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Please help improve this article by expanding it. Further information might be found on the talk page. (October 2008) Crimean-Congo hemorrhagic fever virus Virus classification Group: Group V ((-)ssRNA) Family: Bunyaviridae Genus: Nairovirus Species: Crimean-Congo hemorrhagic fever virus Crimean-Congo hemorrhagic fever Classification and external resources ICD-10 A98.0 ICD-9 065.0 DiseasesDB 31969 Crimean-Congo hemorrhagic fever (CCHF) is a widespread tick-borne viral disease, a zoonosis of domestic animals and wild animals, that may affect humans. The pathogenic virus, especially common in East and West Africa, is a member of the Bunyaviridae family of RNA viruses. Clinical disease is rare in infected mammals, but commonly severe in infected humans, with a 30% mortality rate. Outbreaks of illness are usually attributable to handling infected animals or people. Contents 1 Virology 1.1 Clinical course 2 Prevention 3 Treatment 4 Epidemiology 4.1 Vectors 4.2 Outbreaks 5 History 6 References 7 External links // Virology Clinical course Typically, after a 1–3 day incubation period following a tick bite (5–6 days after exposure to infected blood or tissues), flu-like symptoms appear, which may resolve after one week. In up to 75% of cases, however, signs of hemorrhage appear within 3–5 days of the onset of illness in case of bad containment of the first symptoms: first mood instability, agitation, mental confusion and throat petechiae, then soon nosebleeds, bloody urine and vomiting, and black stools. The liver becomes swollen and painful. Disseminated intravascular coagulation may occur as well as acute kidney failure and shock, and sometimes acute respiratory distress syndrome. Patients usually begin to recover after 9–10 days from symptom onset, but 30% die in the second week of illness. Prevention Where mammal and tick infection is common agricultural regulations require de-ticking farm animals before transportation or delivery for slaughter. Personal tick avoidance measures are recommended, such as use of insect repellents, adequate clothing and body inspection for adherent ticks. When feverish patients with evidence of bleeding require resuscitation or intensive care, body substance isolation precautions should be taken. The United States armed forces maintain special stocks of ribavirin to protect personnel deployed to Afghanistan and Iraq from CCHF. Treatment Treatment is primarily symptomatic and supportive, as there is no established specific treatment. Ribavirin is effective in vitro[1] and has been used during outbreaks,[2] but there is no trial evidence to support its use. Epidemiology Vectors Hyalomma tick Sporadic infection of people is usually caused by Hyalomma tick bite. Clusters of illness typically appear after people treat, butcher or eat infected livestock, particularly ruminants and ostriches. Outbreaks have occurred in clinical facilities where health workers have been exposed to infected. blood and fomites. The causative organism is found in Asia, Eastern Europe, the Middle East, a belt across central Africa and South Africa and Madagascar (see map [3]) The main environmental reservoir for the virus is small mammals (particularly European hare, Middle-African hedgehogs and multimammate rats). Ticks carry the virus to domestic animal stock. Sheep, goats and cattle develop high titers of virus in blood, but tend not to fall ill. Birds are generally resistant with the exception of ostriches. Outbreaks Isolated male patient diagnosed with Crimean-Congo hemorrhagic fever During the summers of 1944 and 1945 over 200 cases of an acute, hemorrhagic, febrile illness occurred in Soviet troops rescuing the harvest following the ethnic cleansing