Crimean–Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: Case report and virological investigation
Identifieur interne : 001386 ( Istex/Corpus ); précédent : 001385; suivant : 001387Crimean–Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: Case report and virological investigation
Auteurs : Zahra Hasan ; Faisal Mahmood ; Bushra Jamil ; Barry Atkinson ; Murtaza Mohammed ; Azra Samreen ; Lamia Altaf ; Tariq Moatter ; Roger HewsonSource :
- Journal of Medical Virology [ 0146-6615 ] ; 2013-03.
English descriptors
- Teeft :
- Alternative genogroups, Arab emirates, Baluchistan province, Calcineurin inhibitors, Case report, Cchf, Cchfv, Chronic liver disease, Dengue fever, Early diagnosis, Haemorrhagic fever, Hemorrhagic, Hemorrhagic fever, Hemorrhagic fever outbreak, Hemorrhagic fever virus, Likely multifactorial, Liver transplant, Liver transplant recipients, Maximum likelihood tree, Nosocomial, Nosocomial transmission, Phylogenetic, Rapid diagnosis, Risk assessment, Sequence alignment, Thrombotic microangiopathy, Transplant, University hospital, Viral, Viral hemorrhagic fever, Viral hemorrhagic fevers, Viral load, Virol, Wiley periodicals.
Abstract
Crimean–Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43‐year‐old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real‐time reverse transcription polymerase chain reaction (RT‐PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post‐onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus. J. Med. Virol. 85:501–504, 2013. © 2012 Wiley Periodicals, Inc.
Url:
DOI: 10.1002/jmv.23473
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ISTEX:A13345A4808D9BC28E1A2A4D23D6E4737604CA6DLe document en format XML
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Karachi 74800, Pakistan.===</mods:affiliation></affiliation></author><author><name sortKey="Mahmood, Faisal" sort="Mahmood, Faisal" uniqKey="Mahmood F" first="Faisal" last="Mahmood">Faisal Mahmood</name><affiliation><mods:affiliation>The Aga Khan University, Karachi, Pakistan</mods:affiliation></affiliation></author><author><name sortKey="Jamil, Bushra" sort="Jamil, Bushra" uniqKey="Jamil B" first="Bushra" last="Jamil">Bushra Jamil</name><affiliation><mods:affiliation>The Aga Khan University, Karachi, Pakistan</mods:affiliation></affiliation></author><author><name sortKey="Atkinson, Barry" sort="Atkinson, Barry" uniqKey="Atkinson B" first="Barry" last="Atkinson">Barry Atkinson</name><affiliation><mods:affiliation>Health Protection Agency, Porton Down, Salisbury, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Mohammed, Murtaza" sort="Mohammed, Murtaza" uniqKey="Mohammed M" first="Murtaza" last="Mohammed">Murtaza Mohammed</name><affiliation><mods:affiliation>The Aga Khan University, Karachi, Pakistan</mods:affiliation></affiliation></author><author><name sortKey="Samreen, Azra" sort="Samreen, Azra" uniqKey="Samreen A" first="Azra" last="Samreen">Azra Samreen</name><affiliation><mods:affiliation>The Aga Khan University, Karachi, Pakistan</mods:affiliation></affiliation></author><author><name sortKey="Altaf, Lamia" sort="Altaf, Lamia" uniqKey="Altaf L" first="Lamia" last="Altaf">Lamia Altaf</name><affiliation><mods:affiliation>The Aga Khan University, Karachi, Pakistan</mods:affiliation></affiliation></author><author><name sortKey="Moatter, Tariq" sort="Moatter, Tariq" uniqKey="Moatter T" first="Tariq" last="Moatter">Tariq Moatter</name><affiliation><mods:affiliation>Health Protection Agency, Porton Down, Salisbury, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Hewson, Roger" sort="Hewson, Roger" uniqKey="Hewson R" first="Roger" last="Hewson">Roger 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genogroups</term><term>Arab emirates</term><term>Baluchistan province</term><term>Calcineurin inhibitors</term><term>Case report</term><term>Cchf</term><term>Cchfv</term><term>Chronic liver disease</term><term>Dengue fever</term><term>Early diagnosis</term><term>Haemorrhagic fever</term><term>Hemorrhagic</term><term>Hemorrhagic fever</term><term>Hemorrhagic fever outbreak</term><term>Hemorrhagic fever virus</term><term>Likely multifactorial</term><term>Liver transplant</term><term>Liver transplant recipients</term><term>Maximum likelihood tree</term><term>Nosocomial</term><term>Nosocomial transmission</term><term>Phylogenetic</term><term>Rapid diagnosis</term><term>Risk assessment</term><term>Sequence alignment</term><term>Thrombotic microangiopathy</term><term>Transplant</term><term>University hospital</term><term>Viral</term><term>Viral hemorrhagic fever</term><term>Viral hemorrhagic fevers</term><term>Viral load</term><term>Virol</term><term>Wiley periodicals</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Crimean–Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43‐year‐old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real‐time reverse transcription polymerase chain reaction (RT‐PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post‐onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus. J. Med. Virol. 