, Butenko AM, Clegg JC, Deubel V, et al. Tick-borne virus diseases of human interest in Europe. Clin Microbiol Infect. 2004;10:Page no:1040-55.

7.      Christova I et.al, Country-wide seroprevalence studies on CrimeanCongo hemorrhagic fever and hantavirus infections in general population of Bulgaria. J Med Virol. 2017;89(10):1720-5.

8.      De Liberato C, Frontoso R, Magliano A, Montemaggiori A, Autorino GL, Sala M, Bosworth A, Scicluna MT. Monitoring for the possible introduction of Crimean-Congo hemorrhagic fever virus in Italy based on tick sampling on migratory birds and serological survey of sheep flocks. Prev Vet Med. 2018; 149:47-52.

9.      Khan A, et al. Viral Hemorrhagic Fevers. Seminars in Pediatric Infectious Diseases. Philadelphia: WB Saunders Co., 1997;8 (suppl 1):64-73.

10.   Papa A, Papadimitriou E, Christova I. The Bulgarian vaccine Crimean-Congo hemorrhagic fever virus strain. Scand J Infect Dis 2011;43: 225-9.

11.   Hawman DW, Feldmann H. Recent advances in understanding Crimean-Congo hemorrhagic fever virus. F1000Res. 2018;7: F1000 Faculty Rev-715.

12. Crimean-Congo Hemorrhagic Fever - Iraq. World Health Organization. June 1, 2022. https://w ww.who.int/emergencies/disease-outbreak-news/item/2022-DON386 (Accessed on June 21, 20 22).

 

II.   BOOK REFERENCE:

13.   O. Ergonul and C. A. Whitehouse (eds.), Crimean-Congo Hemorrhagic Fever, 2007 Springer. Published by Berna Arda, Ahmet Aciduman, Page no: 13–22.

14.   Peters CJ. Viral Hemorrhagic Fevers. Viral Pathogenesis. New York: Lippincott-Raven     Publishers, 1997: Page no: 779-794.

15.   Watts DM et.al, Crimean-Congo hemorrhagic fever. In: Monath TP, editor. Volume 2. CRC Press; Boca Raton, FL, USA: 1988. Page no: 177–260.

16.   Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 109, 2015, Page no: 481–482

17.   Crimean-Congo Hemorrhagic Fever, Marmara University, School of Medicine, Altunizade, Turkey, first edition, Published by Springer Dordrecht, page no: 301-328.

 

 

 

Received on 22.11.2022         Modified on 10.03.2023

Accepted on 07.06.2023       ©A&V Publications All right reserved

A and V Pub Int.  J. of Nursing and Medical Res. 2023; 2(2):52-55.

DOI: 10.52711/ijnmr.2023.14