Video:Crimean–Congo hemorrhagic fever

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Crimean–Congo hemorrhagic fever is a viral disease.[1]The CCHF virus is typically spread by tick bites or contact with livestock carrying the disease.[1] It occurs in Africa, the Balkans, the Middle East, and Asia.[1]

Signs and symptoms

Symptoms of CCHF may include fever, muscle pains, headache, vomiting, diarrhea, and bleeding into the skin.[1] Onset of symptoms is less than two weeks following exposure.[1] Complications may include liver failure.[1] In those who survive, recovery generally occurs around two weeks after onset.[1]


The Crimean-Congo hemorrhagic fever orthonairovirus is a member of the genus Orthonairovirus, family Nairoviridae of RNA viruses.[2]The virions are 80 to 120 nanometers in diameter and are pleomorphic; each virion contains three copies of the genome. The envelope is single layered and is formed from a lipid bilayer 5 nanometers thick, it has no protrusions. The envelope proteins form small projections 5 to 10 nanometers long. The nucleocapsids are filamentous and circular with a length of 200 to 3000 nanometers.[3]

Molecular biology

The genome is circular, negative sense RNA in three parts, Small S, Medium M, and Large L. The L segment is 11 to 14.4 kilobases in length while the M and S segments are 4.4 to 6.3 and 1.7 to 2.1 kilobases long respectively. The L segment encodes the RNA polymerase, the M segment encodes the envelope glycoproteins Gc and Gn, and the S segment encodes the nucleocapsid protein.[3]

Population genetics

Population genetics is the genetic variation within populations and the evolutionary factors that made the variation occur.[4] CCHFV is the most genetically diverse of the arboviruses: Its nucleotide sequences frequently differ between different strains, ranging from a 20 percent variability for the viral S segment to 31 percent for the M segment.[5]


Ticks are both environmental reservoir and vector for the virus, carrying it from wild animals to domestic animals and humans. Tick species identified as infected with the virus include, Hyalomma anatolicum, Hyalomma detritum, and Hyalomma marginatum marginatum.[6]


In terms of the pathogenesis of Crimean-Congo hemorrhagic fever, due to a variety of factors, it is not well understood. What is known of this virus mechanism is that endothelial cells and immune cells play a large role; the occupation of viral antigens in endothelial cells, is an indication that the endothelium is a important target of the virus.[7]


The diagnosis of Crimean-Congo hemorrhagic fever can be done via the following, Antigen-Capture enzyme-Linked Immunosorbent Assay (ELISA), Real time polymerase chain reaction, virus isolation attempts and immunohistochemical staining.[8]


Where mammalian tick infection is common, agricultural regulations require de-ticking farm animals before transportation or delivery . Personal tick avoidance measures are recommended, such as use of insect repellents, adequate clothing, and body inspection for adherent ticks.[9][10]


Management of Crimean Congo hemorrhagic fever is mostly supportive. Ribavirin is used in the treatment of this viral hemorrhagic fever via both oral and intravenous formulations which seem effective.[11]

Epidemiology 1

In 2008, more than 50 cases per year were reported from only 4 countries, Turkey, Iran, Russia and Uzbekistan; 5 to 49 cases per year were present in South Africa, Central Asia (including Pakistan and Afghanistan), and some cases in the Middle East (the United Arab Emirates).[12]

Epidemiology 2

Between 2002 to 2008 the Ministry of Health of Turkey reported 3,128 CCHF cases, with a 5 percent death rate. In July 2005, authorities reported 41 cases of CCHF in central Turkey, Yozgat Province, with one death.[13]


The virus may have evolved around 1500 to 1100 BC. It is thought that changing climate and agricultural practices around this time could be behind its evolution.[14] During the Crimean War, the disease was known as Crimean fever and contracted by many, including Florence Nightingale.[15] In February 1967, virologists Jack Woodall, David Simpson, Ghislaine Courtois and others published initial reports on a virus they would call the Congo virus.[16][17]


