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Patel AA, Dalal YD, Parikh A, Gandhi R, Shah A. Crimean-Congo Hemorrhagic Fever: An Emerging Viral Infection in India, Revisited and Lessons Learned. Cureus 2023; 15:e43315. [PMID: 37700947 PMCID: PMC10492918 DOI: 10.7759/cureus.43315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease caused by the CCHF virus. It was first recognized in 1944 in the Crimea region of the former Soviet Union and then was subsequently isolated in Congo, from a child with similar symptoms. Hence, the virus was termed the Crimean-Congo hemorrhagic fever virus. CCHF is an emerging disease with more than 1000 human cases being reported every year from South-Eastern Europe and Western Asia. The disease is endemic in Africa, the Balkans, the Middle East, and Asia, with an estimated 10,000 to 15,000 CCHF infections each year. The geographic range of the CCHF virus is most extensive among the tick-borne viruses that infect humans. The first outbreak of CCHF in India was described in 2011 in the state of Gujarat with four cases being reported. Since then, there have been sporadic cases in India occurring in small clusters with community and nosocomial spread. Here, we describe three cases that were treated at a tertiary care teaching hospital in the Gujarat state of India. All of them had nonspecific symptoms of viremia initially, followed by rapid deterioration of the general condition. Two of the three patients died. Because of its resemblance with other hemorrhagic fevers, diagnosis of CCHF remains a challenge, especially in non-endemic areas. We aim to sensitize the readers to this emerging arboviral disease because the virus is highly infectious and carries high mortality, and hence, it is crucial to suspect and diagnose the index case at the earliest.
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Affiliation(s)
- Aadil A Patel
- Internal Medicine, Smt. NHL Municipal Medical College, Ahmedabad, IND
| | | | - Amrita Parikh
- Medicine, Smt. NHL Municipal Medical College, Ahmedabad, IND
| | - Rajkamal Gandhi
- Internal Medicine, Smt. NHL Municipal Medical College, Ahmedabad, IND
| | - Anand Shah
- Internal Medicine, Rutgers University New Jersey Medical School, New Jersey, USA
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Tripathi S, Bhati R, Gopalakrishnan M, Bohra GK, Tiwari S, Panda S, Sahay RR, Yadav PD, Nag VL, Garg MK. Clinical profile and outcome of patients with Crimean Congo haemorrhagic fever: a hospital based observational study from Rajasthan, India. Trans R Soc Trop Med Hyg 2021; 114:643-649. [PMID: 32286662 DOI: 10.1093/trstmh/traa014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Crimean Congo haemorrhagic fever (CCHF) is an emerging zoonotic infection with high mortality. Nosocomial spread is described secondary to body fluid contact. METHODS Patients meeting the case definition for viral haemorrhagic fever (VHF) from August to November 2019 were tested for CCHF after ruling out dengue, malaria, scrub typhus and leptospirosis in a tertiary teaching hospital in western Rajasthan, India. Diagnosis was confirmed using both quantitative reverse transcription polymerase chain reaction and immunoglobulin M/immunoglobulin G enzyme-linked immunosorbent assay for all patients. All hospital contacts were line listed and tested and symptomatic high-risk contacts received ribavirin post-exposure prophylaxis. Cohorting, personal protective equipment use and hand washing were employed to prevent nosocomial spread. RESULTS Four patients tested positive for CCHF. We encountered uncommon initial presentations involving motor weakness and supraventricular tachycardia. Elevated serum lactate dehydrogenase and creatinine kinase were useful in clinical diagnosis. Only one patient survived despite ribavirin therapy. There was zero nosocomial transmission. A partial segment of nucleocapsid of amplified CCHF virus was 99.62% identical to the Afghanistan and Oman strains. CONCLUSIONS The distribution of CCHF appears to be expanding, with CCHF emerging as endemic in Rajasthan, India. In this setting of high mortality, hand washing and PPE use prevented nosocomial transmission.
