Case Study

After swine comes the deadly virus congo
Dr. Rahul Jha, Chief Coordinator - Education Department

Before Swine Flu has said its adieu to us, here comes another villain trying to build its Niche at the cost of lives of many innocents. It is the Congo Fever or Crimean - Congo Hemorrhagic Fever (CCHF), which had already claimed six lives in western India.

Crimean- Congo Hemorrhagic Fever
Congo fever is transmitted Hyalomma (bont legged) tick, which is widespread in Africa, Europe and Asia. This disease was first diagnosed in South Africa in 1981 when a child was a bitten by a tick.

Crimean Congo Hemorrhagic Fever (CCHF) is caused by infection from a tick-borne virus (Nairo virus) belonging to the Bunyaviridae family. Since this disease was first characterized in Crimea in 1944 and thus got the name Crimean Hemorrhagic Fever. It was later recognized in 1969 as the reason for wide spreading illness in Congo, thus resulting in the current name of the disease.

Usually the virus spreads from animal to animal and from animal to human beings through ticks. When human beings come in contact with animal secretions or blood or are bitten by the ticks, the chances of infection is high, resulting into 30% of death chances with less transmission rate.

The stretch of CCHF can occur in hospitals, due to improper sterilization of medical equipments, reuse of injection needles and contamination of Medical Supplies.

Symptoms of Crimean Congo Hemorrhagic Fever
The onset of this disease in very high. The initials signs and symptoms include headache, high fever, back pain, joint pain, stomach pain and vomiting. Red eyes, a flushed face, a red throat and petechiae (red spots) on the palate are common. Symptoms may also include jaundice and in some of the severe cases change in moods and sensory perception is noted. As the illness progresses large area of stern bruising, severe nosebleeds and uncontrolled bleeding at the injection sites can be seen.

Human usually show symptoms within 9 days after a tick bite or contact with infected blood. They get a flu like illness and blood spots appear under the skin. This deadly virus can cause death of 30% of the infected people.

The symptoms of Congo Fever are after confused with those of tick-bite fever where a characteristic lesion often develops in the area of tick bite, same as Congo Fever. There are also other diseases which may cause fever and bleeding under the skin, therefore diagnosis is mostly recommended.

How is Crimean Congo Hemorrhagic Fever diagnosed?
Laboratory diagnosis of CCHF can be done by finding a positive serological test result, i.e. evidence of viral antigen in tissue by immune histo-chemical staining and microscopic examination or identification of viral RNA sequence in blood or tissue, in a patient with a clinical history compatible with CCHF. Increasing tourism and improper hygiene is considered as the root for augmentation of vector borne diseases in India.

How is the disease prevented?
The persons who comes in contact of animals very often or have to work with them should use insects repellent on exposed skin and clothing. Insects repellents containing DEET (N, N-diethyl-m-toluamide) are must effective in warding off ticks, wearing gloves and other protective clothing is also recommended. Individuals should also avoid contact with the blood and body fluids of livestock or human who shows symptom of infection. It is very important for Doctors and Health worker to use proper infection control precautions to prevent occupational exposure.

Is the disease fatal?
From the previous documented outbreaks of CCHF, it had seen that fatality rates in hospitalized patients have ranged from 9% to as high as 50%.

Difference between Congo Fever and Bird Flu
Usually “avian influenza virus” referred as influenza “A” viruses are chiefly found in birds, but infection with this virus can occur in human as well. The risk from avian influenza is generally low because the viruses usually do not effect the human. Most cases avian influenza infection in human have resulted from contact with the infected poultry (e.g. domesticated chickens, ducks, turkeys) or surface contamination with secretion / excretions from infected bird. The spread of avian influenza virus from one ill person to another person are reported very rarely and has been limited, inefficient and sustained.

Since the transmission rate in a case of Swine Flu in much higher in comparison to the Congo Fever, therefore in Bird Flu the mortality rate is also higher than Congo Fever.

Is the meat safe for human consumptions?
In the case of bird flu, the chicken is restricted if it's not properly cooked. But in CCHF there is no evidence that Congo Fever virus may be transmitted to human through processed meat according to the Health Regulatory Authority. This virus does not survive in meat, which is cooked or matured (low PH) or in dried blood.

Awareness and proper hygiene can save people from being vulnerable to this kind of infection, by protecting oneself from animal secretions, bloods, ticks and by using proper personnel protecting equipments.

Dr. Subhadeep Laskar, MD
A young lady was admitted on 04.02.2011 with h/o extreme generalized weakness, generalized swelling - 1 wk. High grade fever for 2 days. Patient had blood transfusion at 3 yrs of age and was taken to CMC, Vellore 2003. She was found to have severe pallor angular stomatitis and a systolic mitral murmur.

Metasasis of unknown primary - an unusual presentation
Dr. Subrata Chatterjee, MD, Oncologist

Akthar Ali, had history of ulcerated nodule over upper part of anterior chest wall for 3 mths. He was operated by wide excion elsewhere.As Histopathological report was metastatic squamous cell carcinoma ,he was referred to CHARNOCK Hospital for further management. The patient was asymptomatic at presentation.He was smoker. No Past history of Pulmonary Koch's or other major illness.

On Physical examination, nothing abnormality was found. Operative site was healthy.ENT exam. was normal. CECT thorax & abdomen & endoscpic exam.of G.I. tract were normal. H.P.slide was reviewed particularly to rule out primary skin malignancy. Review report of H.P. slide showed moderately differentiated metastatic squamous cell carcinoma.So, he was diagnosed as Metasasis of unknown primary.He was administered 4 cycles of Chemotherapy with Paclitaxel& Carboplatin. Now,Patient is clinically O.K. on clinical & Radiological examination.He is advised regular check-up.

Charnock in House