85:501–504, 2013. © 2012 Wiley Periodicals, Inc.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>cchf</json:string><json:string>hemorrhagic</json:string><json:string>nosocomial</json:string><json:string>cchfv</json:string><json:string>viral</json:string><json:string>phylogenetic</json:string><json:string>nosocomial transmission</json:string><json:string>hemorrhagic fever</json:string><json:string>virol</json:string><json:string>hemorrhagic fever virus</json:string><json:string>rapid diagnosis</json:string><json:string>liver transplant</json:string><json:string>haemorrhagic fever</json:string><json:string>university hospital</json:string><json:string>transplant</json:string><json:string>sequence alignment</json:string><json:string>arab emirates</json:string><json:string>case report</json:string><json:string>chronic liver disease</json:string><json:string>baluchistan province</json:string><json:string>maximum likelihood tree</json:string><json:string>wiley periodicals</json:string><json:string>likely multifactorial</json:string><json:string>thrombotic microangiopathy</json:string><json:string>viral load</json:string><json:string>calcineurin inhibitors</json:string><json:string>viral hemorrhagic fever</json:string><json:string>dengue fever</json:string><json:string>viral hemorrhagic fevers</json:string><json:string>early diagnosis</json:string><json:string>risk assessment</json:string><json:string>hemorrhagic fever outbreak</json:string><json:string>liver transplant recipients</json:string><json:string>alternative genogroups</json:string></teeft></keywords><author><json:item><name>Zahra Hasan PhD</name><affiliations><json:string>The Aga Khan University, Karachi, Pakistan</json:string><json:string>E-mail: zahra.hasan@aku.edu</json:string><json:string>Correspondence address: Associate Professor, Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, Karachi 74800, Pakistan.===</json:string></affiliations></json:item><json:item><name>Faisal Mahmood</name><affiliations><json:string>The Aga Khan University, Karachi, Pakistan</json:string></affiliations></json:item><json:item><name>Bushra Jamil</name><affiliations><json:string>The Aga Khan University, Karachi, Pakistan</json:string></affiliations></json:item><json:item><name>Barry Atkinson</name><affiliations><json:string>Health Protection Agency, Porton Down, Salisbury, United Kingdom</json:string></affiliations></json:item><json:item><name>Murtaza Mohammed</name><affiliations><json:string>The Aga Khan University, Karachi, Pakistan</json:string></affiliations></json:item><json:item><name>Azra Samreen</name><affiliations><json:string>The Aga Khan University, Karachi, Pakistan</json:string></affiliations></json:item><json:item><name>Lamia Altaf</name><affiliations><json:string>The Aga Khan University, Karachi, Pakistan</json:string></affiliations></json:item><json:item><name>Tariq Moatter</name><affiliations><json:string>Health Protection Agency, Porton Down, Salisbury, United Kingdom</json:string></affiliations></json:item><json:item><name>Roger Hewson</name><affiliations><json:string>Health Protection Agency, Porton Down, Salisbury, United Kingdom</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Congo–Crimean hemorrhagic fever virus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>nosocomial transmission</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>rapid diagnosis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>isolation barrier nursing</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>infection control</value></json:item></subject><articleId><json:string>JMV23473</json:string></articleId><arkIstex>ark:/67375/WNG-6HR08Z7J-S</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>caseStudy</json:string></originalGenre><abstract>Crimean–Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43‐year‐old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real‐time reverse transcription polymerase chain reaction (RT‐PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post‐onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus. J. Med. Virol. 85:501–504, 2013. © 2012 Wiley Periodicals, Inc.</abstract><qualityIndicators><score>7.486</score><pdfWordCount>2894</pdfWordCount><pdfCharCount>18292</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>4</pdfPageCount><pdfPageSize>594 x 792 pts</pdfPageSize><pdfWordsPerPage>724</pdfWordsPerPage><pdfText>true</pdfText><refBibsNative>true</refBibsNative><abstractWordCount>216</abstractWordCount><abstractCharCount>1468</abstractCharCount><keywordCount>5</keywordCount></qualityIndicators><title>Crimean–Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: Case report and virological investigation</title><pmid><json:string>23172105</json:string></pmid><genre><json:string>case-report</json:string></genre><host><title>Journal of Medical