A Crimean-Congo Hemorrhagic Fever Fatality is Reported in Europe
A Spanish man contracted the virus after a tick bite and succumbed to it last week.
Ticks of the genus Hyalomma are the principal vector of Crimean-Congo haemorrhagic fever.
Image credit: Robert Swanepoel/NICD South Africa
A Spaniard who received a tick bite and contracted Crimean-Congo Hemorrhagic Fever has died from the virus, with organ failure as the cause according to a news report from CNN.1 The 74-year old man had initially visited a hospital in Móstoles, Spain on July 19, complaining of a fever and a general malaise. This was after he had been bitten by a tick in Buenasbodas, in the Toledo province of central Spain, days earlier.1
Two days later, health officials reported the man contracted Crimean-Congo hemorrhagic fever (CCHF) and was being treated in the ICU of a hospital in Madrid. Although the man had been reported to be in stable condition, he died days later.1
Virus Onset, Treatment, Mortality Rates
According to the World Health Organization (WHO), the mortality rate for CCHF is approximately 30%, with death occurring in the second week of illness. For those who do survive, patients’ conditions usually improve on the ninth or tenth day after the onset of illness.2
After the tick bite, the incubation period is usually 1 to 3 days, with a maximum of 9 days. The incubation period following contact with infected blood or tissues is usually 5 to 6 days, with a documented maximum of 13 days.
The onset of symptoms happens quickly and can be marked by fever, myalgia, dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia. Additionally, individuals may have nausea, vomiting, diarrhea, abdominal pain and sore throat early on, followed by sharp mood swings and confusion. After 2 to 4 days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly.2
Caused by a tick-borne virus of the genus Hyalomma, these insects are the principal vectors of CCHF. The virus is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north—the geographical limit of the principal tick vector, according to the WHO.2
This fact makes the case in Spain unique as the country is not within this geography. However, the CCHF first arrived in country back in 2013, as it was brought by migratory birds and since then there has been 13 confirmed cases and 5 deaths according to health authorities. Most cases have so far been detected in the northwest of the Extremadura region, but they are starting to spread throughout the rest of Spain.3
WHO reports other symptoms can include tachycardia, lymphadenopathy, and a petechial rash on internal mucosal surfaces, such as in the mouth and throat, and on the skin. The petechiae may give way to larger rashes called ecchymoses, and other hemorrhagic phenomena. There is usually evidence of hepatitis, and severely ill patients may experience rapid kidney deterioration, sudden liver failure or pulmonary failure after the fifth day of illness.2
The antiviral drug, ribavirin, treats CCHF infection and oral and intravenous formulations have been shown to be efficacious. However, typically supportive care is the main approach to CCHF management.2
