Wednesday 28 May 2014


A ProMED-mail post

Date: Sun 25 May 2014
Source: a correspondent who has requested anonymity

 The 1st patient landed in Peshawar,came from Kabul, Afghanistan, and was an animal handler by profession.

On 3 May 2014, he came to Peshawar, admitted in a private hospital
then shifted same day to a public sector hospital in Peshawar and on 5
May 2014 he was referred to PIMS [Pakistan Institute of Medical
Sciences], Islamabad, where he remained alive for 20 hours and expired
on 6 May 2014. He had high-grade fever, bleeding from gums, nostrils,
and rectum. He also had hemorrhagic spots on his body. He was negative
for dengue, however his CCHF [Crimean Congo hemorrhagic fever] status
could not be confirmed. His dead body was taken back to Kabul. He was
45 years old.

The 2nd patient was a 92-year-old retired government employee from
Kohat, based in the Islamabad rural area. He was admitted in PIMS on
15 May 2014 with high grade fever and bleeding from gums, nose, and
injection site. His sample was negative for dengue and positive for
CCHF from NIH Islamabad. He died on 18 May 2014 and his dead body was
taken back to Aurakzai agency for burial. One of his nephews who had
taken care of the patient and his dead body is having symptoms now and
is under investigation. The fatal case was in contact with animals.

The 3rd patient was a 24-year-old taxi driver, with no direct contact
with animals, who presented to PIMS with bleeding symptoms and expired
within 14 hours of admission. He was from Wah Cantt, Rawalpindi. His
sample for dengue was negative, however no sample was taken for CCHF.


Date: Wed 28 May 2014

The nephew of the fatal case who was taking care of him in hospital
and had also bathed his dead body [see [1] above], is positive for
CCHF. He is stable and is not willing to be admitted in hospital. He
went back to his native village in Aurakzai agency. All contacts are
under observation and stable. [without symptoms? - Mod.JW]

[These 3 patients are in addition to the 3 reported in previous posts
(see ProMED-mail archives below). Only the 2nd case was laboratory
confirmed, but the bleeding symptoms of the others strongly suggested
CCHF. The suspected case from Kabul above died 2 weeks before the
Afghanistan national reported in ProMED post 20140524.2496690. CCHF is
endemic in the region of northwestern Pakistan/Afghanistan and
neighboring Iran.

ProMED-mail always respects requests to withhold the identity of
report submitters. It may be the only way to quickly warn public
health personnel to be on the lookout for cases and take barrier
nursing precautions when treating patients.

A map of Afghanistan and Pakistan showing most of the cities mentioned
can be seen at 

Rawalpindi is halfway between Islamabad and Lahore. - 

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