Fatal Crimean-Congo Hemorrhagic Fever with an Atypical Clinical Course during the COVID-19 Pandemic
Abstract
Background: Crimean-Congo hemorrhagic fever (CCHF) is a viral zoonotic disease characterized by high fever, bleeding manifestations, and a high mortality rate. Most patients begin to experience bleeding 5 to 7 days after the onset of the illness, usually while hospitalized. This report highlights that even though patients may develop shock and multi-organ failure, there might be no visible signs of bleeding until shortly before death.
Methods: This case report describes a 42-year-old male patient with a confirmed diagnosis of CCHF via RT-PCR, who died despite intensive care treatment. Despite receiving intensive care treatment, he did not respond to the septic shock therapy and unfortunately passed away within a few hours. The diagnosis of the disease was made by the reference laboratory with a positive reverse transcriptase-polymerase chain reaction (RT-PCR) test for CCHF.
Results: In this case, the patient exhibited no visible signs of bleeding, such as hematemesis, melena, or gross hematuria, despite being in shock. While CCHF mortality (5–30%) typically occurs during the 3–5-day hemorrhagic phase, this patient died suddenly due to massive intra-abdominal bleeding, skipping the typical bleeding phase.
Conclusion: Clinicians should consider that individual differences may be seen in the clinical course of CCHF disease. In addition, the Coronavirus Disease-2019 (COVID-19) pandemic was experienced worldwide when the patient applied. Given the overlapping initial symptoms of COVID-19 and CCHF, clinicians should prioritize differential diagnosis, es-pecially during the COVID-19 pandemic. During the COVID-19 pandemic, diagnostic delays may occur in the manage-ment of CCHF, particularly due to resource allocation.
2. Ergonul O, Celikbas A, Baykam N, Eren S, Dokuzoguz B (2006) Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited. Clin Microbiol Infect. 12(6): 551–554.
3. Zeller H (2007) Laboratory Diagnosis of Crimean Congo Hemorrhagic Fever. İn: Ergonul O, Whitehouse CA (Eds): Crimean Congo Hemorrhagic Fever: A Global Perspective. Vol. 1. Dordrecht (NL): Springer, pp. 233–243.
4. Swanepoel R, Gill DE, Shepherd AJ, Leman PA, Mynhardt JH, Harvey S (1989) The clinical pathology of Crimean-Congo hemorrhagic fever. Rev Infect Dis. 11(Suppl 4): 794–800.
5. Leblebicioğlu H, Sümbül M, Memish ZA, Al-Tawfik JA, Bodur H, Özkul A, Gücükoğlu A, Chinikar S, Hasan Z (2015) Consensus report: Preventive measures for Crimean-Congo Hemorrhagic Fever during Eid-al-Adha festival. Int J Infect Dis. 38: 9–15.
6. Whitehouse CA (2007) Risk Groups and Control Measures for Crimean Congo Hemorrhagic Fever. In: Ergonul O, White-house CA (Eds): Crimean-Congo Hemorrhagic Fever: A Global Perspective. Vol. 1. Dordrecht (NL): Springer, pp. 273–280.
7. Arslan M, Yılmaz G, Menteşe A, Yılmaz H, KarahaN SC, Köksal I (2017) Importance of endothelial dysfunction bio-markers in patients with Crimean-Congo hemorrhagic fever. J Med Virol. 89(12): 2084–2091.
8. Ergonul O (2006) Crimean-Congo haemorrhagic fever. Lancet Infect Dis. 6(4): 203–214.
9. Whitehouse CA (2007) Risk Groups and Control Measures for Crimean Congo Hemorrhagic Fever. In: Ergonul O, Whitehouse CA (Eds): Crimean-Congo Hemorrhagic Fever: A Global Perspective. Vol. 1. Dordrecht (NL): Springer, pp. 273–280.
10. Rasikh AS, Aram MM, Noory AT (2023) Clinical and epidemiological characteristics of 30 fatal cases of Crimean-Congo hemorrhagic fever in Kabul, Afghanistan: a retrospective observational study. Infect Drug Resist. 16: 3469–3476.
11. Bastug A, Kayaaslan B, Kazancioglu S, Aslaner H, But A, Akinci E, Yetkin MA, Eren S, Bodur H (2016) Crimean-Congo Hemorrhagic Fever: Prognostic Factors and the Association of Leukocyte Counts with Mortality. Jpn J Infect Dis. 69(1): 51–55.
12. Bakir M, Ugurlu M, Dokuzoguz B, Bodur H, Tasyaran MA, Vahaboglu H, And The Turkish Cchf Study Group (2005) Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multi-centre study of clinical features and outcome measures. J Med Microbiol. 54(Pt 4): 385–389.
13. Ochani R, Asad A, Yasmin F, Shaikh S, Khalid H, Batra S, Sohail MR, Mahmood SF, Ochani R, Hussham Arshad M, Kumar A, Surani S (2021) COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management. Infez Med. 29(1): 20–36.
14. Pazarlı AC, Parlak Z, Ekiz T (2020) COVID-19 and Crimean-Congo Hemorrhagic Fever: Similarities and Differences. Heart Lung. 49(6): 892–893.
Files | ||
Issue | Articles In Press | |
Section | Case Report | |
Keywords | ||
Crimean-Congo Hemorrhagic Fever; COVID-19; Bleeding; Mortality |
Rights and permissions | |
![]() |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |