Between 20 Mar and 10 Apr 2008, 6 probable Crimean-Congo haemorrhagic fever (CCHF) cases were reported in the municipality of Gotse Delchev, in Blagoevgrad district, Bulgaria, an area bordering Greece and Macedonia. CCHF is an endemic infection in Bulgaria, and particularly in this area. In recent years, several cases of CCHF have been reported (between 2 and 20 cases annually), with a mortality rate varying between 10 and 50 percent (1).
Description of the cases
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The cases presented with different clinical manifestations. The 1st case was a man in his 40s who became ill on 20 Jan [2008] with fever, myalgia and joint pain, one-day diarrhea, and weakness. He was treated at home with aspirin, paracetamol, augmentin, and diclac. On 25 Mar [2008], epistaxis [nosebleed] with heavy bleeding developed. A tamponade was applied at the otorhinolaryngology department of the local hospital. He was admitted in the infectious disease ward with a suspicion of haemorrhagic fever. His condition rapidly deteriorated (strongly expressed leuco- and thrombocytopenia) and he died on 26 Mar [2008].
The 2nd case was a man in his 30s from the same town. The illness began on 22 Jan [2008] with fever and weakness. On 26 Mar [2008], he [coughed up] bloody sputa and was taken into the infectious disease ward. On 27 Mar [2008] he was transferred to the infectious disease hospital in Sofia. He was discharged soon afterwards in good condition.
These 2 patients had, on 17 and 18 Mar [2008], each removed ticks from cows in the neighboring village with unprotected hands, and had taken part in the slaughter of a sick calf. The veterinary authorities reported the calf to have been sick from tannin poisoning.
The 3rd case was a healthcare worker in her 50s who had taken care of the 1st patient when he was bleeding. Although she reported having used gloves, she was abundantly stained by blood and vomit from the patient. She received immunoprophylaxis by specific hyperimmune gamma globulin against CCHF. She was hospitalised on 2 Apr [2008] and discharged in good condition a week later.
The 4th case was a woman in her 40s from the same town, a close family contact of the 1st patient. On 10 Apr [2008], she was hospitalised with fever, weakness, stomach pain, nausea, and vomiting. She had contact with the 1st case's blood when he had a nosebleed before being taken to the hospital. As a result, she received immunoprophylaxis by specific hyperimmune gamma globulin against CCHF. The symptoms of this patient were considerably less severe than in the other cases, and she was discharged from hospital in good condition on 18 Apr [2008].
2 further cases were from other villages in the municipality and did not have any relationship to the cases described above. A man in his 40s became ill on 31 Mar [2008] and a man in his 60s became ill on 9 Apr [2008]. They both had similar clinical pictures: fever, muscle and joint pain, weakness, and bleeding from the nose. It was ascertained that they had both removed ticks from cattle by hand. Following medical treatment, both are in good condition.
All the reported cases in this cluster occurred in areas with climatic conditions favourable to intensive growth of the tick population: 4 patients had been exposed to ticks, and 2 were exposed through blood from a patient.
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Description of the cases
------------------------
The cases presented with different clinical manifestations. The 1st case was a man in his 40s who became ill on 20 Jan [2008] with fever, myalgia and joint pain, one-day diarrhea, and weakness. He was treated at home with aspirin, paracetamol, augmentin, and diclac. On 25 Mar [2008], epistaxis [nosebleed] with heavy bleeding developed. A tamponade was applied at the otorhinolaryngology department of the local hospital. He was admitted in the infectious disease ward with a suspicion of haemorrhagic fever. His condition rapidly deteriorated (strongly expressed leuco- and thrombocytopenia) and he died on 26 Mar [2008].
The 2nd case was a man in his 30s from the same town. The illness began on 22 Jan [2008] with fever and weakness. On 26 Mar [2008], he [coughed up] bloody sputa and was taken into the infectious disease ward. On 27 Mar [2008] he was transferred to the infectious disease hospital in Sofia. He was discharged soon afterwards in good condition.
These 2 patients had, on 17 and 18 Mar [2008], each removed ticks from cows in the neighboring village with unprotected hands, and had taken part in the slaughter of a sick calf. The veterinary authorities reported the calf to have been sick from tannin poisoning.
The 3rd case was a healthcare worker in her 50s who had taken care of the 1st patient when he was bleeding. Although she reported having used gloves, she was abundantly stained by blood and vomit from the patient. She received immunoprophylaxis by specific hyperimmune gamma globulin against CCHF. She was hospitalised on 2 Apr [2008] and discharged in good condition a week later.
The 4th case was a woman in her 40s from the same town, a close family contact of the 1st patient. On 10 Apr [2008], she was hospitalised with fever, weakness, stomach pain, nausea, and vomiting. She had contact with the 1st case's blood when he had a nosebleed before being taken to the hospital. As a result, she received immunoprophylaxis by specific hyperimmune gamma globulin against CCHF. The symptoms of this patient were considerably less severe than in the other cases, and she was discharged from hospital in good condition on 18 Apr [2008].
2 further cases were from other villages in the municipality and did not have any relationship to the cases described above. A man in his 40s became ill on 31 Mar [2008] and a man in his 60s became ill on 9 Apr [2008]. They both had similar clinical pictures: fever, muscle and joint pain, weakness, and bleeding from the nose. It was ascertained that they had both removed ticks from cattle by hand. Following medical treatment, both are in good condition.
All the reported cases in this cluster occurred in areas with climatic conditions favourable to intensive growth of the tick population: 4 patients had been exposed to ticks, and 2 were exposed through blood from a patient.
Full article:
http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,72320