1. Mansoor Nadeem FCPS PNS Shifa Hospital, Karachi 2. Nadir Ali FCPS Combined Military Hospital, Attock 3. Masood Anwar FCPS Armed Forces Institute of Pathology, Rawalpindi 4. Ikhlaq Hussain MBBS Fatima Jinnah Hospital, Quetta 5. Taj Mohammad MBBS Fatima Jinnah Hospital, Quetta 6. Abdul Hayee M phil Head quarters, Log Area, Quetta Correspondence: Surg. Commodore (Brig) Mansoor Nadeem Head, Department of Medicine, P.N.S Shifa Hospital, Defence Housing Authority, Karachi, Pakistan E-mail: mnadeem53@yahoo.com * Received for publication: June 3, 2003 Revision accepted: September 15, 2003 Original Article A COMPARISION OF CLINICAL DIAGNOSIS AND SEROLOGICAL DIAGNOSIS IN AN EPIDEMIC OF CRIMEAN-CONGO HAEMORRHAGIC FEVER Mansoor Nadeem 1 , Nadir Ali 2 , Masood Anwar 3 , Ikhlaq Hussain 4 , Taj Mohammad 5 & Abdul Hayee 6 ABSTRACT: Background: Crimean Congo Haemorrhagic Fever (CCHF) is life-threatening disease caused by Nairovirus of genus Bunyavirus caused by tick bite of Hayalomma species or by direct contact of the blood/sera of the patient and animals suffering from this disease. Epidemics have been occurring in Balochistan province of Pakistan and neighbouring Afghanistan and Iran from time to time with high mortality. Aim: In the absence of facilities for detection of serological markers of CCHF (IgM & IgG antibodies and PCR for viral RNA), a study was designed to diagnose and treat cases of CCHF reporting to a specialist unit hospital situated at Quetta, Pakistan. The aim was to compare the clinical features, complications and outcome of both groups of patients; one detecting the disease clinically only and the other depending upon serological tests for the diagnosis. Methods: Thirty-four patients having fever of less than two weeks of duration with features of bleeding from the skin and various orifices were included in this study from June 2001 to September 2001 after hospitalization. Index case and some of the consecutive cases were subjected to detection of serological markers. Rest of the cases were diagnosed on clinical grounds and baseline laboratory investigations only. Difference in both the groups was noted carefully. All the patients were given Ribavirin and blood products as and when required. Results: Statistically there was no obvious difference in clinical manifestations (fever, body aches, purpuric spots, ecchymosis, epistaxis, gum bleed etc.) and laboratory findings (blood picture, serum ALT, serum urea and electrolytes, PT, APTT, etc). There was also no difference in mortality of the two groups studied. Conclusion: In an on ongoing outbreak of CCHF, history, clinical findings and supportive baseline laboratory investigations may be sufficient for early detection and treatment of CCHF cases. However for documenta- tion of start of epidemic, serological markers should be done. Therefore facilities for detection of viral markers of CCHF should be available at centers like Quetta. KEYWORDS: CCHF, Clinical diagnosis, Lab diagnosis Pak J Med Sci October-December 2003 Vol. 19 No. 4 247-251 www.pjms.com.pk INTRODUCTION Crimean-Congo hemorrhagic fever (CCHF) was first described in Crimea in 1944 and was hence given the name of Crimean hemorrhagic fever. Congo virus was first isolated in Zaire (Africa) from the blood of a febrile patient in 1956. Linkage of the names of two places gave the current name Crimean-Congo hemorrhagic fever (CCHF) 1,2 . CCHF is a serious disease with high mortality in humans 3 . The disease is en- demic in Balochistan (Pakistan) where differ- ent ecological factors provide opportunities for the virus to stay and thrive. Outbreaks of CCHF were confirmed in 1987, 1994, 1995, 1998, 2000 and in 2001 in various parts of the Pak J Med Sci 2003 Vol. 19 No. 4 www.pjms.com.pk 247