A case of Crimean-Congo hemorrhagic fever with the bacteremia of Clostridium perfringens.

Crimean-Congo hemorrhagic fever (CCHF) is a worldwide tick-borne viral infection in humans. The aim of the study is to report a case of a female patient with severe CCHF with the bacteremia of Clostridium perfringens. An 18-year-old woman admitted to the emergency department with sudden onset of fever, nausea and vomiting, myalgia, headache, generalized abdominal pain. It was learned that the patient was living in a rural area and had a history of tick bite 3 days before the admission. At laboratory examination, bicytopenia, abnormal liver function tests, and abnormal coagulation parameters were observed. The diagnosis of the case was confirmed with a positive real-time polymerase chain reaction. On the third day of hospitalization, she had an increase in abdominal pain, confusion, and respiratory distress. She was transferred to the intensive care unit for close monitoring. On the fifth day of hospitalization, she developed fever again. Catheter and peripheral anaerobic blood cultures grew C. perfringens. No evidence of perforation was observed on abdominal tomography. It has been successfully treated with a multidisciplinary approach. CCHF demonstrates different types of clinical presentations, except for common symptoms of fever and hemorrhage. A case of CCHF with C. perfringens bacteremia has not been previously reported before.

Autochthonous Crimean-Congo haemorrhagic fever in Spain: So much to learn / Fiebre hemorrágica de Crimea-Congo autóctona de España: tanto que aprender

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[Genetic monitoring of the Crimean-Congo Hemorrhagic Fever virus in Kazakhstan and Tajikistan in 2001-2003].

Blood specimens obtained from 32 CCHF patients were tested for the presence of CCHF virus markers. In addition, 3210 ticks of the genera Hyalomma asiaticum, Hyalomma anatolicum, and Dermacentor niveus were examined to identify the CCHF virus antigen and RNA. This material was obtained during the 2001-2003 local outbreaks of CCHF in Kazakhstan and Tajikistan. The nucleotide sequence in the region 983-1282 of S segment of the CCHF virus for 12 wild type strains was determined. The phylogenetic relationships among the established biovariants of CCHF virus, and also between these biovariants and those from other regions of the world were identified. We were the first to demonstrate the presence of an African-like genotype of CCHF virus in the territory of Kazakhstan. The conclusion was made that two genotypes of CCHF virus were in circulation in Kazakhstan. It was also demonstrated that CCHF virus, circulating in the territories of Kazakhstan and Tajikistan, was genetically heterogeneous.

Crimean-Congo hemorrhagic fever in Albania, 2001.

During the spring and summer of 2001, an outbreak of eight cases of Crimean-Congo hemorrhagic fever (CCHF) occurred in Albania. The epidemiological investigation, the clinical presentation of the cases, and the course of the disease are described. Seven of the cases were laboratory confirmed. A nosocomial infection and a cluster of cases within a family were observed. Genetic analysis of the CCHF virus strain that caused the outbreak showed that it was clustered together with other European CCHF virus strains except the Greek one (strain AP92). The Greek strain, which forms an independent clade, differed from the causative strain by 25.3% at the nucleotide level.

Experimental transmission of Crimean-Congo hemorrhagic fever virus by west African wild ground-feeding birds to Hyalomma marginatum rufipes ticks.

Hyalomma (H.) marginatum rufipes ticks commonly infest birds and are potential vectors of Crimean-Congo hemorrhagic fever (CCHF) virus in west Africa. An experimental model for investigating the role of birds in the CCHF virus transmission cycle was developed. Following CCHF virus inoculation, antibodies were detected by enzyme-linked immunosorbent assay in one red-beaked hornbill and one glossy starling, but not in two laughing doves and six domestic chickens. None of the birds showed a detectable viremia. Hyalomma marginatum rufipes larvae were placed on three red-beaked hornbills and one glossy starling. These birds were then inoculated with CCHF virus (10(1.5) 50% mouse intracerebral lethal doses). Virus transmission to larvae or nymphs was obtained and seroconversions in birds were recorded. Virus was also detected in 90% of the individually tested nymphs, as well as in adults. The virus was then successfully transmitted by adult ticks to rabbits and the engorged females were allowed to oviposit. Progeny larvae were placed on another group of birds and one of three birds showed seroconversion. The cycle of transmission of virus between ticks and aviremic ground-feeding birds represent a potential reservoir and amplification mechanism of CCHF virus in west Africa.