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 "Crimean-Congo haemorrhagic fever". World Health Organization. January 2013. Archived from the original on 13 July 2017. Retrieved 18 July 2017.
  2. Virus Taxonomy: 2018 Release, EC 50, Washington, DC, July 2018, Email ratification October 2018 (MSL #33) Archived 2020-03-20 at the Wayback Machine
  3. 3.0 3.1 Carter SD, Surtees R, Walter CT, Ariza A, Bergeron É, Nichol ST, et al. (October 2012). "Structure, function, and evolution of the Crimean-Congo hemorrhagic fever virus nucleocapsid protein". Journal of Virology. 86 (20): 10914–23. doi:10.1128/JVI.01555-12. PMC 3457148. PMID 22875964.
  4. Emery and Rimoin's principles and practice of medical genetics (Sixth ed.). [San Diego, California]. 2013. pp. 1–40. ISBN 978-0-12-383834-6. Retrieved 24 March 2022.
  5. Bente DA, Forrester NL, Watts DM, McAuley AJ, Whitehouse CA, Bray M (October 2013). "Crimean-Congo hemorrhagic fever: history, epidemiology, pathogenesis, clinical syndrome and genetic diversity". Antiviral Research. 100 (1): 159–89. doi:10.1016/j.antiviral.2013.07.006. PMID 23906741. Archived from the original on 2017-09-22. Retrieved 2018-11-27.
  6. "Transmission | Crimean-Congo Hemorrhagic Fever (CCHF) | CDC". 27 February 2019. Archived from the original on 28 April 2014. Retrieved 19 March 2022.
  7. Akıncı, Esragül; Bodur, Hürrem; Leblebicioglu, Hakan (July 2013). "Pathogenesis of Crimean-Congo hemorrhagic fever". Vector Borne and Zoonotic Diseases (Larchmont, N.Y.). 13 (7): 429–437. doi:10.1089/vbz.2012.1061. ISSN 1557-7759. Retrieved 22 March 2022.
  8. "Diagnosis | Crimean-Congo Hemorrhagic Fever (CCHF) | CDC". 27 February 2019. Archived from the original on 18 March 2022. Retrieved 19 March 2022.
  9. "Prevention | Crimean-Congo Hemorrhagic Fever (CCHF) | CDC". 27 February 2019. Archived from the original on 20 March 2021. Retrieved 19 March 2022.
  10. Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting (PDF). World Health Organization and Centers for Disease Control and Prevention. December 1998. Archived (PDF) from the original on 8 July 2017. Retrieved 20 October 2014.
  11. "Crimean-Congo haemorrhagic fever". Retrieved 25 March 2022.
  12. "Geographic distribution of Crimean Congo Hemorrhagic fever". Retrieved 28 March 2022.
  13. Leblebicioglu, Hakan; Ozaras, Resat; Irmak, Hasan; Sencan, Irfan (February 2016). "Crimean-Congo hemorrhagic fever in Turkey: Current status and future challenges". Antiviral Research. 126: 21–34. doi:10.1016/j.antiviral.2015.12.003. ISSN 1872-9096. Archived from the original on 5 March 2022. Retrieved 21 March 2022.
  14. Carroll SA, Bird BH, Rollin PE, Nichol ST (June 2010). "Ancient common ancestry of Crimean-Congo hemorrhagic fever virus". Molecular Phylogenetics and Evolution. 55 (3): 1103–10. doi:10.1016/j.ympev.2010.01.006. PMID 20074652.
  15. Cromwell, Judith Lissauer, Florence Nightingale, Feminist, McFarland, 2013, p.149
  16. Simpson DI, Knight EM, Courtois G, Williams MC, Weinbren MP, Kibukamusoke JW (February 1967). "Congo virus: a hitherto undescribed virus occurring in Africa. I. Human isolations--clinical notes". East African Medical Journal. 44 (2): 86–92. PMID 6040759.
  17. Woodall JP, Williams MC, Simpson DI (February 1967). "Congo virus: a hitherto undescribed virus occurring in Africa. II. Identification studies". East African Medical Journal. 44 (2): 93–8. PMID 6068614.