Crimean-Congo fever is caused by viruses. The routes of infection are from animal to human or from human to human. The disease has numerous symptoms that affect the whole organism, ranging from harmless flu-like symptoms to serious complications. To date, there is no vaccination against the disease; therapy with ribavirin is possible.
What is Crimean-Congo fever?
Crimean-Congo fever, or Crimean hemorrhagic fever, sometimes abbreviated as CCHF (Crimean-Congo Haemorrhagic Fever), is a disease caused by viruses. It occurs primarily in southeastern Europe (including Bulgaria, Hungary, Romania, Ukraine, and Turkey), the Middle East (Syria, Iraq, Iran, Afghanistan), and numerous countries in Africa and Asia. The mortality rate ranges from 2% to 50% and depends primarily on the viral strain. When death occurs due to Crimean-Congo fever, it occurs in the second week of illness. Death results from multiple organ failure. The disease-causing virus was first isolated from human blood in 1956 in what is now the Republic of Congo. At the same time, cases of the disease were documented on the Crimean peninsula in Ukraine. For this reason, the disease was given the name Crimean-Congo fever. When several people died from Crimean-Congo fever in the Black Sea region of Turkey in 2006, the disease was revisited.
Causes
Crimean-Congo fever virus belongs to the Bunyavirus family. The pathogens are present in grass-eating domestic and wild animals, for example, cows, rabbits, goats, and sheep. The disease is primarily transmitted by Hyalomma ticks. Over 30 species of the tick have already been identified as vectors. Hyalomma ticks live in warm regions south of the Balkans. They are characterized by their white-brown banded legs. The disease is transmitted from animals to humans not only through the bite of ticks, but also through direct contact with the flesh or blood from the infected animal. Among humans, the virus is transmitted by smear infection (through infected body secretions such as urine, saliva, blood, or stool), but droplet infection cannot be ruled out either.
Symptoms, complaints, and signs
Crimean-Congo fever initially progresses without clear symptoms. After an incubation period of one day to two weeks, the first symptoms appear. Those affected initially feel sick and tired, and flu-like symptoms that rapidly increase in intensity are typical. Fever and chills are joined by muscle and limb pain, headache, upper abdominal pain and gastrointestinal complaints. Many patients suffer from nausea and vomiting, as well as diarrhea and vomiting blood. In addition, irritability, mood swings, and depression may occur. Externally, Crimean-Congo fever can be noticed by the characteristic reddening of the face. This appears after three to five days and can spread to the conjunctiva and down to the throat. In some cases, skin bleeding or swelling occurs. The most obvious sign is the puncture or bite site, which occurs when infected by animals and becomes swollen and inflamed as the disease progresses. Symptoms increase in intensity over the first few days before slowly subsiding after one to two weeks. Provided medical treatment is given, the fever does not cause serious complications. If no treatment is given, the disease can cause serious symptoms and eventually lead to the death of the affected person.
Diagnosis and course
Symptoms of the disease appear suddenly after an incubation period of one to 13 days. The incubation period depends on the route of transmission. Infection from a tick bite produces symptoms somewhat more quickly than human-to-human infection. The disease can have numerous signs. In addition to general flu-like symptoms, neurological, gastrointestinal, and opthalmological symptoms occur. The first symptom is fever, which is constant for 5 to 12 days. In addition to fever, chills, irritability, enlarged lymph nodes, muscle and limb pain, upper abdominal pain, headache, depression, mood swings, nausea, and vomiting are seen. Symptoms typical of the disease are facial edema, facial, throat and conjunctival flushing.Some of the patients suffer complications in the form of a hemorrhagic course from the 3rd to 5th day. In the course of this, intestinal bleeding, hematemesis and skin bleeding occur. The bleeding tendency increases in affected patients. In a few cases, Crimean-Congo fever progresses inapparently, i.e. without symptoms. Since the disease is caused by viruses, diagnosis is made in laboratory facilities. Antibodies against the virus can be detected from the 6th day of the disease. Up to this point, symptoms may become increasingly severe, depending on the route of infection and the type of virus.
Complications
Crimean-Congo fever must be examined and treated by a doctor in any case. Without treatment, this disease can cause the death of the affected person. In this case, these suffer from the usual symptoms and discomforts of influenza. It comes to a strong fever and furthermore also to a lassitude. Not infrequently, patients also suffer from chills and irritability. Abdominal pain and headaches occur, which significantly reduce the quality of life of the affected person. Likewise, reddening of the face may occur. It is not uncommon for skin bleeding or bloody vomiting to occur, which is not infrequently associated with panic attacks or sweating. Likewise, the patient’s ability to cope with stress is reduced and those affected complain of mood swings or depression. It is not uncommon for bleeding to occur in the bowel. As a rule, Crimean-Congo fever can be treated relatively well with the help of medication. No particular complications occur. With early treatment, most of the symptoms can also be limited, resulting in a positive course of the disease. In the process, the life expectancy of the patient is also not reduced.
