Crimean-congo hemorrhagic fever (CCHF) infection in Georgia: Case report and laboratory investigation

The National Center for Disease Control and Public Health (NCDC) of Georgia has suspected that the Crimean-Congo Hemorrhagic Fever (CCHF) virus is circulating in the country for some time. Antigens of the CCHF virus (CCHFV) have been detected in serological surveys of rodent populations and in Ixodes ticks. New diagnostic techniques and surveillance system strategies were developed in the last three years, and, we have now confirmed two CCHF cases. Methods: CCHF case, contacts, vectors and probable sites of exposure were investigated by NCDC staff. Specimens were tested by CCHF IgM ELISA Kit (Vector-Best, Novosibirsk, Russia), real-time PCR (Roche Diagnostics, Basel, Switzer- land).

A 62-year-old man was admitted to the Infectious Diseases Center (ICD) on June 24, 2012 (symptoms onset June 17) with fever of unknown origin, melena, hematemesis, thrombocytopenia, hepatitis, and renal failure. ICD reported to NCDC with suspicion of Leptospirosis, requesting laboratory research. Serum samples were obtained on June 26, 2012. The ELISA result was positive for CCHF IgM (result: 1:10240 (ref <1:20). Inspection revealed the site of the tick bite. Active surveillance was established on probable sites of the exposure (Tbilisi suburb and Gori Rayon) and on all 27 possible contacts with the patient (none of them developed symptoms during observation). The patient was treated with ribavirin and recovered. Based on reports of neighboring countries and findings of past few years from investigations in Georgia, it is suggested that CCHF is endemic in this region and it is necessary to conduct further surveillance for this pathogen.