International Notes Crimean-Congo Hemorrhagic Fever -- Republic of South Africa
During August and September 1984, eight cases of Crimean-Congo hemorrhagic fever (CCHF) occurred in a hospital in Capetown, Republic
International Notes Crimean-Congo Hemorrhagic Fever -- Republic of South Africa
During August and September 1984, eight cases of Crimean-Congo hemorrhagic fever (CCHF) occurred in a hospital in Capetown, Republic of South Africa. Two patients died.
The index case was a 26-year-old man from the Vredenburg district, approximately 120 kilometers north of Cape Town. Although he had no evidence of a recent tick bite, he had had regular contact with farm animals. His illness began on August 28, with a sore throat, muscle pains, and pyrexia. Four days later, he had slight hematemesis, followed by a massive gastrointestinal hemorrhage the next day. After resuscitation at a peripheral hospital, he was transferred to a hospital in Cape Town, late on September 3.
On admission, the patient was in a severe hemorrhagic state requiring rapid transfusion to maintain blood volume. He was transferred to an intensive-care unit, where hemorrhagic fever was suspected. Although the bleeding was controlled, the patient died of multiple organ failure on September 8. The diagnosis was confirmed by isolation of the CCHF virus from blood taken on September 4 and from liver tissue removed immediately after death. No antibodies were detected.
Patients 2, 3, and 4 were nurses who had cared for the index patient during his first few hours in the intensive-care unit and before the institution of isolation procedures. Five days after initial contact, they developed pyrexia, muscle pain, sore throat, conjunctivitis, and upper abdominal tenderness. Four days after the onset of symptoms, a bleeding tendency was noted, and their platelet counts fell dramatically.
Patients 5 and 6 were nurses who had no direct contact with the index patient but came in contact with contaminated material during the setting up of isolation procedures. Five days after this contact, they developed symptoms similar to those of patients 2, 3, and 4. Purpura and bleeding also began on the fourth day of illness.
CCHF was confirmed in patients 2-6 by isolation of the virus and a rising antibody titer.
Patient 7 was a 37-year-old surgeon who had had no known direct contact with the index patient but had visited the intensive-care unit before isolation. Headache and pyrexia began 5 days later, followed by severe thrombocytopenia and bleeding after an additional 5 days. CCHF was not initially suspected, but the virus was isolated from his blood. Despite intensive supportive measures, he died 8 days after onset of illness. As with patient 1, there was no antibody response.
Patient 8 was a senior member of the nursing staff who had contact with all the other CCHF patients. Her probable mode of infection was an unintentional needle prick while nursing patient 3. Prophylactic treatment with antibody-rich plasma, ribavirin, and interferon was begun, but she developed headache, weakness, jaundice, and 