Covid-19 co-infection with Crimean Congo haemorrhagic fever (CCHF) in a CCHF endemic country: a case report

Covid-19 pandemic affected the health care systems globally. In many countries, healthcare services were overwhelmed by the huge number of Covid cases; hence, shifting the focus from locally endemic infectious diseases. Such a case presented to us that was initially managed along the lines of critical Covid pneumonia with steroids, Remdesivir, and supplemental oxygen for hypoxic respiratory failure. The patient also received Baricitinib, to which he was non-responsive and thus offered invasive mechanical ventilation. Post intubation, the patient was managed for Covid-associated ARDS with lung protective ventilation. He later also developed liver dysfunction, renal failure, coagulation derangements, and shock. Workup for malaria and dengue were negative. Later, Crimean Congo PCR was sent which came positive; a possible cause of progressive deterioration. In CCHF endemic areas, it is crucial to rule out the CCHF infection among patients presenting with critical Covid pneumonia due to similar clinical presentation in both the infections.

 

Comments:

Absolutely, distinguishing between different infections, especially in areas where multiple diseases coexist, is critical for appropriate management. The similarity in clinical presentation between Crimean-Congo hemorrhagic fever (CCHF) and severe cases of COVID-19 can pose challenges in diagnosis and treatment.

CCHF is a tick-borne viral disease that can present with symptoms akin to severe COVID-19, such as fever, respiratory distress, and multi-organ dysfunction. Given the overlap in clinical features, confirming the presence of CCHF via specific diagnostic tests like PCR can be crucial for tailored treatment and preventing potential complications.

In regions where CCHF is endemic, maintaining a high index of suspicion for this infection alongside COVID-19 in severe cases can be essential. It underscores the importance of comprehensive diagnostic workups, especially when initial treatments for COVID-19 seem ineffective or when patients exhibit atypical or worsening symptoms despite standard therapies.

Additionally, improved awareness among healthcare professionals about the prevalence of different diseases in specific geographic areas can significantly aid in timely and accurate diagnoses, preventing mismanagement and enabling prompt intervention when needed.

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