Crimean-Congo hemorrhagic fever in a dengue-endemic region: lessons for the future

  • Farheen Ali Aga Khan University, Karachi, Pakistan
  • Taimur Saleem Aga Khan University, Karachi, Pakistan
  • Umair Khalid Aga Khan University, Karachi, Pakistan
  • Syed Faisal Mehmood Aga Khan University, Karachi, Pakistan
  • Bushra Jamil Aga Khan University, Karachi, Pakistan
Keywords: Crimean Congo Hemorrhagic Fever, Ribavirin, Prophylaxis, Thrombocytopenia

Abstract

Crimean-Congo hemorrhagic fever and dengue hemorrhagic fever are endemic in Pakistan. However, the overlap of geographic distribution and early clinical features between the two conditions make a reliable diagnosis difficult in the initial stage of illness. A 16-year-old boy presented with a history of hematemesis and high-grade fever. A preliminary diagnosis of dengue hemorrhagic fever was made and supportive treatment was instituted; however, the patient continued to deteriorate clinically. Dengue IgM antibody testing was negative on the third day of admission. Qualitative polymerase chain reaction test for Crimean-Congo hemorrhagic fever viral RNA was sent but the patient expired shortly after the results became available on the sixth day of admission. Considerable resources had to be expended on contact tracing and administration of ribavirin prophylaxis to all the health-care workers who had come in contact with the patient. It is crucial that Crimean-Congo hemorrhagic fever be recognized and treated at an early stage because of longer term financial and health implications for contacts such as health-care workers in the setting of a developing country. Increased surveillance of dengue and Crimean-Congo hemorrhagic fever cases is warranted for the derivation of reasonably reliable, cost-effective and prompt predictors of disease diagnosis. These predictors can help guide future decisions in the management of similar cases. Ultimately, such a strategy may translate into better cost containment in resource-poor settings. Institution of ribavirin prophylaxis in selected patients also merits consideration.

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Author Biographies

Farheen Ali, Aga Khan University, Karachi, Pakistan
Dr Farheen Ali, MD, is currently Senior Instructor at the Department of Medicine at Aga Khan University, Karachi, Pakistan. She is also a part of the Section of Infectious Diseases at Aga Khan University. She has a special interest in clinical research and management of patients with HIV/AIDS and other endemic viral illnesses in Pakistan.  
Taimur Saleem, Aga Khan University, Karachi, Pakistan
Taimur Saleem, MBBS, recently graduated from Aga Khan University, Karachi, Pakistan with Honors. As an undergraduate student, Taimur Saleem has undertaken research as well as clinical electives at various hospitals in USA such as Ronald Reagan Medical Centre (California), Massachusetts General Hospital (Boston), Memorial-Sloan Kettering Centre (New York) and University of Pennsylvania (Philadelphia). He has published a number of papers in national as well as international peer reviewed journals in a number of disciplines. 
Umair Khalid, Aga Khan University, Karachi, Pakistan
Umair Khalid, MD, is a recent medical graduate of Aga Khan University, Karachi, Pakistan. He has also undertaken clinical as well as research electives at various institutions such as Brighams and Women's Hospital (Boston), Ronald Reagan Medical Centre (California), Mayo Clinic (Rochester) and Memorial-Sloan Kettering Centre (New York). Umair Khalid has also represented Aga Khan University at European Students' Conference at Berlin, Germany.
Syed Faisal Mehmood, Aga Khan University, Karachi, Pakistan
Dr. Faisal Mehmood, MD, is an Associate Professor at the Department of Medicine at Aga Khan University, Karachi, Pakistan. He is also a part of the section of Infectious Diseases at Aga Khan University. He is actively involved in activities of the Annual Conferences of the Infectious Diseases Society of Pakistan. 
Bushra Jamil, Aga Khan University, Karachi, Pakistan

Dr. Bushra Jamil, MBBS, MRCP and FRCP, is an associate professor at the Departments of Medicine as well as Pathology and Microbiology. She is also an Infectious Diseases consultant at Aga Khan University, Karachi, Pakistan. Her research interests include investigation of the correlates of protective immunity in HCV infection, use of lentiviral vectors for gene transfer, immune profiles in pulmonary and extrapulmonary tuberculosis,  and antibiotic resistance in bacteria. 

Published
2010-04-15
How to Cite
1.
Ali F, Saleem T, Khalid U, Mehmood SF, Jamil B (2010) Crimean-Congo hemorrhagic fever in a dengue-endemic region: lessons for the future. J Infect Dev Ctries 4:459-463. doi: 10.3855/jidc.812
Section
Case Reports