Crimean-Congo haemorrhagic fever virus infection in birds: field investigations in Senegal.

In Senegal, wild ground-feeding birds are frequently infested with immature ticks. In two areas where numerous Crimean-Congo haemorrhagic fever (CCHF) virus isolations were obtained from Hyalomma marginatum rufipes adult ticks collected on ungulates, 175 birds were captured and sera collected. CCHF antibodies were detected by ELISA in 6/22 red-beaked hornbills (Tockus erythrorhynchus), 2/11 glossy starlings (Lamprotornis sp.) and 1/3 guinea fowls. The virus was isolated from H. m. rufipes nymphs collected on a hornbill. The role of wild ground-feeding birds in CCHF virus ecology in West Africa is discussed.

[Crimean-Congo hemorrhagic fever in Senegal. Latest data on the ecology of the CCHF virus]. / La fièvre hémorragique de Crimée-Congo au Sénégal. Dernières données sur l'écologie du virus CCHF.

The authors finalize the knowledge on the ecology of the CCHF virus in Senegal, West Africa. They specify two new major data for the understanding of the viral ecology in West Africa. The recognition of a bird species, common and widely distributed in Senegal (Tockus erythrorhynchus, Coraciiformes, Bucerotidae), that replicates the virus and infects the immature stages of its current parasite Hyalomma marginatum rufipes in more than 90% of the cases, explains why the minimum infection rate of the adults of this species of tick is always very high. The implication of Rhipicephalus evertsi evertsi in the viral ecology and/or a high efficiency of the transovarial transmission of the virus in Hy. m. rufipes would help to explain the maintenance of the endemy in the sahelian area. In the sahelian zone, Hy. marginatum rufipes must play the leading part, together with Rh. e. evertsi if vector, for the maintenance of the endemy. Hy. truncatum, the adults of which can readily bite man, ensures the vectorial transmission to him. In the sudanian zone, Amblyomma variegatum must play the same part as the Hyalomma and Rh. e. evertsi (if vector), and is surely the main vector to man, giving perhaps rise to less virulent strains (non hemorrhagic ones).

Ribavirin efficacy in an in vivo model of Crimean-Congo hemorrhagic fever virus (CCHF) infection.

After intraperitoneal (i.p.) infection of infant mice with CCHF virus, virus titers in liver remained significantly higher than in other organs except blood (serum). Within the liver, virus antigen was first found by immunofluorescence (IFA) in Kupffer cells followed by more extensive hepatic spread. Later, virus was found in other organs including brain and heart. Ribavirin treatment significantly reduced infant mouse mortality and extended the geometric mean time to death. Ribavirin treatment reduced CCHF virus growth in liver and significantly decreased, but did not prevent, viremia. Despite a substantial viremia, infection of other organs including brain and heart was not detected in ribavirin-treated mice. A hepatotropic virus subpopulation with less neurovirulence than the parent was isolated from liver of ribavirin-treated mice (single dose, 100 mg/kg). After serial passage in placebo-treated mice, the exclusive hepatotropism was lost.

Experimental vector incompetence of a soft tick, Ornithodoros sonrai (Acari: Argasidae), for Crimean-Congo hemorrhagic fever virus.

Adults and nymphs of a soft tick, Ornithodoros sonrai Sautet & Witkowski, were allowed to feed on suckling mice that had been experimentally infected with Crimean-Congo hemorrhagic fever (CCHF) virus (IbAr 10200 strain). The mean viral titer of mouse blood at the time of tick feeding was 10(3.2) plaque-forming units (PFU) per ml. Samples of ticks were assayed on 12 occasions between days 0 and 31 after the viremic blood meal. Mean CCHF viral titers were 10(2.1) PFU per tick immediately after the viremic meal but declined to 10(1.2) PFU per tick after 2 d, and no virus was detected beyond 8 d. The percentage of ticks with detectable virus was 92% (22/24) immediately after the viremic meal, but then declined to 20% (2/10) after 4 d and to 0% (0/44) after 11 or more days. Ticks were allowed to feed on sets of three naive suckling mice on days 0, 2, 5, 8, 11, 14, 21, and 28 after the viremic blood meal, but CCHF viral transmission did not occur. Similarly, no transovarial transmission of virus from CCHF virus-exposed O. sonrai to their progeny was observed. These results strongly indicate that O. sonrai is not a vector of CCHF virus.