Virology</title><language><json:string>unknown</json:string></language><doi><json:string>10.1002/(ISSN)1096-9071</json:string></doi><issn><json:string>0146-6615</json:string></issn><eissn><json:string>1096-9071</json:string></eissn><publisherId><json:string>JMV</json:string></publisherId><volume>85</volume><issue>3</issue><pages><first>501</first><last>504</last><total>4</total></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Case Report</value></json:item><json:item><value>Case Reports</value></json:item></subject></host><namedEntities><unitex><date><json:string>2011</json:string><json:string>2006</json:string><json:string>2013</json:string><json:string>2008</json:string><json:string>2004</json:string></date><geogName></geogName><orgName><json:string>Pakistan Health Protection Agency, Porton Down, Salisbury, United Kingdom</json:string><json:string>The Aga Khan University</json:string><json:string>Aga Khan University</json:string><json:string>Department of Pathology and Microbiology</json:string><json:string>Aga Khan University Hospital, Karachi</json:string><json:string>Afghanistan and Iran</json:string><json:string>WILEY PERIODICALS, INC</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Barry Atkinson</json:string><json:string>Bushra Jamil</json:string><json:string>Zahra Hasan</json:string><json:string>J. 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2006</json:string><json:string>Chinikar et al., 2008</json:string><json:string>Schmidt et al., 2002</json:string><json:string>McGrath et al., 1998</json:string><json:string>Humolli et al., 2010</json:string><json:string>Bodur et al., 2012</json:string><json:string>Schwarz et al., 1997</json:string><json:string>Begum et al., 1970</json:string><json:string>Burney et al., 1980</json:string><json:string>Ramasubbu et al., 2003</json:string><json:string>Saleem et al., 2009</json:string><json:string>Athar et al., 2003, 2005</json:string><json:string>Hewson et al., 2004</json:string><json:string>Thompson et al., 1994</json:string><json:string>Altaf et al., 1998</json:string><json:string>Hasan et al.</json:string><json:string>Olschlager et al., 2011</json:string><json:string>Durrani et al., 2007</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/WNG-6HR08Z7J-S</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - 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key="PK" xml:lang="en">PAKISTAN</country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">Barry</forename><surname>Atkinson</surname></persName><affiliation><address><addrLine>Health Protection Agency</addrLine><addrLine>Porton Down, Salisbury, United Kingdom</addrLine><country key="GB" xml:lang="en">UNITED KINGDOM</country></address></affiliation></author><author xml:id="author-0004"><persName><forename type="first">Murtaza</forename><surname>Mohammed</surname></persName><affiliation><orgName type="institution">The Aga Khan University</orgName><address><addrLine>Karachi</addrLine><addrLine>Pakistan</addrLine><country key="PK" xml:lang="en">PAKISTAN</country></address></affiliation></author><author xml:id="author-0005"><persName><forename type="first">Azra</forename><surname>Samreen</surname></persName><affiliation><orgName type="institution">The Aga Khan 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<ref target="http://www.tei-c.org/">We use TEI</ref></desc></application></appInfo></encodingDesc><profileDesc><abstract xml:lang="en" style="main"><head>Abstract</head><p>Crimean–Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43‐year‐old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real‐time reverse transcription polymerase chain reaction (RT‐PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post‐onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus. J. Med. Virol. 85:501–504, 2013. © 2012 Wiley Periodicals, Inc.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="kwd1">Congo–Crimean hemorrhagic fever virus</term><term xml:id="kwd2">nosocomial transmission</term><term xml:id="kwd3">rapid diagnosis</term><term xml:id="kwd4">isolation barrier nursing</term><term xml:id="kwd5">infection control</term></keywords><keywords rend="articleCategory"><term>Case Report</term></keywords><keywords rend="tocHeading1"><term>Case Reports</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc><revisionDesc><change when="2019-12-20" who="#istex" xml:id="pub2tei">formatting</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-6HR08Z7J-S/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1096-9071</doi><issn type="print">0146-6615</issn><issn type="electronic">1096-9071</issn><idGroup><id type="product" value="JMV"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="JOURNAL OF MEDICAL VIROLOGY">Journal of Medical Virology</title><title type="short">J. Med. Virol.