Introduction
Crimean-Congo hemorrhagic Fever (CCHF) is a severe viral disease that affects both humans and animals. It is caused by the Crimean-Congo hemorrhagic fever virus (CCHFV), a member of the Nairovirus genus within the Bunyaviridae family. CCHF is primarily transmitted through tick bites or contact with infected animal blood and tissues. The disease is endemic in Africa, the Balkans, the Middle East, and Asia.
History
The disease was first identified in the Crimean Peninsula in 1944, where it caused a widespread outbreak among military personnel and civilians, leading to its initial name, “Crimean hemorrhagic fever.” The virus was later found to be identical to a virus isolated in the Congo in 1956, resulting in the combined name Crimean-Congo hemorrhagic fever.
Transmission
CCHF is transmitted to humans through the bite of infected ticks, particularly those of the Hyalomma genus. It can also spread through direct contact with the blood, tissues, or bodily fluids of infected animals or humans. Livestock such as cattle, sheep, and goats are common reservoirs of the virus, and they can become infected through tick bites without showing any symptoms. In healthcare settings, the virus can be transmitted through contaminated medical instruments or needle sticks.
Symptoms
The incubation period for CCHF ranges from 1 to 13 days, depending on the mode of transmission. The disease typically presents in four distinct phases:
Pre-hemorrhagic Phase
- Sudden onset of fever
- Headache
- Muscle pain
- Dizziness
- Neck pain and stiffness
- Backache
- Sore eyes
- Photophobia (sensitivity to light)
Hemorrhagic Phase
- Severe bleeding from the nose and gums
- Hematuria (blood in urine)
- Hemoptysis (coughing up blood)
- Vomiting blood
- Melena (black, tarry stools)
- Bruising and petechiae (small red or purple spots on the skin)
Post-hemorrhagic Phase
- Gradual improvement of symptoms
- Recovery phase, which may take several weeks
Diagnosis
Diagnosis of CCHF is challenging due to its nonspecific early symptoms and the need for specialized laboratory tests. The following methods are commonly used for diagnosis:
- Reverse transcription-polymerase chain reaction (RT-PCR) to detect viral RNA
- Enzyme-linked immunosorbent assay (ELISA) to detect specific antibodies
- Virus isolation in cell culture
- Immunohistochemistry to identify viral antigens in tissue samples
Treatment
There is no specific antiviral treatment for CCHF. Management focuses on supportive care to alleviate symptoms and prevent complications. This includes:
- Fluid and electrolyte replacement
- Blood transfusions for severe bleeding
- Administration of fresh frozen plasma or platelets
- Pain relief and fever management
- Monitoring and treatment of secondary infections
The antiviral drug ribavirin has shown some efficacy in reducing the severity and duration of the disease when administered early, but its use is still under investigation.
Prevention
Preventing CCHF involves a combination of personal protective measures and public health strategies:
1.Personal Protection
- Avoiding tick-infested areas
- Wearing protective clothing (long sleeves, long pants, and hats)
- Using insect repellents containing DEET or permethrin
- Regularly checking for and removing ticks from the body
2.Animal and Environmental Control
- Implementing tick control measures in livestock, such as acaricides (tick-killing chemicals)
- Avoiding contact with livestock blood and tissues
- Ensuring proper disposal of animal carcasses
3.Infection Control in Healthcare Settings
- Adhering to strict infection control practices, including the use of personal protective equipment (PPE)
- Proper sterilization and disposal of medical instruments
- Isolation of suspected or confirmed cases to prevent nosocomial transmission
What causes death in Crimea-Congo hemorrhagic fever?
There’s not a lot of research into the causes of death from CCHF. That said, some studies suggest that potential causes of death could include:
- Multiple organ failure
- Issues with blood clotting
- Your immune system doesn’t respond properly to the virus
Is there a Crimean-Congo hemorrhagic fever vaccine?
No, there isn’t a vaccine available for CCHF at this time. But scientists have been developing vaccines for CCHF for over a decade. They’re currently studying their safety and effectiveness in clinical trials.
Nursing Management of Crimean-Congo Haemorrhagic Fever
Crimean-Congo hemorrhagic fever (CCHF) is a severe viral disease transmitted to humans through tick bites or contact with infected animal blood and tissues. Healthcare workers are at significant risk of infection when handling patients with CCHF, making nursing management and strict infection control measures paramount in preventing disease spread.
Assessment and Monitoring
1.Initial Assessment
Nurses should conduct a thorough assessment of patients suspected or confirmed to have CCHF. This includes:
- Reviewing the patient’s medical history and potential exposure risks
- Assessing for clinical signs and symptoms such as high fever, muscle aches, dizziness, neck pain, and bleeding tendencies
- Monitoring vital signs, including temperature, heart rate, blood pressure, and respiratory rate
2.Ongoing Monitoring
Continuous monitoring is crucial to detect any changes in the patient’s condition. This includes:
- Frequent assessment of vital signs
- Monitoring for signs of hemorrhage or organ failure
- Observing for neurological symptoms, which may indicate central nervous system involvement
- Recording fluid intake and output to ensure proper hydration and renal function
3.Infection Control
Nurses must adhere to stringent infection control practices to prevent nosocomial transmission of CCHF. Key measures include:
- Using personal protective equipment (PPE) such as gloves, gowns, masks, and eye protection
- Practicing hand hygiene before and after patient contact
- Properly sterilizing and disposing of medical instruments
- Isolating suspected or confirmed cases to contain the virus
4.Supportive Care
Nursing care for patients with CCHF focuses on providing supportive treatment and managing symptoms:
- Administering antipyretics for fever management
- Providing pain relief for muscle aches and headaches
- Ensuring adequate hydration through intravenous (IV) fluids if necessary
- Transfusing blood products if there is significant bleeding or anemia
5.Patient Education
Nurses play a crucial role in educating patients and their families about CCHF and preventive measures:
- Informing patients about the mode of transmission and the importance of avoiding tick bites
- Advising on the proper handling and disposal of animal products
- Reinforcing the necessity of infection control measures to prevent the spread within households
REFERENCES
- Benoit J, Frohne C. Viral Hemorrhagic Fevers. In: Schmidt GA, Kress JP, Douglas IS, eds. Hall, Schmidt and Wood’s Principles of Critical Care. 5th Ed. McGraw Hill; 2023.
- Hawman, DW, Feldmann H. Crimean-Congo haemorrhagic fever virus (https://pubmed.ncbi.nlm.nih.gov/36918725/). Nat Rev Microbiol. 2023(21): 463-477.
- Muzammil K, Rayyani S, Abbas Sahib A, et al. Recent Advances in Crimean-Congo Hemorrhagic Fever Virus Detection, Treatment, and Vaccination: Overview of Current Status and Challenges. https://pubmed.ncbi.nlm.nih.gov/38926669/. Biol Proced Online. 2024;26(1):20.
- Shope Robert E. Bunyaviruses https://www.ncbi.nlm.nih.gov/books/NBK8004/. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996.
- Whitehouse CA. Crimean-Congo hemorrhagic fever (https://pubmed.ncbi.nlm.nih.gov/15550268/). Antiviral Res. 2004;64(3):145-160.
- World Health Organization. Crimean-Congo haemorrhagic fever https://www.who.int/news-room/fact-sheets/detail/crimean-congo-haemorrhagic-fever. Updated 5/23/2022.
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