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1/7. Imported Crimean-congo hemorrhagic fever.

    Crimean-congo hemorrhagic fever (CCHF) is a tick-borne disease that may also be transmitted through person-to-person transmission by exposure to infected body fluids. Despite its wide geographic distribution in animals, CCHF virus is rarely associated with recognized human diseases. We report the first case of imported CCHF in france.
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2/7. Crimean-congo hemorrhagic fever: case series from a medical center in Golestan province, Northeast of iran (2004).

    Crimean-congo hemorrhagic fever (CCHF) is a widely distributed lethal disease, worldwide. humans are usually infected with CCHF virus through a tick bite or close contact with viral contaminated tissues or with blood of domestic animals or of infected patients. The present study reports six cases of CCHF, who were in contact with both infected tissues and blood from sheep. In some regions like Golestan province (North of iran), clinician suspicion may have an important role in early diagnosis and treatment of the disease. Conservative therapy (intensive monitoring) and prescription of antiviral medication (ribavirin) accompanied with corticosteroids, was useful at the early stage of CCHF.
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3/7. A common-source outbreak of Crimean-congo haemorrhagic fever on a dairy farm.

    An outbreak of Crimean-congo haemorrhagic fever (CCHF) on a dairy farm in the Orange Free State in 1984 is described. Forty-six cows were purchased from the western Cape Province in January 1984; 2 died from the tick-borne disease anaplasmosis in March and a labourer who helped butcher the carcasses became ill a few days later. Another cow died at the end of April and within 9 days 4 people who had come into contact with its blood became ill. antibodies to CCHF virus were found in the sera of the 5 patients but not in other residents of the farm. Three patients recovered from a severe influenza-like illness without seeking medical attention; 1 patient, who was admitted to hospital, recovered from illness marked by haematemesis, epistaxis and amnesia and the 5th patient died of complications of surgery for brain haemorrhage. Antibody studies indicated that many of the cows became infected with CCHF after their arrival on the farm. It can be deduced that animals reared in tick-free, or relatively tick-free, circumstances, which are then moved to where they are subject to heavy parasitization by ticks, can acquire common tick-borne diseases of livestock plus CCHF infection simultaneously. In such circumstances there is a definite risk of human exposure to CCHF-infected blood or other tissues.
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4/7. congo-Crimean haemorrhagic fever in south africa. Report of a fatal case in the Transvaal.

    A 13-year-old boy, after having spent a week at a camp in a nature reserve in the western Transvaal, developed an acute illness of sudden onset characterized by chills, severe headache, muscle pains and high fever. On the 3rd day he developed a haemorrhagic state with profuse bleeding from the gastro-intestinal tract and other mucous membranes and petechial haemorrhages into the skin, from which he died on the 6th day after onset of the illness. A tick, identified as a species of Hyalomma, was found attached to his scalp. The provisional clinical diagnosis of congo virus fever was confirmed in the laboratory by the isolation of the virus in newborn mice inoculated with the patient's blood. This is the first incrimination of congo virus as the cause of a fatal case of haemorrhagic fever in south africa, although it is known to occur in several countries in the tropical region of Africa and in south-eastern europe and asia.
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5/7. Crimean congo-haemorrhagic fever treated with oral ribavirin.

    Crimean-congo Haemorrhagic fever (CCHF) is an often-lethal haemorrhagic fever caused by a tick-borne virus. There are no published data on ribavirin treatment of CCHF-infected patients, despite established in-vitro and in-vivo sensitivity. We report three health workers--two surgeons and a hospital worker--infected with CCHF virus in pakistan who were treated with oral ribavirin 4 g/day for four days, then 2.4 g/day for six days. Intravenous ribavirin was unavailable. All three patients were severely ill with low platelet and white-cell counts, raised aspartate transaminase and evidence of impaired haemostasis. Based on published reports, all had an estimated probability of death of 90% or more. The patients became afebrile, and their haematological and biochemical abnormalities returned to normal within 48 h of ribavirin treatment; all made a complete recovery, and developed IgG and IgM antibody to CCHF virus. Our experience with ribavirin treatment is encouraging, but does not constitute evidence of efficacy. Given the difficulties in gathering adequate treatment data, we propose a consensus protocol for both intravenous and oral treatment of CCHF. This protocol could be distributed to key medical personnel in areas endemic for CCHF and used to provide a firm basis for effective treatment recommendations.
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6/7. Investigation of tick-borne viruses as pathogens of humans in south africa and evidence of Dugbe virus infection in a patient with prolonged thrombocytopenia.

    In the course of investigating suspected cases of viral haemorrhagic fever in south africa patients were encountered who had been bitten by ticks, but who lacked evidence of infection with Crimean-congo haemorrhagic fever (CCHF) virus or non-viral tick-borne agents. cattle sera were tested by enzyme-linked immunoassay to determine whether tick-borne viruses other than CCHF occur in the country. The prevalence of antibody in cattle sera was 905/2116 (42.8%) for CCHF virus, 70/1358 (5.2%) for Dugbe, 21/1358 (1.5%) for louping ill, 6/450 (1.3%) for West Nile, 7/1358 (0.5%) for nairobi sheep disease, 3/625 (0.5%) for Kadam and 2/450 (0.4%) for Chenuda. No reactions were recorded with Hazara, Bahig, Bhanja, Thogoto and Dhori viruses. The CCHF findings confirmed previous observations that the virus is widely prevalent within the distribution range of ticks of the genus Hyalomma, while antibody activity to Dugbe antigen was detected only within the distribution range of the tick Amblyomma hebraeum. Cross-reactivity for the nairoviruses, Hazara, nairobi sheep disease and Dugbe, was detected in serum samples from 3/72 human patients with confirmed CCHF infection, and serum from 1/162 other patients reacted monospecifically with Dugbe antigen. The latter patient suffered from febrile illness with prolonged thrombocytopenia.
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7/7. Crimean-congo haemorrhagic fever virus infection in the western province of saudi arabia.

    In 1990, an outbreak of suspected viral haemorrhagic fever involving 7 individuals occurred in Mecca in the Western Province of saudi arabia. congo-Crimean haemorrhagic fever (CCHF), not previously known to be present in saudi arabia, was incriminated. A study of the epidemiology of this virus was therefore carried out in Mecca, and in nearby Jeddah and Taif in 1991-1993; 13 species of ixodid ticks (5 Hyalomma spp., 5 rhipicephalus spp., 2 Amblyomma spp., 1 Boophilus sp.) were collected from livestock (camels, cattle, sheep, goats), and of these 10 were capable of transmitting CCHF. camels had the highest rate of tick infestation (97%), and H. dromedarii was the commonest tick (70%). Attempts to isolate virus from pools of H. dromedarii and H. anatolicum anatolicum were unsuccessful. The source of infection in 3 confirmed cases of CCHF was contact with fresh mutton and, in a suspected case, slaughtering sheep. An investigation in Mecca, which included a serological survey of abattoir workers, identified 40 human cases of confirmed or suspected CCHF between 1989 and 1990, with 12 fatalities. Significant risk factors included exposure to animal blood or tissue in abattoirs, but not tick bites. It is suspected that the CCHF virus may have been introduced to saudi arabia by infected ticks on imported sheep arriving at Jeddah seaport, and that it is now endemic in the Western Province.
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