Re: Pakistan: 3 Congo virus patients admitted to hospital
Re: Pakistan: 3 Congo virus patients admitted to hospital
:tiphat: Promed
Archive Number 20100917.3372
Published Date 17-SEP-2010
Subject PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (02): (KI)
CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (02): (KARACHI)
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A ProMED-mail post
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International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 16 Sep 2010
Source: Dawn, local news [edited]
<http://www.dawn.com/wps/wcm/connect/dawn-content-library/dawn/the-newspaper/local/second-congo-fever-case-reported-in-two-weeks-690>
Another Congo fever case reported in 2 weeks
--------------------------------------------
A young tannery worker who was admitted to the city government-run
Abbasi Shaheed Hospital (ASH) for the treatment of dengue fever has
tested positive for viral Crimean-Congo haemorrhagic fever (CCHF)
virus infection as well. It was the 2nd such case of CCHF reported
from the city hospitals during the short span of 2 weeks, said
medical circles, adding that the 1st patient had been discharged from
a private hospital after his recovery.
Reports about 2 deaths from CCHF in July [2010] and the preceding
months this year set alarm bells ringing and the city and health
practitioners and relevant authorities have stressed the need [to
undertake] urgent preventive measures.
The medical superintendent of the ASH, Dr Hamid Zaheer, told the Dawn
[newspaper] on Wednesday [15 Sep 2010] that a 23-year-old patient, a
resident of Sector 9/E, Orangi Town, [had been] brought to the
hospital with pain, high-grade fever and respiratory problems. "As I
have been told by doctors, the patients bled 2 days back, following
which in addition to initial tests and symptomatic treatment, some
serological tests were conducted and it was known by Tuesday [14 Sep
2010] that the patient had tested positive both for dengue fever
[virus] and CCHF [virus] infections. Initially he was kept in the
intensive care unit, but now [he is being treated] in an isolation
ward of the hospital, while the doctors and paramedics have also been
asked to observe the appropriate protocol while [treating] the
patients in question," Dr Zaheer stated.
Of the 5 patients tested positive for the viral disease [CCHF} since
March [2010], 2 have survived, while one is under treatment at the
ASH.
The death of a patient, in his mid-thirties, a resident of Bismillah
Colony, Landhi, was confirmed by the Indus Hospital, Korangi, in July
[2010]. This patient was a butcher by profession -- said to be one of
the most vulnerable jobs to contract the highly infectious disease.
The occupation of the other patient who died from CCHF in May was not
known.
Some of the experts after knowing about the CCHF [cases] in July had
highlighted the need to undertake a retrospective study of CCHF
patients, [to determine] their occupations and their contact with
other people during the period of incubation of the virus, and to
determine the sensitivity of lab results and [communication of] a
timely update by the hospitals on the cases to the health authorities.
The deputy medical superintendent of the ASH, Dr Javed Akhtar, said
that the [23-year-old patient currently being treated], a worker at
tannery, was admitted to the hospital on Sat 11 Sep 2010 and was kept
in the Medical-III [ward] initially and then was transferred to the
medical intensive care unit (ICU) in view of his deteriorating
condition.
The laboratory of the Aga Khan University Hospital (AKUH) informed
the hospital on Tue 14 Sep 2010 of positive test results for dengue
fever virus infection and CCHF virus infection, and as a result the
patient was transferred to an isolation ward.
Relatives of of the patient had also been debarred from meeting him,
the doctor said, adding that the patient was being provided with
blood platelets, which had critically decreased. Replying to a
question, Dr Akhtar said that the AKUH laboratory handed over the
formal serology test report to the ASH on Wednesday [15 Sep 2010] for
this patient, who is now being given all possible care and is now in
a stable condition and conscious.
The head of the infections control committee of the AKUH, Dr Bushra
Jamil, told Dawn that the AKUH lab had tested 2 samples positive in
recent days for CCHF -- one pertained to a patient admitted to the
AKUH and discharged after recovery a week ago, and the other the
sample received from the ASH.
An expert said that the doctors and paramedics [known] to have come
into contact with these patient during treatment, and relatives of
the patients, also needed to be kept under observation as a
preventive measure. It is worth noting that a few years back a doctor
handling a patient suffering from CCHF later died of the same
disease. [Nosocomial transmission of infection in hospitals in
Pakistan has been recorded previously. In 2002, a female doctor
contracted CCHF virus infection from a patient and died. 2 doctors
involved in her treatment also contracted infection; both survived
(see: ProMED-mail post - Crimean-Congo hemorrhagic fever - Pakistan
(02) 20020313.3735).]
Previously, in 1974, a physician died in Rawalpindi General Hospital
as a result of CCHFV infection contracted from patients. - Mod.CP]
[Byline: Mukhtar Alam]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The geographical distribution of CCHF virus, like that of its tick
vectors (_Hyalomma_ spp.), is widespread. Evidence of CCHF virus has
been found in Africa, Asia, the Middle East and Eastern Europe.
Health care workers in endemic areas should be aware of the illness
and the correct infection control procedures to protect themselves
and their patients from the risk of nosocomial (hospital-acquired)
infection.
Humans who become infected with CCHF acquire the virus from contact
with blood or other infected tissues from livestock, or they may
become infected directly from a tick bite. The majority of cases have
occurred in those involved with the livestock industry, such as
agricultural workers, slaughterhouse workers and veterinarians.
Following infection via tick bite, the incubation period is usually
one to 3 days, with a maximum of 9 days.
The incubation period following contact with infected blood or
tissues is usually 5 to 6 days. Onset of symptoms is sudden, with
fever, myalgia (aching muscles), dizziness, neck pain and stiffness,
backache, headache, sore eyes and photophobia (sensitivity to light).
There may be nausea, vomiting and sore throat early on, which may be
accompanied by diarrhoea and generalised abdominal pain. Details of
the subsequent course of the illness can be found at:
<http://www.who.int/mediacentre/factsheets/fs208/en/index.html>.
The mortality rate from CCHF is approximately 30 percent, with death
occurring in the 2nd week of illness. In those patients who recover,
improvement generally begins on the 9th or 10th day after the onset
of illness.
Of the 5 CCHF patients treated in the city of Karachi in recent
months, 2 (a butcher and a tannery worker) have worked with livestock
or livestock products. The case of the 23-year-old tannery worker
described in the above report is exceptional in that the patient has
tested positive for 2 unrelated hemorrhagic fever viruses -- dengue
fever virus (a flavivirus) and CCHF virus (a bunyavirus). Further
information on the course, treatment and outcome of the tannery
worker's illness are matters of general interest and would be
welcomed.
The HealthMap/ProMED-mail interactive map of Pakistan, showing the
location of the city of Karachi can be accessed at:
<http://healthmap.org/r/00tj>. - Mod.CP]
[see also:
Crimean-Congo hem. fever - Pakistan ex Afghanistan: RFI 20100629.2161
2009
----
Crimean-Congo hem. fever - Pakistan (03): differential 20091012.3527
Crimean-Congo hem. fever - Pakistan (02): ex Saudi Arabia, susp. 20091011.3516
Crimean-Congo hem. fever - Pakistan (Abottabad): RFI 20090927.3377
2008
----
Crimean-Congo hem. fever - Pakistan (03): (PB), susp. 20081121.3678
Crimean-Congo hem. fever - Pakistan (02): (PB), susp. 20081117.3630
Crimean-Congo hem. fever - Pakistan: (BA) 20081027.3392]
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