Crimean-Congo Hemorrhagic Fever, Southwestern Bulgaria

Christova, Iva; Di, Antonino; Papa, Anna; Castilletti, Concetta; Andonova, L.; Kalvatchev, Nikolay; Papadimitriou, Εvangelia; Carletti, Fabrizio; Mohareb, Emad; Capobianchi, Maria Rosaria; Ippolito, Giuseppe; Rezza, Giovanni

doi:10.3201/eid1506.081567

Cited by 46 publications

(24 citation statements)

References 8 publications

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“…Genetic analysis of the virus isolates from Bulgaria [8], Kosovo [9], Albania [10] and Turkey [6] has also shown that these strains are closely related to isolates from south-west * Tel. : +90 362 4576069; fax: +90 362 4576014.…”

Section: Microbiology and Phylogenetic Analysismentioning

confidence: 97%

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Crimean–Congo haemorrhagic fever in Eurasia

Leblebicioğlu

2010

International Journal of Antimicrobial Agents

123

100

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Section: Microbiology and Phylogenetic Analysismentioning

confidence: 97%

“…Four confirmed cases of CCHF were seen in south-western Bulgaria near the border with Greece in early spring 2001. However, the risk of CCHF is assumed to be low in this region [8]. The disease is more prevalent in the eastern and southern provinces and Pazardjik [16].…”

Section: Bulgariamentioning

confidence: 99%

Crimean–Congo haemorrhagic fever in Eurasia

Leblebicioğlu

2010

International Journal of Antimicrobial Agents

123

100

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“…Currently, CCHFV is considered to be the most geographically widespread tick-borne virus (Ergonul, 2007). Its epidemiology mirrors the geographical distribution of Hyalomma ticks in more than 30 countries throughout Africa, south-east Europe, the Middle East and Asia (Chinikar et al, 2008;Ergonul, 2006;Papa et al, 2008;Rai et al, 2008;Christova et al, 2009). The human disease caused by CCHFV infection is usually very severe: after an incubation period of 3-7 days, the clinical spectrum starts with fever, headache, myalgia, nausea, vomiting and diarrhoea during the pre-haemorrhagic stage, and is followed by the haemorrhagic manifestations such as petechiae, haematemesis, melaena, haematuria and haemoptysis during the haemorrhagic phase, leading to a mortality rate of up to 50 % (Ergonul, 2006;Swanepoel et al, 1987).…”

Section: Introductionmentioning

confidence: 98%

Differential activation profiles of Crimean-Congo hemorrhagic fever virus- and Dugbe virus-infected antigen-presenting cells

Peyrefitte

Perret

Garcia

et al. 2009

Journal of General Virology

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Crimean-Congo hemorrhagic fever virus (CCHFV) is a highly pathogenic, tick-borne member of the family Bunyaviridae and the genus Nairovirus. To better elucidate the pathogenesis of CCHFV, we analysed the host innate immune response induced in antigen-presenting cells (APCs) infected in vitro by CCHFV. Monocyte-derived dendritic cells (DCs) and macrophages (MPs) were both shown to be permissive for CCHFV and to replicate the virus, as monitored by genomic and antigenomic strand quantification. Virus replication was, however, controlled, corroborating an efficient alpha interferon-induced response. The upregulation of CD-83 and CD-86 indicated that CCHFV induced a partial maturation of DCs, which were also shown to activate the secretion of interleukin (IL)-6 and IL-8, but no tumour necrosis factor alpha (TNF-alpha). On the other hand, in MPs, CCHFV infection elicited a high IL-6 and TNF-alpha response and a moderate chemokine response. Nevertheless, when we compared these APC responses with those seen after infection with Dugbe virus (DUGV), a mildly pathogenic virus genetically close to CCHFV, we found that, in spite of some similarities, DUGV induced a higher cytokine/chemokine response in MPs. These results suggest that CCHFV is able to inhibit the activation of inflammatory mediators selectively in infection in vitro and that these differences could be relevant in pathogenesis.

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“…Surveys have detected CCHFV-specific antibodies in livestock where the disease is most prevalent, and identified CCHFV by RT-PCR in 2% of some 900 ticks sampled (Gergova et al, 2012). A cluster of cases was recently reported in southwestern Bulgaria, where the disease had not previously been seen (Christova et al, 2009).…”

Section: Southeastern Europementioning

confidence: 99%

“…Nonetheless, immune globulin therapy was introduced in Bulgaria, where it remains in use (Vassilev et al, 1991;Papa et al, 2004;Christova et al, 2009). A 1990 article described the rapid improvement of patients treated with intramuscular and intravenous anti-CCHF immunoglobulin, but its efficacy has still not been assessed in a randomized clinical trial (Vassilenko et al, 1990).…”

Section: Antibody Therapymentioning

confidence: 99%

Crimean-Congo hemorrhagic fever: History, epidemiology, pathogenesis, clinical syndrome and genetic diversity

et al. 2013

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Bente, Dennis A.; Forrester, Naomi L.; Watts, Douglas M.; McAuley, Alexander J.; Whitehouse, Chris A.; and Bray, Mike, "CrimeanCongo hemorrhagic fever: History, epidemiology, pathogenesis, clinical syndrome and genetic diversity" (2013 b s t r a c tCrimean-Congo hemorrhagic fever (CCHF) is the most important tick-borne viral disease of humans, causing sporadic cases or outbreaks of severe illness across a huge geographic area, from western China to the Middle East and southeastern Europe and throughout most of Africa. CCHFV is maintained in vertical and horizontal transmission cycles involving ixodid ticks and a variety of wild and domestic vertebrates, which do not show signs of illness. The virus circulates in a number of tick genera, but Hyalomma ticks are the principal source of human infection, probably because both immature and adult forms actively seek hosts for the blood meals required at each stage of maturation. CCHF occurs most frequently among agricultural workers following the bite of an infected tick, and to a lesser extent among slaughterhouse workers exposed to the blood and tissues of infected livestock and medical personnel through contact with the body fluids of infected patients. CCHFV is the most genetically diverse of the arboviruses, with nucleotide sequence differences among isolates ranging from 20% for the viral S segment to 31% for the M segment. Viruses with diverse sequences can be found within the same geographic area, while closely related viruses have been isolated in far distant regions, suggesting that widespread dispersion of CCHFV has occurred at times in the past, possibly by ticks carried on migratory birds or through the international livestock trade. Reassortment among genome segments during co-infection of ticks or vertebrates appears to have played an important role in generating diversity, and represents a potential future source of novel viruses. In this article, we first review current knowledge of CCHFV, summarizing its molecular biology, maintenance and transmission, epidemiology and geographic range. We also include an extensive discussion of CCHFV genetic diversity, including maps of the range of the virus with superimposed phylogenetic trees. We then review the features of CCHF, including the clinical syndrome, diagnosis, treatment, pathogenesis, vaccine development and laboratory animal models of CCHF. The paper ends with a discussion of the possible future geographic range of the virus. For the benefit of researchers, we include a Supplementary Table listing all published reports of CCHF cases and outbreaks in the English-language literature, plus some principal articles in other languages, with total case numbers, case fatality rates and all CCHFV strains on GenBank.

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Crimean-Congo Hemorrhagic Fever, Southwestern Bulgaria

Cited by 46 publications

References 8 publications

Crimean–Congo haemorrhagic fever in Eurasia

Crimean–Congo haemorrhagic fever in Eurasia

Differential activation profiles of Crimean-Congo hemorrhagic fever virus- and Dugbe virus-infected antigen-presenting cells

Crimean-Congo hemorrhagic fever: History, epidemiology, pathogenesis, clinical syndrome and genetic diversity

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