Crimean-Congo haemorrhagic fever without bleeding

Abstract

Introduction. Crimean-Congo hemorrhagic fever (CCHF) is the most widespread tick-borne infection, but an underestimated cause of febrile illness, especially in the absence of bleeding. The objective of the study was to analyze atypical CCHF presentation, which poses difficulties in diagnosing the infection. Material and methods. We conducted a retrospective study on febrile patients without bleeding who resided or visited endemic areas for CCHF between June and August, 2018, in Bulgaria. Polymerase chain reaction (PCR) and enzyme-linked immune-sorbent assay (ELISA) were performed to test for CCHF virus. In case of a suggestive medical history, the patients were deemed either confirmed (based on serology and/or PCR) or probable (based on epidemiology). Results. Five out of 6 serologically confirmed patients with CCHF without bleeding were studied. Three of the patients, referred from another hospital, were correctly diagnosed at admission, yet the other two patients were misdiagnosed initially. Laboratory investigations at admission were notable for thrombocytopenia and leucopenia (in four patients) and normal coagulation parameters. All patients received intensive cаre support, including intravenous fluids, platelet concentrate and fresh frozen plasma. Three patients were given steroids. All patients recovered uneventfully. Conclusions. This case series study shows that CCHF without bleeding is an important and poorly recognized cause of illness in endemic areas, even in infectious diseases clinics. A lower threshold to test for CCHF would be warranted in patients with febrile illness in endemic areas.

Keywords

• crimean-congo hemorrhagic fever
• haemorrhage
• flu-like illness