of the Crimean Tatars. On July 28, 2005 authorities reported 41 cases of CCHF in Turkey's Yozgat Province, with one death. As of August 2008, a total of 50 people were reported to have lost their lives in various cities in Turkey due to CCHF. 3128 Crimean-Congo hemorrhagic fever cases with 5% of case-fatality rate have been reported by the Ministry of Health of Turkey between 2002-2008. On May 27, 2010 Hospitals reported 70 cases of CCHF in Kosovo 's Kosovo Polje, with 4 deaths reported so far. The Authorities are not able to deal with the diesease because of the lack of advanced medication In september 2010, in outbreak has occurred in the khyber pakhtoon khwa province of pakistan...where hundreds of cases suffer from this disease with a fatality rate of above 10 %. History Soviet scientists first identified the disease they called Crimean hemorrhagic fever in 1944 and established its viral etiology by passage of the virus through human "volunteers" (fatality rate unreported), but were unable to isolate the agent at that time.[4] In June 1967, Soviet virologist Mikhail Chumakov registered an isolate from a fatal case that occurred in Samarkand (on the ancient Silk Road in Central Asia, not the Crimea) in the Catalogue of Arthropod-borne Viruses.[5] Four months earlier, virologists Jack Woodall, D Simpson and others had published initial reports[6][7]on a virus they called the Congo virus, first isolated in 1956 by physician Ghislaine Courtois, head of the Provincial Medical Laboratory, Stanleyville, Belgian Congo. Strain V3010, isolated by Courtois, was sent to the Rockefeller Foundation Virus Laboratory (RFVL) in New York City and found to be identical to another strain from Uganda, but to no other named virus at that time. Chumakov later sent his strain to the RFVL, where it was found to be identical to the Congo virus.[8] The International Committee on Taxonomy of Viruses proposed the name Congo-Crimean hemorrhagic fever virus, but the Soviets insisted on Crimean-Congo hemorrhagic fever virus. Against all principles of scientific nomenclature based on priority of publication, it was adopted as the official name in 1973 in possibly the first instance of a virus losing its name to politics and the Cold War. However, since then Congo-Crimean or just Congo virus has been used in many reports, which would be missed in searches of medical databases using the official name. These reports include records of the occurrence of the virus or antibodies to the virus from Greece, Portugal, South Africa, Madagascar (the first isolation from there), the Maghreb, Dubai, Saudi Arabia, Kuwait and Iraq.[9] [10][11] References ^ Watts DM, Ussery MA, Nash D, Peters CJ. (1989). "Inhibition of Crimean-Congo hemorrhagic fever viral infectivity yields in vitro by ribavirin". Am J Trop Med Hyg. 41: 581–5. PMID 2510529.  ^ Ergönül Ö, Celikbas A, Dokuzoguz B, et al. (2004). "The chacteristics of Crimean-Congo hemorrhagic fever in a recent outbreak in Turkey and the impact of oral ribavirin therapy". Clin Infect Dis 39: 285–9. doi:10.1086/422000. PMID 15307042. http://www.journals.uchicago.edu/cgi-bin/resolve?CID32782.  ^ Map ^ Chumakov, 1947 INCOMPLETE ^ Chumakov MP, Butenko AM, Shalunova NV, Mart'ianova LI, Smirnova SE, Bashkirtsev IuN, Zavodova TI, Rubin SG, Tkachenko EA, Karmysheva VIa, Reingol'd VN, Popov GV, Savinov AP. [New data on the viral agent of Crimean hemorrhagic fever] Vopr Virusol. 