Close Contact Precautions Could Prevent an Outbreak of Crimean-Congo Hemorrhagic Fever: A Case Series Report from Southern Part of Tehran
On 29th June 2011, a 36-year-old male construction worker presented to the same hospital with chief complaint of fever, malaise, myalgia and headache, ecchymoses and hematemesis unresponsive to conservative managements. His symptoms were started 3 days prior to admission. There was no history of recent travel or direct contact with domestic animals, but a history of contact with his brother's blood and body fluid, who had worked in a live stock and died about 10 days before his admission.\nOn physical examination, the patient was hypotensive (mean arterial blood pressure: 80 mmHg), respiratory rate 36/min and pulse rate 100/min.\nThe patient had yellowish discoloration of sclera, a few petechiae on hard palate and multiple ecchymoses on extremities were detectable.\nLaboratory tests revealed leukocytosis, thrombocytopenia, increased PT, PTT, INR, aminotransferases, CPK and creatinine.\nFluid resuscitation and critical care managements were started. Ribavirin, loading and first doses were administered to him.\nSerum IgG, IgM ELISA tests and RT-PCR for CCHF virus were obtained.\nAfter a few hours of admission, the patient developed intractable hematemesis and epistaxis, not responding to medical managements; the patient's condition deteriorated and finally he died on 30th June, 2011. Surprisingly report of RT-PCR was negative for CCHF virus by reference laboratory.\nHis family members and all close contacts were informed to refer for evaluation. On 30th June, 13 suspicious cases were evaluated, 4 out of 13 were admitted to the hospital and the others who met the criteria for receiving prophylactic ribavirin were discharged with oral ribavirin. They advised to refer to the hospital in case of finding any sign or symptom of CCHF (temperature over 38.5 by mouth, headache, myalgia, petechia, arthralgia, or hemorrhagic manifestations.)\nshows the consanguinity of these cases.