When should one go to the doctor?
Since Crimean-Congo fever has a high mortality rate, a visit to the doctor should be made as soon as possible, as soon as various health impairments appear. They include fever, nausea and vomiting. A physician should be consulted for headaches, aching limbs, or any other diffuse pain experience. Cramps, limitations of the musculoskeletal system or disturbances of concentration as well as attention should be examined and treated. Affected persons suffer from muscular discomfort, various dysfunctions and digestive problems. If vomiting of blood occurs, a worrying condition is present. A visit to the doctor is required immediately. Also noticeable are signs such as chills, a general feeling of malaise, and discoloration of the facial skin. If the affected person suffers from a drop in the usual performance level, sleep disturbances or abnormalities of the heart rhythm, a doctor should be consulted. Crimean-Congo fever occurs primarily in people who are in Asia, the Middle East, southeastern Europe or Africa. Therefore, especially residents or visitors of these regions should consult a doctor if they suffer from the described irregularities. If existing complaints increase in scope and intensity or if new symptoms develop, a visit to the doctor should be made. If individual functional systems of the organism fail, an emergency service is required. In the event of a circulatory collapse or loss of consciousness, acute action is required. Since there is danger to life, bystanders must take first aid measures and call an emergency physician.
Treatment and therapy
Treatment is primarily aimed at ensuring that vital signs are maintained. While at risk of infection, infected patients are cared for in an isolation ward. There is as yet no vaccination against Crimean-Congo fever, but therapy is possible. This is done with ribavirin, a nucleoside analogue that can fight DNA and RNA viruses. The efficacy of ribavirin cannot yet be conclusively assessed.
Prospect and prognosis
As with many diseases that preferentially occur in the developing world, the prognosis for Crimean-Congo fever depends heavily on the quality of medical care. Crimean-Congo hemorrhagic fever (CCHF), which has occurred regionally to date, is transmitted by ticks. Often, a rather mild course of the disease leads to a good prognosis. Patients have few symptoms in this case. However, Crimean-Congo fever can also take a severe or even fatal course. So far, Germany has not been affected by Crimean-Congo fever.However, other European countries such as Greece, Turkey, Albania, Bulgaria or Serbia have already reported a small number of people affected. Therefore, some deaths from this fever have already passed through the European press. If medical care ensures proper treatment of Crimean-Congo fever, the prognosis is quite good. However, it is problematic that Crimean-Congo fever is occasionally mistaken for other tick-borne diseases in areas with less good infrastructure. It is precarious when Crimean-Congo fever is confused with early summer meningoencephalitis (TBE) or Lyme disease. In such a misdiagnosis, the infection is usually treated incorrectly or too late. This worsens the prognosis, especially in a severe course of Crimean-Congo fever. To date, there is no protective vaccination against Crimean-Congo hemorrhagic fever. However, tick protection is available.
Prevention
The first and most important preventive measure is protection against ticks. This is done by wearing closed, light-colored clothing and by using deterrents. Attention should always be paid to these protective measures, especially when staying in countries where the presence of Hyalomma ticks has been proven. In any case, it is recommended to search the whole body for ticks and, if necessary, to remove them.
Follow-up
In most cases of Crimean-Congo fever, the measures of aftercare are severely limited. First and foremost, the disease must be detected early by a physician to prevent further complications or further discomfort. Early diagnosis has a positive effect on the further course of the disease and can also prevent a further worsening of the symptoms. The affected person should therefore see a doctor at the first signs and symptoms of Crimean-Congo fever. After an infection, contact with other people should be avoided at all costs to prevent infection. The disease itself is usually treated with the help of medication. Care should always be taken to ensure that the correct dosage is given and that the medication is taken regularly in order to provide lasting relief from the symptoms. If there are any uncertainties or questions, a doctor should always be consulted first. The affected person should in any case rest and take it easy on his body. Strenuous or stressful activities should be avoided. If Crimean-Congo fever is not treated in time or adequately, the affected person may have a reduced life expectancy.
Here’s what you can do yourself
If Crimean-Congo fever is suspected, the affected person should immediately go to the nearest hospital. Because of the risk of infection, infected patients must be treated in an isolation ward. After the acute phase of the disease is over, similar measures apply as for other infectious diseases. The affected person needs bed rest in order to survive the after-effects of the disease well. In addition, he should take in plenty of fluids and pay attention to a gentle diet. Water and tea, as well as chicken broth and rusks, have proven effective. A suitable home remedy is a tea infusion of elderflower, yarrow and lime blossom, because these medicinal plants support the immune system and make the body sweat. In consultation with the doctor, calf compresses can be applied. Homeopathic remedies such as Belladonna or Aconitum also help against the typical fever symptoms. If Crimean-Congo fever has not completely subsided after a week, the doctor must be informed. There may be a serious complication that cannot be treated by the affected person himself. In the case of depressive moods, even an extended conversation with friends or a walk in the fresh air can help. If in doubt, a therapist should be consulted.