What Is Crimean-Congo Hemorrhagic Fever?

Medically Reviewed by Carol DerSarkissian, MD on March 03, 2024
3 min read

Crimean-Congo hemorrhagic fever (CCHF) is a disease that’s usually spread by ticks. In its later stages, the illness can cause large areas of bruising, intense nosebleeds, or uncontrollable bleeding from injections. Experts first discovered CCHF in the Crimea in 1944. They later realized it was in the Congo in 1969. Today, researchers have found CCHF in Eastern Europe (specifically the former Soviet Union), Southern Europe, throughout the Mediterranean, in Northwestern China, Central Asia, Africa, the Middle East, and the Indian subcontinent.

There have been no outbreaks in the U.S.

Ixodid or hard ticks typically spread CCHF. But you can also get the disease during or after animal slaughter. This happens after you come in contact with animal tissue or blood that has the virus. Many domestic or wild animals could be hosts for the virus including, cattle, sheep, and goats.

CCHF can also spread from one person to another through infected blood or body fluids. Experts have found that CCHF can spread in hospitals from poor sterilization of medical tools, contaminated medical supplies, or used needles.

In countries with CCHF, livestock workers, slaughterhouse workers, and animal herders are at risk for the disease. Health care workers in these regions are also at risk for infection if they’re unprotected around infected blood or body fluids. People who travel to affected countries could also be at risk.

After infection from a tick bite, the incubation period of CCHF is usually 1 to 3 days. It can last up to a maximum of 9 days. After contact with infected blood or tissues, the incubation period is about 5 to 6 days and can last up to 13 days.

CCHF symptoms develop quickly. Common first signs include:

  • Headache
  • Dizziness
  • High fever
  • Back or neck pain
  • Joint pain
  • Muscle aches
  • Stomach pain
  • Vomiting
  • Diarrhea
  • Red or sore eyes
  • Photophobia (sensitivity to light)
  • Flushed face
  • Red or sore throat
  • Petechiae (red spots) on the roof of your mouth or throat

Some people may also have jaundice. In severe cases of CCHF, you may notice mood shifts, sensory perception changes, and confusion. After 2 to 4 days, you may feel sleepy and depressed. Your stomach pain may move to your upper right area due to liver enlargement (hepatomegaly).

As CCHF gets worse, your symptoms will change. Around the fourth day of illness (and lasting up to about 2 weeks), symptoms include:

  • Large areas of serious bruising
  • Severe nosebleeds
  • Uncontrollable bleeding from injections

Experts have noted other signs, including a fast heart rate (tachycardia), enlarged lymph nodes (lymphadenopathy), and hepatitis. In very sick people, rapid kidney deterioration, sudden liver failure, or lung failure can happen after the 5th day of the disease.

Recovery with this illness is slow. There’s not enough research to confirm if there are any long-term effects or complications of CCHF.

Doctors can diagnose CCHF through lab tests including:

  • Antigen-capture enzyme-linked immunosorbent assay (ELISA)
  • Real-time polymerase chain reaction (RT-PCR)
  • Virus isolation attempts
  • Detection of antibody by ELISA (IgG and IgM)

During the severe phase of the illness, doctors can use your clinical history and other testing methods to diagnose CCHF.

Immunohistochemical staining, a method to diagnose abnormal cells, can also help detect the disease.

In survivors of CCHF, doctors can find antibodies in the blood to confirm a past case. But antigens, viral RNA, and the virus won’t be detectable anymore.

Most people receive supportive care for CCHF. This includes:

  • Careful attention to a person’s fluid balance
  • Correction of electrolyte abnormalities
  • Oxygenation and hemodynamic support
  • Proper care of secondary infections

Some doctors have used an antiviral drug, called ribavirin, to treat CCHF. Experts report that this has had some benefit.

According to the CDC, the death rate from CCHF is as high as 50%. Most fatal cases occur in the second week of illness. For people who recover, improvements tend to start about 10 days after illness.

There are no vaccines for humans or animals to prevent CCHF. Because of this, the only way to lower the number of cases is through risk factor awareness and teaching you about ways to lower your risk of exposure.

Agricultural workers and others who work with animals should take proper safety measures:

  • Use insect repellent (with DEET) on exposed skin and clothing
  • Wear gloves and other protective clothes
  • Avoid contact with blood or body fluids of animals or people who show symptoms of infection

Health care workers should also use proper infection control measures to avoid exposure.