1968 May-Jun;13(3):377. Russian. ^ Simpson DI, Knight EM, Courtois G, Williams MC, Weinbren MP, Kibukamusoke JW.Congo virus: a hitherto undescribed virus occurring in Africa. I. Human isolations--clinical notes.East Afr Med J. 1967 Feb;44(2):86-92. ^ Woodall JP, Williams MC, Simpson DI. Congo virus: a hitherto undescribed virus occurring in Africa. II. Identification studies.East Afr Med J. 1967 Feb;44(2):93-8. ^ Casals J. Antigenic similarity between the virus causing Crimean hemorrhagic fever and Congo virus. Proc Soc Exp Biol Med. 1969 May;131(1):233-6. ^ Crowcroft NS, Morgan D, Brown D. Viral haemorrhagic fevers in Europe--effective control requires a co-ordinated response. Euro Surveill. 2002 Mar;7(3):31-2. Review. ^ Al-Tikriti SK, Al-Ani F, Jurji FJ, Tantawi H, Al-Moslih M, Al-Janabi N, Mahmud MI, Al-Bana A, Habib H, Al-Munthri H, Al-Janabi S, AL-Jawahry K, Yonan M, Hassan F, Simpson DI. Congo/Crimean haemorrhagic fever in Iraq. Bull World Health Organ. 1981;59(1):85-90. ^ Okorie TG. Comparative studies on the vector capacity of the different stages of Amblyomma variegatum Fabricius and Hyalomma rufipes Koch for Congo virus, after intracoelomic inoculation. Vet Parasitol. 1991 Mar;38(2-3):215-23. External links Ergönül O. (2006). "Crimean-Congo haemorrhagic fever". Lancet Infect Dis 6: 203–214. doi:10.1016/S1473-3099(06)70435-2.  World Health Organization Fact Sheet v • d • e Zoonotic viral diseases (A80–B34, 042–079) Arthropod/ (arbovirus) Mosquito Bunyaviridae Arbovirus encephalitis: La Crosse encephalitis (LCV) · California encephalitis (CEV) Viral hemorrhagic fever: Rift Valley fever (RVFV) Flaviviridae Arbovirus encephalitis: Japanese encephalitis (JEV) · Australian encephalitis (MVEV, KUNV) · St. Louis encephalitis (SLEV) · West Nile fever (WNV) Viral hemorrhagic fever: Dengue fever (DV) other: Yellow fever (YFV) · Zika fever Togaviridae Arbovirus encephalitis: Eastern equine encephalomyelitis (EEEV) · Western equine encephalomyelitis (WEEV) · Venezuelan equine encephalomyelitis (VEEV) other: Chikungunya (CV) · O'Nyong-nyong fever (OV) · Ross River fever (RRV) Tick Bunyaviridae Viral hemorrhagic fever: Crimean-Congo hemorrhagic fever (CCHFV) Flaviviridae Arbovirus encephalitis: Tick-borne encephalitis (TBEV) · Powassan encephalitis (PV) · Deer tick virus encephalitis (DTV) Viral hemorrhagic fever: Omsk hemorrhagic fever (OHFV) · Kyasanur forest disease (KFDV/Alkhurma virus) Reoviridae Colorado tick fever (CTFV) Mammal Rodent (Robovirus) Arenaviridae Viral hemorrhagic fever: Lassa fever (LV) · Venezuelan hemorrhagic fever (Guanarito virus) · Argentine hemorrhagic fever (Junin virus) · Bolivian hemorrhagic fever (Machupo virus) · Lujo virus Bunyaviridae Puumala virus · Andes virus · Sin Nombre virus · Hantavirus (HV) Bat Filoviridae VHF: Ebola hemorrhagic fever  · Marburg hemorrhagic fever Rhabdoviridae Australian bat lyssavirus · Mokola virus · Duvenhage virus · Lagos bat virus · Chandipura virus(sandfly) Bornaviridae Menangle · Henipavirus · Borna disease (Borna disease virus) Multiple Rhabdoviridae Rabies (RV) M: VIR virs (prot) cutn/syst (hppv, hiva, infl, zoon), epon drugJ(dnaa, rnaa, rtva, vacc) v • d • e Zoonosis: Tick-borne diseases and mite-borne diseases Bacterial infection (all G-) Rickettsiales Boutonneuse fever · Ehrlichiosis (Human granulocytic ehrlichiosis, Human monocytic ehrlichiosis) · Rocky Mountain spotted fever Spirochaete Lyme disease · Relapsing fever Thiotrichales Tularemia Viral infection Colorado tick fever · Tick-borne encephalitis · Crimean-Congo hemorrhagic fever · Omsk hemorrhagic fever · Kyasanur forest disease · Powassan encephalitis Protozoan infection Babesiosis Neurotoxin Tick paralysis General Tick infestation Vectors Ticks Ixodes: Ixodes scapularis · Ixodes holocyclus · Ixodes pacificus · Ixodes ricinus Dermacentor: Dermacentor variabilis · Dermacentor andersoni Amblyomma: Amblyomma americanum · Amblyomma cajennense other: Rhipicephalus sanguineus Mites Leptotrombidium deliense · Liponyssoides sanguineus M: IFT helm,arth (acar) helm, arth (lice), zoon helm, arth [[tr:Kırım-Kongo kanamalı ateş