THREE HEALTH WORKERS: A REPORT FROM IRAN

Crimean-Congo hemorrhagic fever (CCHF) is caused by Nairovirus, genus Bunyavirus in family of bunyaviridae, and is spread by the tick Hyalomma spp or via blood transfusion and contaminated blood of human and animal. CCHF virus infection was rarely reported in Iran before 1999. From January 1st 1999 to October 1st 2002 nearly 144 confirmed sporadic CCHF cases reported from many provinces of Iran. Seroepidemiological details of three cases of nosocomial CCHF that were seen in three different hospitals throughout Iran are described here. Of the three patients in this study, two died. All three patients initially presented with severe Ebola virus-like or influenza-like symptoms, making the disease difficult to diagnose in the early stage. However, petechiae and signs of bleeding distinguish CCHF from influenza, but not from Ebola which is not related to this disease and has not been reported in Iran. Leukopenia and thrombocytopenia were the most important laboratory findings. Rising IgG and IgM titers made the diagnosis certain in two of the cases. Despite the low mortality rate because of very effective treatment with ribavirin among the general population, two of the three CCHF patients died. This poor prognosis for CCHF signals the importance of early diagnosis and admission of suspicious cases to hospital