dr hadeel fadhil FIBMS
Hemorrhagic Fever
Identification: a viral disease with sudden onset of fever, malaise , weakness, irritability, headache, severe pain in limbs & loins. Vomiting, abdominal pain , anorexia & diarrhea occasional occur.
Flash on face & chest & conjunctiva . Hemorrhage of soft palate, uvula & pharynx, & a fine petechial rash spreading from the chest & abdomen to the rest of the body, large purpuric areas are observed. There may be bleeding from gums, nose, lungs, uterus & intestine often associated with severe liver damage.
Hematurea & albumin urea are common but usually not massive . fever is consistently elevated for 5-12 days , leucopenia with lymphopenia more marked than neutropenia. Thrombocytopenia is common.
The case fatality rate ranging from 2-50% .
Diagnosis is made by isolation of virus from blood, serologic diagnosis is by ELISA . specific Ig M may be present during the acute phase.
Most patients are animals husbandry workers or medical personals. Seasonal occurrence is from June to September, the period of vector activity. Hemorrhagic fever cases have been reported in Russia, Albania, Bulgaria, Iraq, Pakistan, western china, tropical Africa & south Africa.
@Infectious Agent: the Crimean-Congo hemorrhagic fever virus.
@Reservoir: Hyalomma spp Of ticks. Domestic animals (sheep, goats & cattle) may act as amplifying hosts.
Mode of transmission: by bite of infective adults, Hyalomma marginatum or H. anatolicum . ticks are believed to acquired infection from animal hosts. Nosocomial infection of medical workers occurring after exposure to blood & secretion from patient, has been important in recent outbreaks, tertiary cases have occurred in family members of medical workers.
@I P: usually 1-3 days.
@Period of communicability: highly infectious in the hospital setting. Nosocomial infection are common After exposure to blood & secretion.
@Susceptibility & resistance:
Immunity after infection probably last for life.
Preventive controls:
1- educate the public about the mode of tick transmission & the means for personal protection, wear light colored clothing that covers legs & arms so that ticks may be more easily seen, & apply tick repellent.
2- avoid tick infested areas when feasible , if working or playing in an infested areas, search the total body area daily , do not neglect hairy area & remove ticks promptly. Following removal, cleans the attachment site with soap & water.
3- take measure to reduce tick population on residential properties (host management, habitat modification, chemical control).
Control of patients, contact & immediate environment:
1- report to local health authority.
2- isolation : blood & body fluid precaution.
3- concurrent disinfection: bloody discharge are infective, so disinfected by heat or chlorine.
4- investigation of contact & source of infection: search for missed cases & the presence of infected animals & possible vectors.