KARACHI: An acute lack of awareness among doctors to differentiate between Crimean-Congo haemorrhagic fever (CCHF) and other viral fevers, and a near-absence of diagnostic facilities that impedes early treatment, have contributed to the loss of life by the tick-borne viral infection in the country.

So far, at least 28 people have died of CCHF this year; Balochistan reported 10 deaths with 25 positive cases, Punjab six deaths with 29 positive cases, Sindh six deaths with eight positive cases, and Khyber Pakhtunkhwa (KP) has had six mortalities with 36 positive cases.

Families whose loved ones fell victim to the deadly disease told Dawn that had doctors at government tertiary care hospitals — where the patients were first taken — thought of the possibility of a Congo virus infection, their relatives’ lives could have been saved.

“My husband’s initial complaints were of throat infection and body pains. Over the next two days he developed high-grade fever along with shivering and diahorrea, for which he took some medicines but there was no improvement in his condition,” said Sadia, a medical doctor herself and mother of two, whose husband Dr Sagheer Sameejah died of multiple organ failure over a month ago at a Karachi hospital.

Dr Sameejah was a senior surgeon at the Bahawal Victoria Hospital (BVH) where he was initially treated, underwent multiple tests and remained under observation. He was thought to have dengue.

“On the sixth day, he showed signs of shock and asked me to check his pulse which I found to be very weak. We rushed him again to BVH but doctors still found no clue to the disease,” she said, adding that no physician suspected the Congo virus infection even after her husband’s gums started to bleed.

Frustrated enough, the family brought him to the Aga Khan University Hospital (AKUH) in Karachi where doctors immediately suggested that he might have CCHF. Their assumption, according to Dr Sadia, was based on his case history shared with them.

Unfortunately, it was too late for Dr Sameejah.

A similar ordeal was faced by 32-year-old Liaquat Khan’s family in March. He was initially admitted to the Sheikh Zayed Hospital in Rahim Yar Khan, Punjab, with high-grade fever, vomiting and diarrhoea.

Married with four children, Khan was an animal trader.

“After the doctors’ failure in diagnosing him, he was shifted to the AKUH where he was diagnosed with CCHF and treated for a week. But, he passed away. The family spent Rs1.8m on his treatment,” said Zain Bajwa, Khan’s childhood friend.

Mohammad Ibrahim of Loralai, Balochistan, lost his cousin Saifullah last month from the same disease and in similar circumstances.

“Initially, he took medicines for high-grade fever and got better. But then again he developed fever and we took him to the Combined Military Hospital (CMH) in Loralai where doctors suspected dengue and treated him for it for a few days,” explained Ibrahim.

“However, his condition worsened and the family shifted him to a private hospital in Multan for a day and then to the dengue ward of Nishtar Hospital where he died the next day,” he shared.

Married with four kids, Saifullah was unemployed and financially supported by his brothers.

“He was a poor man. The family tried to find the best care for him and spent over Rs80,000 to save his life that included the treatment cost as well as the expenses to transport him to Multan,” said Ibrahim. The wooden coffin alone, he added, cost Rs8,000.

According to Ibrahim, nobody at the CMH, Loralai, informed the family about any precautions that they needed to take.

“I stayed with him, at times drinking tea from the same cup. After he developed internal and external bleeding, doctors at Nishtar Hospital told us that he may have Congo fever and that the disease would be confirmed from the test report that would come from Islamabad where his blood samples had been sent,” he explained.

At that point, he said, doctors informed the family about the care they needed to take while caring for a patient infected with Congo virus.

‘A single case is an outbreak’

According to consultant infectious diseases at the Indus Hospital Dr Samreen Sarfaraz, a single CCHF case should be constituted as an outbreak since there is no regulatory or preventive mechanism in place at any level in the country.

CCHF cases, she pointed out, were increasing every year and there was a need to give it the same importance as accorded to dengue.

“Ironically, the period of occurrence of dengue, CCHF and malaria coincides. CCHF presents with similar symptoms (high fever, vomiting, diarrhoea, dizziness, sore eyes, body pains etc) as that of other viral fevers, which make it difficult for doctors to differentiate CCHF from other diseases like dengue,” she observed.

She, however, was of the view that a detailed patient case history would definitely help doctors rule out other ailments.

It is suggested that doctors should immediately start supportive CCHF treatment if symptoms and patient case history indicate that he or she may have the Congo virus infection.

“CCHF cases are usually witnessed between June and October as it is the breeding period of the tick. And, since Eidul Azha for some years will be observed in these months, precautionary measures are required at every level,” she said.

According to her, once the CCHF patient develops internal or external bleeding after a week or so, the chances of recovery are grim. “This is so because the drug used in the initial stage either loses its efficacy or harm the patient if administered at a later stage,” she said.

Given the continued rise in CCHF cases every year, experts believe that the government should equip at least major tertiary care hospitals with facilities to perform CCHF diagnostic tests, which at present are only available at the AKUH and the National Institute of Health, Islamabad.

“Though there is no antiviral with proven benefits, early diagnosis and proper supportive care (administration of ribavirin before bleeding sets in) improve recovery chances of CCHF patients. Besides, the hospital staff must adopt the WHO-recommended infection control protocol while treating such patients,” she said.

Published in Dawn, September 12th, 2016