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The Grim Reaper among Us!

It was just another normal day for Naseer, a regular fellow who worked at the cattle farm in the rural areas of Bahawalpur, Pakistan. But that evening when he came home, he had a mild fever. Naseer thought that it was not a big deal and went to sleep. By the coming next days, that fever grew stronger and stronger. Along with that came chills and soon after Naseer started to behave in a really strange way. His mood swings were difficult to understand, he developed the fear of light too. To make the conditions even worse, he got diarrhea, vomiting along with excessive body bleeding. His family thought that it was some sort of demonic possession. So, they tried to get rid of that evil by conventional spiritualistic means. But they were totally unaware of the angel of death that had invaded the body of that poor fellow. Exactly on the fifteenth day, death mourns could be heard clearly from Naseer’s home. The poor fellow had passed away due to the ignorance of his kin and unavailability of proper medical aid.

Naseer was one of many cases that suffered a cruel fate at the hands of Crimean-Congo Hemorrhagic Fever. Its hard to comprehend that all this devastation was caused by the smallest entity that barely possesses the life force.  But then, if we analyze the entire history of pain and pestilence, we can easily conclude that these smallest entities have always been the greatest evolutionary competitors of human race. I believe “War can cause damage but if you want a massive devastation and ultimate catastrophe, just make it VIRAL”.

History:

Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae. The disease was first identified in the Crimea in 1944 and given the name Crimean hemorrhagic fever. It was then later recognized in1969 as the cause of massive mortality in the Congo, thus resulting in the current name of the disease.

Geographical Distribution:

Crimean-Congo hemorrhagic fever is found in Eastern Europe, particularly in the former Soviet Union, throughout the Mediterranean, in northwestern China, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.

Epidemiology:

Congo virus has a very notorious reputation for being very gruesome in its virulence. Due to its highly variable genome, its virulence and disease is also seen in many variable forms depending on the organism. Common hosts of this virus are small and large herbivores. Ticks act as the vectors for transmission of this virus to humans which is its secondary host. The virus completes its lytic cycle in the humans. In herbivores, normally no major disease is seen to be caused by Congo virus. However smaller herbivores and other animals may show mild symptoms of the disease when injected at young age for experimental purposes.

Transmission:

Ixodid (hard) ticks, mainly those of Hyalomma genus, are both a source and a vector for the CCHF virus. Numerous wild and domestic animals, such as cattle, goats, sheep and hares, serve as amplifying hosts for the virus. Transmission to humans occurs through contact with infected ticks or animal blood. CCHF can be transmitted from one infected human to another by contact with infectious blood or body fluids. CCHF spread has also occurred in hospitals due to unsatisfactory sterilization of medical equipment, contamination of medical supplies. Reuse of injection needles.

Symptoms:

The mortality rate caused by CCHF in hospitalized patients have ranged from as low as 9% to as high asv50-80% depending on the region and the environment of the hospital along with the treatment methods. The incubation time of this virus after exposure is normally 3-5 days. Some of the commonly noticed symptoms of CCHF are described regarding to the phase of virus activity. The three major phases along with their common symptoms are:

  1. Pre-hemorrhagic phase:
  • Sudden onset fever.
  • Dizziness with neck pain and chills.
  • Nausea and Vomiting.
  • Non-bloody diarrhea.
  • Low blood pressure.
  1. Hemorrhagic phase:
  • Red spots on palate and inside buccal cavity and throat
  • Petechial rashes.
  • Excessive nose bleeding.
  • Bleeding from other sites.
  1. Convalescent Phase:
  • After 10 -20 days of general infection generalized weakness along with Tachycardia is observed.

Diagnosis:

The diagnostic techniques that are generally used to isolate the virus are ELISA, PCR and RT-PCR.

Treatment:

Ribavirin has been reported to show positive recovery results in this infection. Passive immune therapy is also effective in some cases.

Prevention:

The most effective way to prevent this disease is to use insect repellents to avoid ticks. People working in farms and diagnostic labs should wear proper gloves and other body covers to prevent the exposure. Proper recommended disinfectants should be used to clean the hands after dealing with Congo virus in labs.

Prevalence in Pakistan:

The massive outbreaks of Congo virus in the last half decade have been reported with high mortality rate due to absence of proper medical aid, however the epidemic was controlled by devising a proper treatment and proper protocols for the patients. In 2016, only 19 such cases have been reported so far, in which two patients were from Bahawalpur, 5 from Karachi and 12 from Quetta. This scenario clearly depicts that the disease is under control.

PS: Regarding any illness no matter how minor or major it is, if you observe even minor symptoms, rush to the doctor and do remember “Better safe than Sorry”

 

 

 

 

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About the author

Waleed Sohail Chohan