Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 30, Number 5—May 2024
CME ACTIVITY - Synopsis

Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Epidemiology, Clinical Manifestations, and Prevention

Maria G. FrankComments to Author , Gretchen Weaver, Vanessa Raabe1, and State of the Clinical Science Working Group of the National Emerging Pathogens Training and Education Center’s Special Pathogens Research Network2
Author affiliations: Denver Health and Hospital Authority, Denver, Colorado, USA (M.G. Frank); University of Colorado School of Medicine, Denver (M.G. Frank); University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA (G. Weaver); New York University Grossman School of Medicine, New York, New York, USA (V. Raabe)

Main Article

Figure 2

Crimean-Congo hemorrhagic fever case definitions, modified from Ergonul et al. (1). ALT, alanine aminotransferase; AST, aspartate aminotransferase; CCHF, Crimean-Congo hemorrhagic fever; CCHFV, CCHF virus; LDH, lactate dehydrogenase.

Figure 2. Crimean-Congo hemorrhagic fever case definitions, modified from Ergonul et al. (1). ALT, alanine aminotransferase; AST, aspartate aminotransferase; CCHF, Crimean-Congo hemorrhagic fever; CCHFV, CCHF virus; LDH, lactate dehydrogenase.

Main Article

References
  1. Ergonual  O, Whitehouse  CA. Crimean-Congo hemorrhagic fever: a global perspective. The Netherlands: Springer; 2007.
  2. Mishra  AK, Hellert  J, Freitas  N, Guardado-Calvo  P, Haouz  A, Fels  JM, et al. Structural basis of synergistic neutralization of Crimean-Congo hemorrhagic fever virus by human antibodies. Science. 2022;375:104–9. DOIPubMedGoogle Scholar
  3. World Health Organization. Introduction to Crimean Congo hemorrhagic fever [cited 2023 Jul 1]. https://cdn.who.int/media/docs/default-source/documents/health-topics/crimean-congo-haemorrhaigc-fever/introduction-to-crimean-congo-haemorrhagic-fever.pdf
  4. Al-Abri  SS, Abaidani  IA, Fazlalipour  M, Mostafavi  E, Leblebicioglu  H, Pshenichnaya  N, et al. Current status of Crimean-Congo haemorrhagic fever in the World Health Organization Eastern Mediterranean Region: issues, challenges, and future directions. Int J Infect Dis. 2017;58:82–9. DOIPubMedGoogle Scholar
  5. Hawman  DW, Feldmann  H. Recent advances in understanding Crimean-Congo hemorrhagic fever virus. F1000 Res. 2018;7:7. DOIPubMedGoogle Scholar
  6. Belobo  JTE, Kenmoe  S, Kengne-Nde  C, Emoh  CPD, Bowo-Ngandji  A, Tchatchouang  S, et al. Worldwide epidemiology of Crimean-Congo Hemorrhagic Fever Virus in humans, ticks and other animal species, a systematic review and meta-analysis. PLoS Negl Trop Dis. 2021;15:e0009299. DOIPubMedGoogle Scholar
  7. Khan  AS, Maupin  GO, Rollin  PE, Noor  AM, Shurie  HH, Shalabi  AG, et al. An outbreak of Crimean-Congo hemorrhagic fever in the United Arab Emirates, 1994-1995. Am J Trop Med Hyg. 1997;57:519–25. DOIPubMedGoogle Scholar
  8. Nurettin  C, Engin  B, Sukru  T, Munir  A, Zati  V, Aykut  O. The seroprevalence of Crimean-Congo hemorrhagic fever in wild and domestic animals: an epidemiological update for domestic animals and first seroevidence in wild animals from Turkey. Vet Sci. 2022;9:9. DOIPubMedGoogle Scholar