</title></titleGroup></publicationMeta><publicationMeta level="part" position="30"><doi origin="wiley" registered="yes">10.1002/jmv.v85.3</doi><numberingGroup><numbering type="journalVolume" number="85">85</numbering><numbering type="journalIssue">3</numbering></numberingGroup><coverDate startDate="2013-03">March 2013</coverDate></publicationMeta><publicationMeta level="unit" type="caseStudy" position="170" status="forIssue"><doi origin="wiley" registered="yes">10.1002/jmv.23473</doi><idGroup><id type="unit" value="JMV23473"></id></idGroup><countGroup><count type="pageTotal" number="4"></count></countGroup><titleGroup><title type="articleCategory">Case Report</title><title type="tocHeading1">Case Reports</title></titleGroup><copyright ownership="publisher">Copyright © 2012 Wiley Periodicals, Inc.</copyright><eventGroup><event type="manuscriptAccepted" date="2012-10-23"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:3.1.9 mode:FullText" date="2013-01-22"></event><event type="publishedOnlineEarlyUnpaginated" date="2012-11-21"></event><event type="firstOnline" date="2012-11-21"></event><event type="publishedOnlineFinalForm" date="2013-01-22"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:4.0.1" date="2014-03-20"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.6.4 mode:FullText" date="2015-10-02"></event></eventGroup><numberingGroup><numbering type="pageFirst">501</numbering><numbering type="pageLast">504</numbering></numberingGroup><correspondenceTo>Associate Professor, Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, Karachi 74800, Pakistan.===</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:JMV.JMV23473.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="0"></count><count type="referenceTotal" number="30"></count><count type="wordTotal" number="3277"></count></countGroup><titleGroup><title type="main" xml:lang="en">Crimean–Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: Case report and virological investigation<link href="#fn1"></link></title><title type="short" xml:lang="en">Real‐Time PCR Based Detection of CCHF</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Zahra</givenNames><familyName>Hasan</familyName><degrees>PhD</degrees></personName><contactDetails><email>zahra.hasan@aku.edu</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Faisal</givenNames><familyName>Mahmood</familyName></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Bushra</givenNames><familyName>Jamil</familyName></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Barry</givenNames><familyName>Atkinson</familyName></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Murtaza</givenNames><familyName>Mohammed</familyName></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Azra</givenNames><familyName>Samreen</familyName></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Lamia</givenNames><familyName>Altaf</familyName></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Tariq</givenNames><familyName>Moatter</familyName></personName></creator><creator xml:id="au9" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Roger</givenNames><familyName>Hewson</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="PK" type="organization"><unparsedAffiliation>The Aga Khan University, Karachi, Pakistan</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="GB" type="organization"><unparsedAffiliation>Health Protection Agency, Porton Down, Salisbury, United Kingdom</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Congo–Crimean hemorrhagic fever virus</keyword><keyword xml:id="kwd2">nosocomial transmission</keyword><keyword xml:id="kwd3">rapid diagnosis</keyword><keyword xml:id="kwd4">isolation barrier nursing</keyword><keyword xml:id="kwd5">infection control</keyword></keywordGroup><fundingInfo><fundingAgency>The Aga Khan University, Karachi</fundingAgency></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Crimean–Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43‐year‐old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real‐time reverse transcription polymerase chain reaction (RT‐PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post‐onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus. J. Med. Virol. 85:501–504, 2013. © 2012 Wiley Periodicals, Inc.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>The authors declare that they have no competing interests.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Crimean–Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: Case report and virological investigation</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Real‐Time PCR Based Detection of CCHF</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Crimean–Congo hemorrhagic fever nosocomial infection in a immunosuppressed patient, Pakistan: Case report and virological investigation</title></titleInfo><name type="personal"><namePart type="given">Zahra</namePart><namePart type="family">Hasan</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>The Aga Khan University, Karachi, Pakistan</affiliation><affiliation>E-mail: zahra.hasan@aku.edu</affiliation><affiliation>Correspondence address: Associate Professor, Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, Karachi 74800, Pakistan.