An Overview of Complications and Mortality of Crimean-Congo Hemorrhagic Fever

Abstract

Context: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne acute viral hemorrhagic fever with variable complications and mortality. Its mortality rate could be as high as 60% - 80% or as low as 0% - 5%. The most common complications are hemorrhage, shock, DIC, and multi-organ failure that might result in death. Evidence Acquisition: This review was conducted based on 18 articles, two text books, and the experience gained by the author on CCHF cases since 1999. The articles were taken from different sources, specially Google Scholar. Three of the articles were published by the author and his colleagues. Different sections of the reviewed articles including results, conclusion, and discussion were used for this overview. Results: The most common complication of CCHF in different studies has been hematologic disorders of which, thrombocytopenia and increased PTT and PT time are the most common disorders seen in up to 100% of CCHF patients. Bleeding in different organs, especially the oral cavity, is the next common complication. The average mortality rate is 10% to 40%, but it might vary from as low as 0-5% in Iran to as high as 60% - 80% in different regions. The usual causes of death are shock, DIC, and multi-organ failure including hepatic, renal, and respiratory failure. Moreover, rare complications such as intracerebral hemorrhage, compartment syndrome, intra-abdominal, pleural and pericardial effusions, acute pancreatitis, myocarditis, and cholecystitis are reported. Conclusions: CCHF has many common and rare complications some of which may lead to death. The most important causes of mortality are hemorrhage, shock, and multi-organ failure, but the mortality rate is very different and is related to the experience of the treatment center in early diagnosis and treatment of the disease and its fatal complications. Moreover, there are other less common or rare complications of CCHF that may be difficult to be diagnosed and managed by inexperienced physicians.