Abdus Salam Khan, MD FACP – August, 2016
Each year a sizable number of patients die due to viral hemorrhagic fever. That time of year is again upon us and we have seen a few cases. This year is especially tragic because one of the treating doctors Dr. Saghir has given his life in the line of duty. He contracted viral hemorrhagic fever while he was treating a patient who had passed the virus to him doing course of treatment.
Let me first talk about viral hemorrhagic fever. It is a collection of illnesses that stem from different viruses. In summer time Congo virus is especially responsible each and every year for quite some time. Dengue is also one of these illnesses. In case of Congo virus which is also called Congo Cremean hemorrhagic fever the patients usually contract this through animal contact and this virus is highly infectious. Patients are usually living around or exposed to animals especially sheep or cows. People involved in the business of sheep/cows are especially at risk and shepherds and butchers are seen as victims. Also during the season of Eid- Adha it is more common as non-professional people slaughter animals with no precautions and people [potentially can get exposed.
This sickness starts with fever and then patients experience bodyache, headache and muscle pain. The clotting mechanism is disturbed and the platelet count goes down. Patients start having rashes and then they bleed from different parts of the body, specially nose, gums, eyes and mouth. The have internal bleeding in urine and stool. The diagnosis is made by high index of suspicion in an appropriate setting and then confirmed by lab analysis like
1. Viral isolation by cell culture
2. Eliza test
3. Antigen detection
4. Antibody detection both IDM or IgG.
Test on patient sample has to be dealt with an extreme caution as the sample is infectious and should only be dealt with under maximum biological containment condition.
Usually general supportive care with treatment of the symptoms is only approach available so far. Oral and IV antiviral drug is of benefit and should be used for prophylaxis also.
Now let me talk a bit about prevention and containing the spread. It is a life-threatening illness and in case of any suspected patient, full precautions should be utilized. Good isolation practices are must and all contacts should be traced, isolated and offered the antiviral drug right Ribavirin.
It is very sad to see a physician contracting the illness and having no suspicion regarding CCHF. I salute the work of Dr. Saghir, yet at the same time question the practices of doctors in this regard. Safety of patients come after assessing safety of the caregiver himself/herself. We have to create the environment of safety for our younger physicians and engrave it in their practices so they also think about their safety in any unusual circumstance. We also have to create awareness in general public as well as our first point of contact regarding any safety issues whether they are infectious or otherwise.
The catastrophe of Dr. Saghir was an avoidable situation and as the healthcare community we all need to work together through education and changing our practices to first spot such cases and then isolate and report. This practice will not just safeguard the patient but also result in limiting unnecessary exposure to healthcare workers.
I can be reached at askhan65@yahoo.com.