  9. Saksida  A, Duh  D, Wraber  B, Dedushaj  I, Ahmeti  S, Avsic-Zupanc  T. Interacting roles of immune mechanisms and viral load in the pathogenesis of crimean-congo hemorrhagic fever. Clin Vaccine Immunol. 2010;17:1086–93. DOIPubMedGoogle Scholar
  10. Rodriguez  SE, Hawman  DW, Sorvillo  TE, O’Neal  TJ, Bird  BH, Rodriguez  LL, et al. Immunobiology of Crimean-Congo hemorrhagic fever. Antiviral Res. 2022;199:105244. DOIPubMedGoogle Scholar
  11. Garrison  AR, Smith  DR, Golden  JW. Animal models for Crimean-Congo hemorrhagic fever human disease. Viruses. 2019;11:11. DOIPubMedGoogle Scholar
  12. Frank  MG, Weaver  G, Raabe  V. State of the Clinical Science Working Group of the National Emerging pathogens Training and Education Center’s Special Pathogens Research Network. Crimean-Congo hemorrhagic fever virus for clinicians—virology, pathogenesis, and pathology. Emerg Infect Dis. 2024;30:XXX–XXX.
  13. Frank  MG, Weaver  G, Raabe  V; State of the Clinical Science Working Group of the National Emerging Pathogens Training and Education Center’s Special Pathogens Research Network. Crimean-Congo hemorrhagic fever virus for clinicians—diagnosis, clinical management, and therapeutics. Emerg Infect Dis. 2024;30:XXX–XXX.
  14. Bente  DA, Forrester  NL, Watts  DM, McAuley  AJ, Whitehouse  CA, Bray  M. Crimean-Congo hemorrhagic fever: history, epidemiology, pathogenesis, clinical syndrome and genetic diversity. Antiviral Res. 2013;100:159–89. DOIPubMedGoogle Scholar
  15. Lorenzo Juanes  HM, Carbonell  C, Sendra  BF, López-Bernus  A, Bahamonde  A, Orfao  A, et al. Crimean-Congo hemorrhagic fever, Spain, 2013–2021. Emerg Infect Dis. 2023;29:252–9. DOIPubMedGoogle Scholar
  16. Shahhosseini  N, Wong  G, Babuadze  G, Camp  JV, Ergonul  O, Kobinger  GP, et al. Crimean-Congo hemorrhagic fever virus in Asia, Africa and Europe. Microorganisms. 2021;9:9. DOIPubMedGoogle Scholar
  17. Spengler  JR, Bente  DA. Crimean-Congo hemorrhagic fever in Spain—new arrival or silent resident? N Engl J Med. 2017;377:106–8. DOIPubMedGoogle Scholar
  18. Hawman  DW, Feldmann  H. Crimean-Congo haemorrhagic fever virus. Nat Rev Microbiol. 2023;21:463–77. DOIPubMedGoogle Scholar
  19. Saijo  M, Tang  Q, Shimayi  B, Han  L, Zhang  Y, Asiguma  M, et al. Possible horizontal transmission of crimean-congo hemorrhagic Fever virus from a mother to her child. Jpn J Infect Dis. 2004;57:55–7.PubMedGoogle Scholar
  20. Pshenichnaya  NY, Sydenko  IS, Klinovaya  EP, Romanova  EB, Zhuravlev  AS. Possible sexual transmission of Crimean-Congo hemorrhagic fever. Int J Infect Dis. 2016;45:109–11. DOIPubMedGoogle Scholar
  21. Hoogstraal  H. The epidemiology of tick-borne Crimean-Congo hemorrhagic fever in Asia, Europe, and Africa. J Med Entomol. 1979;15:307–417. DOIPubMedGoogle Scholar
  22. Pshenichnaya  NY, Nenadskaya  SA. Probable Crimean-Congo hemorrhagic fever virus transmission occurred after aerosol-generating medical procedures in Russia: nosocomial cluster. Int J Infect Dis. 2015;33:120–2. DOIPubMedGoogle Scholar
  23. Tsergouli  K, Karampatakis  T, Haidich  AB, Metallidis  S, Papa  A. Nosocomial infections caused by Crimean-Congo haemorrhagic fever virus. J Hosp Infect. 2020;105:43–52. DOIPubMedGoogle Scholar
