Clinicians should consider the possibility of Crimean-Congo hemorrhagic fever and take appropriate precautions for febrile travelers returning from endemic areas, according to recent findings.
In the study, researchers characterized a fatal case of Crimean-Congo hemorrhagic fever (CCHF) contracted by a US soldier stationed in Kandahar City, Afghanistan, in 2009. The patient, aged 22 years, had experienced diarrhea, abdominal pain, vomiting and fever. He had been exposed to tick bites, undercooked goat meat and other outdoor risk factors before initiation of symptoms. On day 6 of illness, the patient was transported by emergency air evacuation to Landstuhl Regional Medical Center in Germany, where laboratory and radiographic results revealed presumptive CCHF.
The patient had severe pulmonary hemorrhage and hepatorenal failure and required repeated bronchoscopies and renal and hepatic dialysis. The patient was treated with oral then IV ribavirin. After a decrease in viral load and decreased need for ventilator support and blood transfusions, the patient was taken off liver dialysis on day 11 of illness. The patient, however, died suddenly from cerebellar tonsil herniation caused by cerebral/cerebellar edema.
Two health care workers (HCWs) then were infected with CCHF. These HCWs, and 14 other HCWs at the hospital, had been given ribavirin postexposure prophylaxis, and had mild or no CCHF symptoms. All HCWs who received ribavirin experienced adverse effects. For both of the infected HCWs, their symptoms and laboratory abnormalities were initially attributed to the ribavirin adverse effects.
According to the researchers, this case underscores the need to refine the use of ribavirin and improve postexposure prophylaxis in cases of suspected CCHF.
“Although in this case, the potential antiviral effect of ribavirin may have been decreased because of late initiation of the drug and poor penetration of the blood-brain barrier, ribavirin may have contributed to the patient’s improved clinical condition and decreased serum viral load,” the researchers wrote. “The probable CCHF virus seroconversion of two HCWs who had ameliorated or no symptoms after receiving ribavirin postexposure prophylaxis may contribute further to the experience with and dosing regimen for ribavirin postexposure prophylaxis in HCWs exposed to CCHF virus.”
Disclosure: The researchers report no relevant financial disclosures.