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  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 <http://www.iljournal.it/wp-content/uploads/2010/09/india-pakistan-afghanistan.png>. Rawalpindi is halfway between Islamabad and Lahore. -