Clinical Scenario:
A 6-year-old boy from a rural area presents with high-grade fever, severe headache, generalized myalgia and abdominal pain for 4 days. On examination, he is toxic-looking with petechiae, conjunctival injection and bleeding from the gums. His pulse is 124/min and blood pressure is 90/60 mmHg.
Investigations show:
- WBC: 2,300/mm³
- Platelets: 42 × 10⁹/L
- AST and ALT: markedly elevated
- Prothrombin time: prolonged
His father reports that the child was present when a sheep was slaughtered at home 5 days before the onset of illness.
Which of the following is the most likely diagnosis?
A. Dengue hemorrhagic fever
B. Crimean-Congo hemorrhagic fever
C. Leptospirosis
D. Meningococcemia
E. Severe malaria
Correct answer & Explanation:
Correct answer: B. Crimean-Congo hemorrhagic fever
Explanation
Crimean-Congo hemorrhagic fever (CCHF) is a severe viral hemorrhagic disease caused by CCHF virus, an orthonairovirus transmitted primarily by Hyalomma ticks. Humans can also acquire infection through contact with the blood or tissues of infected livestock, particularly during slaughtering.
The illness often begins abruptly with high fever, severe headache, myalgia, back pain, abdominal pain and vomiting. As the disease progresses, patients may develop petechiae, ecchymoses, mucosal bleeding, hypotension and multiorgan dysfunction.
The combination of:
- Acute high-grade fever
- Severe myalgia
- Leukopenia and marked thrombocytopenia
- Elevated transaminases
- Prolonged coagulation studies
- Mucosal bleeding
- Recent exposure to fresh blood/tissues of livestock
strongly supports CCHF.
Why not dengue? Dengue can cause fever, thrombocytopenia and hemorrhage, but the history of direct exposure to livestock blood during slaughtering is particularly important for CCHF.
Why not leptospirosis? Severe leptospirosis may cause renal and hepatic dysfunction and hemorrhage, but typically has additional clues such as conjunctival suffusion and significant renal involvement.
Why not meningococcemia? Meningococcemia can cause fever, petechiae and shock, but the marked transaminitis, thrombocytopenia and epidemiological exposure in this case favor a viral hemorrhagic fever.
Why not severe malaria? Severe malaria can cause thrombocytopenia and shock, but would generally be supported by parasitemia and other characteristic findings.
Reference:
World Health Organization. Crimean-Congo haemorrhagic fever. WHO Crimean-Congo haemorrhagic fever information
Centers for Disease Control and Prevention. Crimean-Congo Hemorrhagic Fever. CDC Crimean-Congo Hemorrhagic Fever