Crimean-Congo haemorrhagic fever virus replication in adult Hyalomma truncatum and Amblyomma variegatum ticks.

The kinetics of the replication of the Crimean-Congo haemorrhagic fever virus (CCHFV) was studied in intra-anally inoculated adult Hyalomma truncatum and Amblyomma variegatum ticks. The virus was re-isolated by suckling mouse inoculation and revealed by antigen capture with ground ticks and indirect immunofluorescence of haemolymph. The virus was detected in ticks in the first hours post-inoculation (p.i.) and its replication was observed from 36 h p.i. onwards. Virus titre reached a maximum within 3-5 days then decreased slowly to a level of at 2 log LD50/ml for several months until the end of observations. Several specific, non-identified factors seem to favour CCHFV replication in H. truncatum. Long-term virus persistence seems to occur in CCHFV-infected adult ticks.

Comparative studies on the vector capacity of the different stages of Amblyomma variegatum Fabricius and Hyalomma rufipes Koch for Congo virus, after intracoelomic inoculation.

Groups of nymphs and adults of Hyalomma rufipes and larvae, nymphs and adults of Amblyomma variegatum were infected by intracoelomic inoculation with Congo virus at concentrations of 10(3.5)LD50 (Group A), 10(1.5)LD50 (Group B) and 10(0.5)LD50 (Group C). The infection rates for the different groups were: Groups A, 92-100% for all stages of ticks, except for adult H. rufipes which had 87%; Group B, 56.8, 68.1 and 50.7% for larvae, nymphs and adults of A. variegatum, respectively, and 96.3 and 84.4% for nymphs and adults of H. rufipes, respectively; Group C, 0% for larvae, nymphs and adults of A. variegatum and 8 and 1.7%, respectively, for nymphs and adult adult of H. rufipes. The 1-5% infection threshold was 10(0.5)LD50 for nymphs of H. rufipes and a dose greater than this for all the other stages of the two species of ticks. The 50% infection threshold was 10(1.5)LD50 for larvae and adults of A. variegatum, but less than 10(1.5)LD50 for nymphs of A. variegatum and nymphs and adults of H. rufipes. Peak virus titres obtained for H. rufipes were 10(6.0) for Group A and B nymphs and 10(3.0) for Group A and B adults, and 10(1.0) each for Group C nymphs and adults. For A. variegatum, the peak titres for Groups A, B and C were, respectively, 10(1.0), 10(0.8), and 0 for nymphs and 10(1.5), 10(0.6) and 0 for adults. Sera from 100% (24/24) of rabbits used to feed adult H. rufipes and from 65% (31/48) used to feed nymphs and adult A. variegatum were positive for compliment fixation antibody to Congo virus at a titre of 1:8 from Days 15-35 postattachment of ticks. Viremia in rabbit was detected in 12.5% (3/25) of rabbits used to feed adult H. rufipes.

[Cases of Crimean-Congo hemorrhagic fever in Astrakhan Province]. / O sluchaiakh Krymskoi--Kongo gemoragicheskoi likhoradki v Astrakhanskoi oblasti.

The paper briefly presents clinical, epidemiological, virological and serological data on cases of Crimean-Congo hemorrhagic fever (CCHF) in Astrakhan Province. The results indicate annual infection of the regions population with CCHF virus, the main mode of transmission being vector-borne. The advantages of the fluorescence antibody technique and enzyme immunoassay-for diagnosis of the disease were demonstrated.

Viremia and antibody response of small African and laboratory animals to Crimean-Congo hemorrhagic fever virus infection.

