Zahit TAŞ, Meliha Çağla SÖNMEZER, Gülçin TELLİ DİZMAN, Ahmet Çağkan İNKAYA, Ömrüm UZUN, Murat AKOVA

A Case of Crimean-Congo Haemorrhagic Fever (CCHF) Mimicking the COVID-19 Disease

A 74-year-old female from a rural district in Central Anatolia, Turkey, was admitted with persisting fever, malaise, cough, and vomiting. There is no abnormal finding on physical examination. There was no petechiae, purpura, ecchymosis, or bleeding in organ systems at any time. Laboratory findings showed increased D-dimer level and acute inflammation biomarkers such as C-reactive protein, ferritin, and thrombocytopenia with prolonged prothrombin time. Since the patient applied with clinic features indicating a viral infection and on a pandemic period, firstly, we focused on coronavirus disease 2019 (COVID-19 )disease. However, the probability was reduced with negative chest imaging and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction (RT-PCR) results. Any patient admitting with symptoms indicative of COVID-19 disease during the pandemic era should also be evaluated for other infections, especially endemic zoonotic infections such as brucellosis, Crimean-Congo hemorrhagic fever (CCHF), Q fever. In this case, serologic tests were all negative (Leptospira Toxoplasma, Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Rubella, Brucella, Coxiella, Hepatitis B, Hepatitis C). The patient was found to be IgM and RNA positive for the CCHF virus by ELISA and polymerase chain reaction (PCR) methods, respectively. In endemic areas, CCHF is one of the diseases which should be considered in the differential diagnosis. In addition, it is essential to accurately identify CCHF infection using proper medical tests to prevent misdiagnosis amid this COVID-19 pandemic. Hence, we need to keep an eye on the cases that come from endemic rural areas in the Central Anatolia region of Turkey. Herein, we present a case of CCHF patients initilally evaluated to have COVID-19.

PDF

___

[1] Ergonul O. Crimean-Congo hemorrhagic fever virus: new outbreaks, new discoveries. Curr Opin Virol. Apr 2012;2(2):215-20. doi:10.1016/j.coviro.2012.03.001
[2] Yilmaz GR, Buzgan T, Irmak H, et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002- 2007. Int J Infect Dis. May 2009;13(3):380-6. doi:10.1016/j. ijid.2008.07.021
[3] Ertem G, Sönmezer M, Temoçin F, Ataman Hatipoğlu Ç, Tülek N, Oral B. The efficacy of oral ribavirin on clinical and laboratory parameters inCrimean-Congo hemorrhagic fever: an observational study from Turkey. Turk J Med Sci. Nov 17 2016;46(5):1407-1414. doi:10.3906/sag-1506-92
[4] Heydari Aa. Acute Complicated Brucellosis Mimicking Crimean-Congo Hemorrhagic Fever (CCHF) and Vice Versa. Review article. Journal of Medical Microbiology and Infectious Diseases. 2019;7(1):1-5. doi:10.29252/ JoMMID.7.1.2.1
[5] Sonmezer MC, Inkaya AC. COVID-19: Virology, pathogenesis, Clinical Features, Treatment. Turkey Clinics specail issue COVID-19. 2020. p. 1-8. Online ISBN: 978-625- 401-397-3.
[6] Pazarlı AC, Parlak Z, Ekiz T. COVID-19 and Crimean- Congo Hemorrhagic Fever: Similarities and Differences. Heart Lung. Nov-Dec 2020;49(6):892-893. doi:10.1016/j. hrtlng.2020.05.013
[7] Kara SS, Kara D, Fettah A. Various clinical conditions can mimic Crimean-Congo hemorrhagic fever in pediatric patients in endemic regions. J Infect Public Health. Sep- Oct 2016;9(5):626-32. doi:10.1016/j.jiph.2016.01.007
[8] Tasdelen Fisgin N, Doganci L, Tanyel E, et al. Initial high rate of misdiagnosis in Crimean Congo haemorrhagic fever patients in an endemic region of Turkey. Epidemiol Infect. Jan 2010;138(1):139-44. doi:10.1017/s0950268809990318
[9] Butt MH, Ahmad A, Misbah S, Mallhi TH, et al. Crimean- Congo hemorrhagic fever and Eid-Ul-Adha: A potential threat during the COVID-19 pandemic. J Med Virol. Feb 2021;93(2):618-619. doi:10.1002/jmv.26388
[10] Zayet S, Kadiane-Oussou NJ, Lepiller Q, et al. Clinical features of COVID-19 and influenza: a comparative study on Nord Franche-Comte cluster. Microbes Infect. Oct 2020;22(9):481-488. doi:10.1016/j.micinf.2020.05.016
[11] Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez- Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. Mar-Apr 2020;34:101623. doi:10.1016/j. tmaid.2020.101623
[12] Onguru P, Dagdas S, Bodur H, et al. Coagulopathy parameters in patients with Crimean-Congo hemorrhagic fever and its relation with mortality. J Clin Lab Anal. 2010;24(3):163-6. doi:10.1002/jcla.20383