Crimean-Congo Hemorrhagic Fever in Pregnancy: Two Cases from Turkey and a Review of the Literature

Abstract

Crimean-Congo hemorrhagic fever (CCHF) is a serious viral disease. There are limited data on the clinical course of the disease during pregnancy. Here, we report two pregnant women with CCHF and literature review. Tick bite history, thrombocytopenia, leukopenia, and elevated liver enzymes were noted in both cases. The diagnosis was confirmed via CCHF virus-polymerase chain reaction (PCR) or IgM positivity. Supportive therapy was given to the patients, but ribavirin was not administered. Blood product was not required in one of the patients, and three apheresis thrombocyte suspensions were given to the other one. Both patients were treated successfully and improved. Pregnancy was terminated in one and continued without any problem in the other patient and a healthy baby was born. Overall there were 42 CCHF diagnosed pregnants reported in the literature and 15 of these were from Turkey (including our cases). Maternal and fetal mortality rates were found to be 6.6% (1/15) and 40% (6/15), respectively in Turkish patients. Fetal loss was observed in 3/4 in the first trimester, 2/7 in the second trimester, and 1/4 in the third trimester. There was hemorrhage in 8 of 15 pregnants (53.3%). Maternal mortality was recorded in 1/8 (12.5%) patients with bleeding, and there was fetal loss in 6/6 (100%). CCHF during pregnancy is a rare but an important clinical problem. Clinical severity is of great importance for mother survival, and both gestational week and mother"s clinical condition seem to be important for fetus health. The virus may be transmitted by the vertical mode and fetal infection may cause intrauterine death. CCHF should be considered in women with vaginal bleeding in endemic areas.

Keywords

• Crimean-Congo hemorrhagic fever
• tick
• pregnancy
• maternal mortality
• fetal mortality