Crimean–Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: Case report and virological investigation

Abstract

Crimean-Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43-year-old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real-time reverse transcription polymerase chain reaction (RT-PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post-onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus.

A nosocomial outbreak of Crimean-Congo hemorrhagic fever

“…8 Cases with a high viral load and those presenting with weak or no antibody response gener- ally result in death. 2,11,14 Death almost always occurs after 6-10 days due to shock and multiple organs failure. 2 However, our patient who died, a medical worker, exhibited the same course since infection can occur from person to person.…”

“…9,10,11 Deficient injection sterilization, random use of injections during treatment, and reuse of syringes are also significant factors in terms of contamination and aerosolization. 1,14 Spaces in infection control practices are the common elements in the emergence of nosocomial outbreaks. 9 Nine nosocomial cases were reported between 2004 and 2011 in a study from Ankara, Turkey, that evaluated needle injuries and contacts among health personnel.…”

Biosafety standards for working with Crimean-Congo hemorrhagic fever virus

“…A more recent detailed literature review of nosocomial CCHF transmission to HCWs listed 44 infections in 494 HCW contacts in 12 countries (Tarantola et al, 2007). Nosocomial infections were reported from South Africa Shepherd et al, 1985;Vandewal et al, 1985;Vaneeden et al, 1985a, b), Mauretania (Nabeth et al, 2004), Sudan (Elata et al, 2011), Albania (Harxhi et al, 2005;Papa et al, 2001), Kosovo (Papa et al, 2002), Bulgaria (Kunchev & Kojouharova, 2008;Papa et al, 2004), Turkey (Celikbas et al, 2014;Gürbüz et al, 2009), Iran (Chinikar et al, 2013;Mardani et al, 2009;Naderi et al, 2013), Dubai (Suleiman et al, 1980), Pakistan (Burney et al, 1980;Hasan et al, 2013), India , Tajikistan (ProMED-mail, 2009b), Kazakhstan (ProMED-mail, 2009a) and Germany (Conger et al, 2015).…”

Non-fatal case of Crimean-Congo haemorrhagic fever imported into the United Kingdom (ex Bulgaria), June 2014

“…CCHF can be transmitted nosocomially, especially in cases presenting with extensive haemorrhagic manifestations or those requiring surgical intervention [5][6][7][8][9]. Therefore, following the laboratory diagnosis on 2 July 2014, the use of full personal protective equipment was mandated and contact tracing was commenced.…”