Eleven species of small African wild mammals, laboratory rabbits, guinea pigs, and Syrian hamsters were infected with Crimean-Congo hemorrhagic fever (CCHF) virus. Low-titered viremia followed by development of antibody was observed in scrub hares (Lepus saxatilis), Cape ground squirrels (Xerus inauris), red veld rats (Aethomys chrysophilus), white tailed rats (Mystromys albicaudatus), bushveld gerbils (Tatera leucogaster), striped mice (Rhabdomys pumilio), and guinea pigs. The maximum viremic titer in 4 scrub hares was 10(1.7-4.2) 50% mouse lethal doses/ml. Viremia was detected in 1/17 infected laboratory rabbits. Antibody response was only detected in South African hedgehogs (Atelerix frontalis), highveld gerbils (T. brantsii), Namaqua gerbils (Desmodillus auricularis), 2 species of multimammate mouse (Mastomys natalensis and M. coucha), and Syrian hamsters. The results of the study indicate that a proportion of infected scrub hares develop CCHF viremia of an intensity shown in the Soviet Union to be sufficient for infection of feeding immature ixodid ticks, but that South African hedgehogs and wild rodents are unlikely to be of importance as maintenance hosts of the virus in southern Africa.

Characteristics of Crimean-Congo hemorrhagic fever virus (Xinjiang strain) in China.

Virus strains isolated from blood of patients during a hemorrhagic fever outbreak in 1968 in southern Xinjiang, China, from Hyalomma asiaticum and from sheep, were found to be identical or closely related to Crimean-Congo hemorrhagic fever (C-CHF) virus by complement fixation and indirect immunofluorescence tests with convalescent sera of patients and with C-CHF reference antibody. The virus was inactivated by ether and acid. Viral synthesis was not suppressed by 5-iododeoxyuridine suggesting an RNA-containing genome. The buoyant density in sucrose was 1.16-1.18 g/cm3. The particle weight was estimated at 3.26 +/- 0.46 X 10(8). The diameter of the virus particles was 85-105 nm.

A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part V. Virological and serological observations.

A nosocomial outbreak of Crimean-Congo haemorrhagic fever occurred in Tygerberg Hospital near Cape Town in September 1984 when 7 medical personnel became ill after admission of an index patient. The disease was fatal in the index and 1 secondary case, and was confirmed in the index and 6 secondary cases by isolation of the virus. An antibody response was demonstrated in the remaining patient, thought to be a tertiary case, but the fact that the patient received immune plasma therapy raises doubts about the validity of the diagnosis. The index case had contact with ticks and horses but his infection could not be related to a specific incident.

Crimean-congo hemorrhagic fever in South Africa.

Crimean-Congo hemorrhagic fever virus was isolated for the first time in South Africa in February 1981, from the blood of a 13-year-old boy who died in Johannesburg after attending a camp in a nature reserve in the western Transvaal. Virus was isolated from 21/120 pools of questing ticks from the nature reserve, the infected species being Hyalomma marginatum rufipes and H. truncatum. Virus was also isolated from 4/38 pools of partially engorged ticks and other ectoparasites collected off hosts, the infected species being H.m. rufipes, H. truncatum and Rhipicephalus evertsi. Antibodies were found in the sera of 5/74 humans, 8/26 wild vertebrates, 74/270 sheep, and 109/170 cattle from the reserve and surrounding farms. Antibodies were also found in 28/200 hares from various locations in the country. It was concluded that the virus is widely prevalent in South Africa, but the full medical and veterinary significance of its presence has yet to be determined.

Crimean-Congo haemorrhagic fever virus in Iraq: isolation, identification and electron microscopy.

Crimean-Congo haemorrhagic fever (CCHF) virus was isolated for the first time in Iraq from the blood of three patients. It caused a cytopathic effect in lamb kidney and BHK-21 cell cultures. The virus particles were spherical, enveloped and had 90 nm in diameter similar particles were found in ultrathin sections of the liver from two fatal cases. The isolated virus proved to be antigenically closely related to CCHF virus.

A comparative study of the Crimean hemorrhagic fever-Congo group of viruses.

Twelve strains of the Crimean hemorrhagic fever (CHF)-Congo group of viruses the Bunyaviridae family were investigated with respect to sensitivity to lipid solvents and temperature, pathogenicity for animals, interactions with cell cultures and antigenic relationships. Complement fixation, agar gel diffusion and precipitation, immunofluorescence and neutralization tests showed Hazara virus to have a number of features distinguishing it from the other antigenic type of the CHF-Congo group.