===</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Faisal</namePart><namePart type="family">Mahmood</namePart><affiliation>The Aga Khan University, Karachi, Pakistan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bushra</namePart><namePart type="family">Jamil</namePart><affiliation>The Aga Khan University, Karachi, Pakistan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Barry</namePart><namePart type="family">Atkinson</namePart><affiliation>Health Protection Agency, Porton Down, Salisbury, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Murtaza</namePart><namePart type="family">Mohammed</namePart><affiliation>The Aga Khan University, Karachi, Pakistan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Azra</namePart><namePart type="family">Samreen</namePart><affiliation>The Aga Khan University, Karachi, Pakistan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lamia</namePart><namePart type="family">Altaf</namePart><affiliation>The Aga Khan University, Karachi, Pakistan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Tariq</namePart><namePart type="family">Moatter</namePart><affiliation>Health Protection Agency, Porton Down, Salisbury, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Roger</namePart><namePart type="family">Hewson</namePart><affiliation>Health Protection Agency, Porton Down, Salisbury, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="case-report" displayLabel="caseStudy" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-29919SZJ-6">case-report</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2013-03</dateIssued><dateValid encoding="w3cdtf">2012-10-23</dateValid><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><extent unit="figures">1</extent><extent unit="tables">0</extent><extent unit="references">30</extent><extent unit="words">3277</extent></physicalDescription><abstract lang="en">Crimean–Congo hemorrhagic fever (CCHF) is endemic in the Baluchistan province, Pakistan. Sporadic outbreaks of CCHF occur throughout the year especially in individuals in contact with infected livestock. Nosocomial transmission remains a risk due to difficulties in the diagnosis of CCHF and limited availability of facilities for the isolation of suspected patients. Rapid diagnosis of CCHF virus infection is required for early management of the disease and to prevent transmission. This study describes the case of a 43‐year‐old surgeon who contracted CCHF during a surgical procedure in Quetta, Baluchistan and who was transferred to a tertiary care facility at the Aga Khan University Hospital, Karachi within 1 week of contracting the infection. Diagnosis of CCHF was made using a rapid real‐time reverse transcription polymerase chain reaction (RT‐PCR) assay for CCHF viral RNA. The patient had chronic hepatitis B and hepatitis D infection for which he had previously received a liver transplant. He proceeded to develop classic hemorrhagic manifestations and succumbed to the infection 14 days post‐onset of disease. There was no further nosocomial transmission of the CCHF during the hospital treatment of the surgeon. Early diagnosis of CCHF enables rapid engagement of appropriate isolation, barrier nursing and infection control measures thus preventing nosocomial transmission of the virus. J. Med. Virol. 85:501–504, 2013. © 2012 Wiley Periodicals, Inc.</abstract><note type="content">*The authors declare that they have no competing interests.</note><note type="funding">The Aga Khan University, Karachi</note><subject lang="en"><genre>keywords</genre><topic>Congo–Crimean hemorrhagic fever virus</topic><topic>nosocomial transmission</topic><topic>rapid diagnosis</topic><topic>isolation barrier nursing</topic><topic>infection control</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Medical Virology</title></titleInfo><titleInfo type="abbreviated"><title>J. Med. Virol.</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>article-category</genre><topic>Case Report</topic><topic>Case Reports</topic></subject><identifier type="ISSN">0146-6615</identifier><identifier type="eISSN">1096-9071</identifier><identifier type="DOI">10.1002/(ISSN)1096-9071</identifier><identifier type="PublisherID">JMV</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>85</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>501</start><end>504</end><total>4</total></extent></part></relatedItem><relatedItem type="references" displayLabel="cit1"><titleInfo><title>Crimean–Congo hemorrhagic fever in a dengue‐endemic region: Lessons for the future</title></titleInfo><name type="personal"><namePart type="given">F</namePart><namePart type="family">Ali</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T</namePart><namePart type="family">Saleem</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Mahmood</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B</namePart><namePart type="family">Jamil</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal-article</genre><note type="citation/reference">Ali F, Saleem T, Mahmood S, Jamil B. 2012. 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