CRIMEAN-CONGO HEMORRHAGIC FEVER (CCHF)

Crimean-Congo haemorrhagic fever (CCHF) is a viral disease caused by tick-borne virus (Nairovirus).

It is a zoonotic (could be transmitted from animals to humans) vector-borne disease. CCHF causes severe illness in humans and has a case-fatality rate of up to 40%.

The disease was first described in the Crimea (former USSR) in 1944 and given the name Crimean haemorrhagic fever. In 1969, it was recognized that the pathogen causing Crimean haemorrhagic fever was the same as that responsible for an illness identified in 1956 in the Congo and linkage of the both place names resulted in the current name for the disease and the virus.

The disease is widespread in many countries in Africa, Europe, Middle East and Central Asia with sporadic outbreaks recorded in Kosovo, Albania, Iran, and Turkey.

In India the first confirmed case of CCHF was reported during a nosocomial (Infections caught in hospitals) outbreak in Ahmadabad, Gujarat, in January 2011.Subsquently outbreaks were reported from different districts of Gujarat every year. During 2012–2015, several outbreaks and cases of CCHF transmitted by ticks via livestock and several nosocomial infections were reported in the states of Gujarat and Rajasthan. Cases were documented from 6 districts of Gujarat (Ahmadabad, Amreli, Patan, Surendranagar, Kutch, and Aravalli) and 3 districts of Rajasthan (Sirohi, Jodhpur, and Jaisalmer). A CCHF case was also reported from Uttar Pradesh state. Pakistan reports 50-60 cases annually.

CCHF outbreaks constitute a threat to public health services because of its epidemic potential (biological capacity of a pathogen to cause disease in a particular environment), its high case fatality ratio (10-40%), its potential for nosocomial (hospital acquired infection) outbreaks and the difficulties in its treatment and prevention.

SYMPTOMS: fever,myalgia, (muscle ache),dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light),nausea, vomiting, diarrhoea, abdominal pain and sore throat early on, followed by sharp mood swings and confusion.

After two to four days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement).

Clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin. The petechiae may give way to larger rashes called ecchymoses, and other haemorrhagic phenomena such as melaena (bleeding from the upper bowel, passed as altered blood in the faeces), haematuria (blood in the urine), epistaxis (nosebleeds) and bleeding from the gums.

ITIOLOGY:

CCHF is caused by virus belongs to family Bunyaviridae, genus Nairovirus. Since it is enveloped virus, it can be readily inactivated. CCHF virus is stable for up to 10 days in blood kept at 40⁰ C.

Vector (living organisms that can transmit infectious diseases between humans or from animals to humans) - The common vector of CCHF is the member of Hyalomma genus, the family Ixodidae. These are hard ticks and suck blood from animals and humans. Both male and female ticks can act as a vector for disease transmission.

CCHF virus may infect a wide range of wild animals and domestic ruminant animals such as hares, rats, camel, cattle, sheep and goats.

DIAGNOSIS: Diagnosis of suspected CCHF is performed in specially-equipped, high bio-safety level laboratories. IgG and IgM antibodies detection in serum, Virus detection in blood or tissue samples, The polymerase chain reaction (PCR) and Real-Time PCR.

HOMOEOPATHIC MANAGEMENT:

 Arsenic Alb-  High temperature. Periodicity marked with adynamia. Septic fevers. Intermittent. Paroxysms incomplete, with marked exhaustion. Hay-fever. Cold sweats. Typhoid, not too early; often after Rhus. Complete exhaustion. Delirium; worse after midnight. Great restlessness. Great heat about 3 am.

 Eupatorium Perf-  Perspiration relieves all symptoms except headache. Chill between 7 and 9 am, preceded by thirst with great soreness and aching of bones. Nausea, vomiting of bile at close of chill or hot stage; throbbing headache. Knows chill is coming on because he cannot drink enough.

 Gelsemium-  Wants to be held, because he shakes so. Pulse slow, full, soft, compressible. Chilliness up and down back. Heat and sweat stages, long and exhausting. Dumb-ague, with much muscular soreness, great prostration, and violent headache. Nervous chills. Bilious remittent fever, with stupor, dizziness, faintness; thirstless, prostrated. Chill, without thirst, along spine; wave-like, extending upward from sacrum to occiput.

 Belladona- high feverish state with comparative absence of toxæmia. Burning, pungent, steaming, heat. Feet icy cold. Superficial blood-vessels, distended. Perspiration dry only on head. No thirst with fever.

 Sulphur- Frequent flashes of heat. Violent ebullitions of heat throughout entire body. Dry skin and great thirst. Night sweat, on nape and occiput. Perspiration of single parts. Disgusting sweats. Remittent type.

 Rhus Tox- Adynamic; restless, trembling. Typhoid; tongue dry and brown; sordes; bowels loose; great restlessness. Intermittent; chill, with dry cough and restlessness. During heat, urticaria. Hydroa. Chilly, as if cold water were poured over him, followed by heat and inclination to stretch the limbs.