  24. Nuttall  PA, Labuda  M. Tick-host interactions: saliva-activated transmission. Parasitology. 2004;129(Suppl):S177–89. DOIPubMedGoogle Scholar
  25. Aksoy  D, Barut  H, Duygu  F, Çevik  B, Kurt  S, Sümbül  O. Characteristics of headache and its relationship with disease severity in patients with Crimean-Congo hemorrhagic fever. Agri. 2018;30:12–7.PubMedGoogle Scholar
  26. Flick  R, Whitehouse  CA. Crimean-Congo hemorrhagic fever virus. Curr Mol Med. 2005;5:753–60. DOIPubMedGoogle Scholar
  27. Cevik  MA, Erbay  A, Bodur  H, Gülderen  E, Baştuğ  A, Kubar  A, et al. Clinical and laboratory features of Crimean-Congo hemorrhagic fever: predictors of fatality. Int J Infect Dis. 2008;12:374–9. DOIPubMedGoogle Scholar
  28. Öztoprak  B, Öztoprak  İ, Engin  A. Is the brain spared in Crimean-Congo haemorrhagic fever? An MR-SWI study to reveal CNS involvement. Eur Radiol. 2018;28:3893–901. DOIPubMedGoogle Scholar
  29. Spengler  JR, Kelly Keating  M, McElroy  AK, Zivcec  M, Coleman-McCray  JD, Harmon  JR, et al. Crimean-Congo hemorrhagic fever in humanized mice reveals glial cells as primary targets of neurological infection. J Infect Dis. 2017;216:1386–97. DOIPubMedGoogle Scholar
  30. Ahmeti  S, Berisha  L, Halili  B, Ahmeti  F, von Possel  R, Thomé-Bolduan  C, et al. Crimean-Congo hemorrhagic fever, Kosovo, 2013–2016. Emerg Infect Dis. 2019;25:321–4. DOIPubMedGoogle Scholar
  31. Gülhan  B, Kanık-Yüksek  S, Çetin  İİ, Özkaya-Parlakay  A, Tezer  H. Myocarditis in a child with Crimean-Congo hemorrhagic fever. Vector Borne Zoonotic Dis. 2015;15:565–7. DOIPubMedGoogle Scholar
  32. Engin  A, Yilmaz  MB, Elaldi  N, Erdem  A, Yalta  K, Tandogan  I, et al. Crimean-Congo hemorrhagic fever: does it involve the heart? Int J Infect Dis. 2009;13:369–73. DOIPubMedGoogle Scholar
  33. Bastug  A, Kayaaslan  B, But  A, Aslaner  H, Sertcelik  A, Akinci  E, et al. A case of Crimean-Congo hemorrhagic fever complicated with acute pancreatitis. Vector Borne Zoonotic Dis. 2014;14:827–9. DOIPubMedGoogle Scholar
  34. Kaya  S, Yilmaz  G, Ertunç  B, Koksal  I. Parotitis associated with Crimean Congo hemorrhagic fever virus. J Clin Virol. 2012;53:159–61. DOIPubMedGoogle Scholar
  35. Aksoy  HZ, Yilmaz  G, Aksoy  F, Koksal  I. Crimean-Congo haemorrhagic fever presenting as epididymo-orchitis. J Clin Virol. 2010;48:282–4. DOIPubMedGoogle Scholar
  36. Swanepoel  R, Gill  DE, Shepherd  AJ, Leman  PA, Mynhardt  JH, Harvey  S. The clinical pathology of Crimean-Congo hemorrhagic fever. Rev Infect Dis. 1989;11(Suppl 4):S794–800. DOIPubMedGoogle Scholar
  37. Bakir  M, Öksüz  C, Karakeçili  F, Baykam  N, Barut  Ş, Büyüktuna  SA, et al. Which scoring system is effective in predicting mortality in patients with Crimean Congo hemorrhagic fever? A validation study. Pathog Glob Health. 2022;116:193–200. DOIPubMedGoogle Scholar
  38. Gul  S, Gul  EU, Yesilyurt  M, Ozturk  B, Kuscu  F, Ergonul  O. Health-related quality of life and the prevalence of post-traumatic stress disorder among Crimean-Congo hemorrhagic fever survivors. Jpn J Infect Dis. 2012;65:392–5. DOIPubMedGoogle Scholar
  39. Mendoza  EJ, Warner  B, Safronetz  D, Ranadheera  C. Crimean-Congo haemorrhagic fever virus: Past, present and future insights for animal modelling and medical countermeasures. Zoonoses Public Health. 2018;65:465–80. DOIPubMedGoogle Scholar
