Ahmedabad, Jan 18: A  deadly virus called CCHF ( Crimean Congo Haemorrhage Fever)  has caused the death of a lady patient, and the doctor and nurse attending on her  in Ahmedabad’s Shalby Hospital.

Amina Momin, aged 30, from Karod village in Sanand died of this  virus on January 3. Dr Gagan sharma, 38, of Shalby Hospital and a nurse Asha John of the same hospital contracted the deadly virus and died on January 13 and today respectively.

The nurse died in Sterling Hospital today  A team from the National Institute of Virology, Pune has confirmed the virus.

Door-to-door survey has begun in village Karod.

Amina’s husband Hussain rahman and his brother Hussain Rasool have also contracted the virus, doctors said.

Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever of the Nairovirus group. Although primarily a zoonosis, sporadic cases and outbreaks of CCHF affecting humans do occur. The disease is endemic in many countries in Africa, Europe and Asia, and during 2001, cases or outbreaks have been recorded in Kosovo, Albania, Iran, Pakistan, and South Africa.

The disease was first described in the Crimea in 1944 and given the name Crimean haemorrhagic fever. In 1969 it was recognized that the pathogen causing Crimean haemorrhagic fever was the same as that responsible for an illness identified in 1956 in the Congo, and linkage of the 2 place names resulted in the current name for the disease and the virus. CCHF is a severe disease in humans, with a high mortality rate. Fortunately, human illness occurs infrequently, although animal infection may be more common.
The geographical distribution of the virus, like that of its tick vector, is widespread. Evidence of CCHF virus has been found in Africa, Asia, the Middle East and Eastern Europe. Healthcare workers in endemic areas should be aware of the illness and the correct infection control procedures to protect themselves and their patients from the risk of nosocomial (hospital-acquired) infection.

The virus which causes CCHF is a Nairovirus, a group of related viruses forming one of the five genera in the Bunyaviridae family of viruses. All of the 32 members of the Nairovirus genus are transmitted by argasid or ixodid ticks, but only three have been implicated as causes of human disease: the Dugbe and Nairobi sheep viruses, and CCHF, which is the most important human pathogen amongst them.

Clinical features

•    The length of the incubation period for the illness appears to depend on the mode of acquisition of the virus. Following infection via tick bite, the incubation period is usually one to three days, with a maximum of nine days. The incubation period following contact with infected blood or tissues is usually five to six days, with a documented maximum of 13 days.

•    Onset of symptoms is sudden, with fever, myalgia (aching muscles), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting and sore throat early on, which may be accompanied by diarrhoea and generalised abdominal pain. Over the next few days, the patient may experience sharp mood swings, and may become confused and aggressive. After two to four days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the right upper quadrant, with detectable hepatomegaly (liver enlargement).

•    Other clinical signs which emerge include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechial rash (a rash caused by bleeding into the skin), both on internal mucosal surfaces, such as in the mouth and throat, and on the skin. The petechiae may give way to ecchymoses (like a petechial rash, but covering larger areas) and other haemorrhagic phenomena such as melaena (bleeding from the upper bowel, passed as altered blood in the faeces), haematuria (blood in the urine), epistaxis (nosebleeds) and bleeding from the gums. There is usually evidence of hepatitis. The severely ill may develop hepatorenal (i.e., liver and kidney) and pulmonary failure after the fifth day of illness.

•    The mortality rate from CCHF is approximately 30%, with death occurring in the second week of illness. In those patients who recover, improvement generally begins on the ninth or tenth day after the onset of illness.