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Affiliation(s)
- Swapnil Tripathi
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India
| | - Rajendra Bhati
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India
| | - Maya Gopalakrishnan
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India
| | - Gopal Krishna Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India
| | - Sarika Tiwari
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India
| | - Rima R Sahay
- Indian Council of Medical Research, National Institute of Virology, 20/ A, Dr. Ambedkar Road, Pune, 411001, India
| | - Pragya D Yadav
- Indian Council of Medical Research, National Institute of Virology, 20/ A, Dr. Ambedkar Road, Pune, 411001, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Basni Industrial estate, Jodhpur, 342005, India
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Crisci T, Arregui S, Canas J, Hooks J, Chan M, Powers C, Schwaderer AL, Hains DS, Starr MC. Placement on COVID-19 Units Does Not Increase Seroconversion Rate of Pediatric Graduate Medical Residents. Front Pediatr 2021; 9:633082. [PMID: 33996685 PMCID: PMC8116566 DOI: 10.3389/fped.2021.633082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/02/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease COVID-19 (coronavirus disease 2019) has presented graduate medical education (GME) training programs with a unique set of challenges. One of the most pressing is how should hospital systems that rely on graduate medical residents provide appropriate care for patients while protecting trainees. This question is of particular concern as healthcare workers are at high risk of SARS-CoV-2 exposure. Objective: This cross-sectional study sought to assess the impact of hospital COVID-19 patient placement on pediatric graduate medical residents by comparing rates of SARS-CoV-2 seroconversion rates of residents who worked on designated COVID-19 teams and those who did not. Methods: Forty-four pediatric and medicine-pediatric residents at Riley Children's Hospital (Indianapolis, IN) were tested for SARS-CoV-2 immunoglobulin M (IgM) and IgG seroconversion in May 2020 using enzyme-linked immunosorbent assays (Abnova catalog no. KA5826), 2 months after the first known COVID-19 case in Indiana. These residents were divided into two groups: those residents who worked on designated COVID-19 teams, and those who did not. Groups were compared using χ2 or Fisher exact test for categorical variables, and continuous variables were compared using Student t testing. Results: Forty-four of 104 eligible residents participated in this study. Despite high rates of seroconversion, there was no difference in the risk of SARS-CoV-2 seroconversion between residents who worked on designated COVID-19 teams (26% or 8/31) and those who did not (31% or 4/13). Eleven of 44 residents (25%) tested positive for SARS-CoV-2 IgG, whereas only 5/44 (11.4%) tested positive for SARS-CoV-2 IgM, without a detectable difference between exposure groups. Conclusion: We did not observe a difference in SARS-CoV-2 seroconversion between different exposure groups. These data are consistent with growing evidence supporting the efficacy of personal protective equipment. Further population-based research on the role of children in transmitting the SARS-CoV-2 virus is needed to allow for a more evidence-based approach toward managing the COVID-19 pandemic.
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Affiliation(s)
- Timothy Crisci
- Medicine-Pediatric Residency, Indiana University, Indianapolis, IN, United States
| | - Samuel Arregui
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Jorge Canas
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Jenaya Hooks
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Melvin Chan
- Medicine-Pediatric Residency, Indiana University, Indianapolis, IN, United States
| | - Cory Powers
- Medicine-Pediatric Residency, Indiana University, Indianapolis, IN, United States
| | - Andrew L Schwaderer
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - David S Hains
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Michelle C Starr
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
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Tschudin-Sutter S, Frei R, Schwahn F, Tomic M, Conzelmann M, Stranden A, Widmer AF. Prospective Validation of Cessation of Contact Precautions for Extended-Spectrum β-Lactamase-Producing Escherichia coli(1). Emerg Infect Dis 2018; 22:1094-7. [PMID: 27191171 PMCID: PMC4880108 DOI: 10.3201/eid2206.150554] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
After contact precautions were discontinued, we determined nosocomial transmission of extended-spectrum β-lactamase (ESBL)–producing Escherichia coli by screening hospital patients who shared rooms with ESBL-producing E. coli–infected or –colonized patients. Transmission rates were 2.6% and 8.8% at an acute-care and a geriatric/rehabilitation hospital, respectively. Prolonged contact was associated with increased transmission.
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