  40. Pshenichnaya  NY, Leblebicioglu  H, Bozkurt  I, Sannikova  IV, Abuova  GN, Zhuravlev  AS, et al. Crimean-Congo hemorrhagic fever in pregnancy: A systematic review and case series from Russia, Kazakhstan and Turkey. Int J Infect Dis. 2017;58:58–64. DOIPubMedGoogle Scholar
  41. Tezer  H, Sucakli  IA, Sayli  TR, Celikel  E, Yakut  I, Kara  A, et al. Crimean-Congo hemorrhagic fever in children. J Clin Virol. 2010;48:184–6. DOIPubMedGoogle Scholar
  42. Gayretli Aydin  ZG, Yesilbas  O, Reis  GP, Guven  B. The first pediatric case of hemophagocytic lymphohistiocytosis secondary to Crimean-Congo haemorrhagic fever successfully treated with therapeutic plasma exchange accompanying ribavirin and intravenous immunoglobulin. J Clin Apher. 2021;36:780–4. DOIPubMedGoogle Scholar
  43. Oygar  PD, Gürlevik  SL, Sağ  E, İlbay  S, Aksu  T, Demir  OO, et al. Changing disease course of Crimean-Congo hemorrhagic fever in children, Turkey. Emerg Infect Dis. 2023;29:268–77. DOIPubMedGoogle Scholar
  44. Pan  H, Wang  G, Guan  E, Song  L, Song  A, Liu  X, et al. Treatment outcomes and prognostic factors for non- malignancy associated secondary hemophagocytic lymphohistiocytosis in children. BMC Pediatr. 2020;20:288. DOIPubMedGoogle Scholar
  45. Álvarez-Rodríguez  B, Tiede  C, Hoste  ACR, Surtees  RA, Trinh  CH, Slack  GS, et al. Characterization and applications of a Crimean-Congo hemorrhagic fever virus nucleoprotein-specific Affimer: Inhibitory effects in viral replication and development of colorimetric diagnostic tests. PLoS Negl Trop Dis. 2020;14:e0008364. DOIPubMedGoogle Scholar
  46. Ergonul  O, Celikbas  A, Baykam  N, Eren  S, Dokuzoguz  B. Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited. Clin Microbiol Infect. 2006;12:551–4. DOIPubMedGoogle Scholar
  47. Bakır  M, Gözel  MG, Köksal  I, Aşık  Z, Günal  Ö, Yılmaz  H, et al. Validation of a severity grading score (SGS) system for predicting the course of disease and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF). Eur J Clin Microbiol Infect Dis. 2015;34:325–30. DOIPubMedGoogle Scholar
  48. Cevik  MA, Erbay  A, Bodur  H, Eren  SS, Akinci  E, Sener  K, et al. Viral load as a predictor of outcome in Crimean-Congo hemorrhagic fever. Clin Infect Dis. 2007;45:e96–100. DOIPubMedGoogle Scholar
  49. Duh  D, Saksida  A, Petrovec  M, Ahmeti  S, Dedushaj  I, Panning  M, et al. Viral load as predictor of Crimean-Congo hemorrhagic fever outcome. Emerg Infect Dis. 2007;13:1769–72. DOIPubMedGoogle Scholar
  50. Ahmed  A, Tahir  MJ, Siddiqi  AR, Dujaili  J. Potential of Crimean-Congo Hemorrhagic Fever outbreak during Eid-Ul-Adha Islamic festival and COVID-19 pandemic in Pakistan. J Med Virol. 2021;93:182–3. DOIPubMedGoogle Scholar

Main Article

1Current affiliation: Pfizer Inc., New York, New York, USA. These materials reflect only the personal views of the author and may not reflect the views of her employer.

2Members of this group are listed at the end of this article.

Page created: March 07, 2024
Page updated: April 23, 2024
Page reviewed: April 23, 2024
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external