Crimean-Congo haemorrhagic fever

Clinical severity scoring index (SSI) for CCHF[79]Dokuzoguz B, Celikbas AK, Gök ŞE, et al. Severity scoring index for Crimean-Congo hemorrhagic fever and the impact of ribavirin and corticosteroids on fatality. Clin Infect Dis. 2013;57:1270-4. http://cid.oxfordjournals.org/content/57/9/1270.long http://www.ncbi.nlm.nih.gov/pubmed/23946218?tool=bestpractice.com

• Platelet count (×10³ platelets/mm³)

  • >150=0

  • 150-50=1

  • 49-20=2

  • <20=3

• aPTT (seconds)

  • ≤34=0

  • 35-45=1

  • 46-59=2

  • >60=3

• Fibrinogen level (mg/dL)

  • ≥180=0

  • 179-160=1

  • 159-120=2

  • <120=3

• Bleeding

  • No=0

  • Petechiae=1

  • Ecchymosis= 2

  • Bleeding=3

• Somnolence

  • No=0

  • Yes=1

0-2 points=mild

3-9 points=moderate

10-13 points=severe.

A score >10 points is associated with a case fatality rate >50%.

Centers for Disease Control and Prevention: viral hemorrhagic fever (VHF) case definition[65]Centers for Disease Control and Prevention. Viral hemorrhagic fever (VHF) 2011 case definition [internet publication]. https://ndc.services.cdc.gov/case-definitions/viral-hemorrhagic-fever-2011

Clinical criteria

• An illness with acute onset with:

  • Fever >40°C (104°F), and

• One or more of the following clinical findings:

  • Severe headache

  • Muscle pain

  • Erythematous maculopapular rash on the trunk with fine desquamation 3–4 days after rash onset

  • Vomiting

  • Diarrhoea

  • Abdominal pain

  • Bleeding not related to injury

  • Thrombocytopenia.

Laboratory criteria

• One or more of the following laboratory findings:

  • Detection of VHF viral antigens in blood by ELISA antigen detection

  • VHF viral isolation in cell culture for blood or tissues

  • Detection of VHF-specific genetic sequence by reverse transcription-polymerase chain reaction (RT-PCR) from blood or tissues

  • Detection of VHF viral antigens in tissues by immunohistochemistry.

Epidemiologic linkage

• One or more of the following exposures within the 3 weeks before onset of symptoms:

  • Contact with blood or other body fluids of a patient with VHF

  • Work in a laboratory that handles VHF specimens

  • Work in a laboratory that handles bats, rodents, or primates from endemic areas

  • Residence in/travel to a VHF-endemic area

  • Exposure to semen from a confirmed acute or convalescent case of VHF within the 10 weeks of that person's onset of symptoms.

Case classification

• Suspected case: meets the clinical and epidemiologic linkage criteria

• Confirmed case: meets the clinical and laboratory criteria.