Crimean-Congo haemorrhagic fever

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 24 Oct 2024

Last updated: 28 Jun 2024

Crimean-Congo haemorrhagic fever is a notifiable condition.

Presents as a sudden-onset, severe illness with initial influenza-like symptoms, red eyes, and petechiae leading to signs of haemorrhage around day 4.

Transmission to humans is primarily through the bite of an infected tick. Most cases occur in adults exposed to ticks during the course of their work. Human-to-human transmission occurs via contact with body fluids or blood from infected patients.

Appropriate personal protective equipment should be used and the patient isolated.

Supportive therapy is the standard of care, although some people may benefit from treatment with ribavirin.

Definition

Crimean-Congo haemorrhagic fever (CCHF) is a fatal viral infection caused by the CCHF virus which has been reported in parts of Africa, Asia, Eastern Europe, and the Middle East.[1] The virus belongs to the genus Orthonairovirus in the Nairoviridae family (formerly Bunyaviridae) and causes severe diseases in humans, with a reported mortality rate of 3% to 40%.[2][3] The geographical range of CCHF virus is the largest among tickborne viruses affecting humans. After dengue viruses, it is the most widespread of medically important arboviruses.[2] Humans are infected through tick bites, through contact with a person in the acute phase of CCHF infection, or from viraemic livestock (through blood or tissue contact).[1][2]

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History and exam

Key diagnostic factors

presence of risk factors
fever
myalgia
malaise
bleeding
macular or petechial rash

Full details

Other diagnostic factors

headache
nausea
abdominal pain
hepatomegaly
splenomegaly
somnolence
diarrhoea
hypotension
conjunctivitis
arthralgia

Full details

Risk factors

residency in or recent travel to CCHF-endemic region
history of tick exposure
contact with infected body fluids
occupational exposure
contact with infected animals
unprotected sexual contact with an infected individual

Full details

Diagnostic investigations

1st investigations to order

reverse transcription-polymerase chain reaction (RT-PCR)
malaria investigations

Full details

Investigations to consider

serology
FBC
coagulation studies
LFTs
serum creatinine and urea
urinalysis
serum electrolytes
lactate dehydrogenase
creatine phosphokinase

Full details

Treatment algorithm

INITIAL

potential exposure

ACUTE

suspected or confirmed infection

Contributors

Authors

Maryam Keshtkar Jahromi, MD, MPH, FIDSA

Assistant Professor of Medicine

Division of Infectious Diseases

Johns Hopkins University School of Medicine

Baltimore

Disclosures

MKJ declares that she has no competing interests.

Mohammad Fereidouni, MD

Postdoctoral Research Fellow

Division of Infectious Diseases

Johns Hopkins University School of Medicine

Baltimore

Disclosures

MF declares that he has no competing interests.

Acknowledgements

Dr Maryam Keshtkar Jahromi and Dr Mohammad Fereidouni would like to gratefully acknowledge Dr Onder Ergonul, a previous contributor to this topic.

Disclosures

OE is the author of references cited in this topic.

Peer reviewers

John S. Schieffelin, MD

Associate Professor of Pediatrics

Adjunct Associate Professor of Medicine

Sections of Pediatric & Adult Infectious Diseases

Tulane University School of Medicine

New Orleans

Disclosures

JSS declares that he has no competing interests.

Vanessa Raabe, MD, MSc

Adult and Pediatric Infectious Disease Fellow

Emory University

Atlanta

Disclosures

VR declares that she has no competing interests.

Tom Fletcher, MBChB, MRCP, DTM&H

Wellcome Trust/MoD Research Fellow

Liverpool School of Tropical Medicine

Liverpool

Disclosures

TF receives Crimean-Congo haemorrhagic fever research funding from the Wellcome Trust and UK Surgeon General. He is a member of the WHO secretariat for Crimean-Congo haemorrhagic fever guideline development.

Ayşe Erbay, MD, MPH

Professor of Infectious Diseases

Faculty of Medicine

Bozok University

Yozgat

Turkey

Disclosures

AE declares that she has no competing interests.

Differentials
- Malaria infection
- Ebola virus infection
- Lassa fever
More Differentials
Guidelines
- CDC health information for international travel (Yellow Book): viral hemorrhagic fevers
- Crimean-Congo haemorrhagic fever: origins, reservoirs, transmission and guidelines
More Guidelines
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Crimean-Congo haemorrhagic fever

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

potential exposure

suspected or confirmed infection

Contributors

Authors

Maryam Keshtkar Jahromi, MD, MPH, FIDSA

Disclosures

Mohammad Fereidouni, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

John S. Schieffelin, MD

Disclosures

Vanessa Raabe, MD, MSc

Disclosures

Tom Fletcher, MBChB, MRCP, DTM&H

Disclosures

Ayşe Erbay, MD, MPH

Disclosures

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

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