Death From Crimean-Congo Hemorrhagic Fever in Spain After Tick Bite

Dr Isabelle Catala

September 09, 2016

MADRID — A 62-year-old man died of Crimean-Congo hemorrhagic fever (CCHF) in a Madrid hospital on August 25 after being bitten by a tick during a walk in the countryside in the province of Castile and León. The cause of death was acute liver failure.

Madrid health authorities confirmed the diagnosis on September 1. In addition, on August 26 a nurse in the intensive care unit the patient had been admitted to was infected as well. Her condition was considered stable, although she was still in isolation in intensive care.

The regional health agency is currently monitoring 190 people who came in contact with these two patients in accordance with the Ebola protocol adopted in Spain in 2015. Most of them are hospital personnel (100 medical staff) and family members.

Health authority spokesperson Jesus Sanchez Martos pointed out that "this disease has nothing to do with Ebola," and that "people shouldn't think that all tick bites in Spain are now going to transmit this illness."

People shouldn't think that all tick bites in Spain are now going to transmit this illness. Dr Jesus Sanchez Martos

Presence of Virus Known Since 2010

This hemorrhagic fever probably found its way to Spain with the importing of animals. In 2010, the Center of Excellence for the Rickettsioses (San Pedro Hospital) reported the presence of the CCHF virus in ticks in Spain.

A research study conducted from 2013 to 2015 concluded that "ticks of the genus Hyalomma, which have the characteristic of migrating easily, contain genetic material from the CCHF virus in the Iberian Peninsula. The emergence potential in Spain is high. An active surveillance system is needed."

Kidney and Liver Failure

CCHF is transmitted through tick bites and by farm animals (cattle, sheep, and goats). Person-to-person transmission is rare. The fever is caused by a nairovirus of the family Bunyaviridae. The disease is endemic in Africa, the Balkans, the Middle East, and Asia.

After a tick bite, symptoms appear within 5 to 6 days, including fever, muscle pain, dizziness, nuchal stiffness, headaches, photophobia, nausea, diarrhea, and abdominal pain. Secondarily, neurologic signs may develop, as may hepatomegaly. Patients die of severe kidney or liver failure. The mortality rate is close to 30%.

There is currently no vaccine for CCHF.

This news story originally appeared on the Medscape Français edition.

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