title: A nosocomial transmission of crimean-congo hemorrhagic fever to an attending physician in North Kordufan, Sudan.
abstract: BACKGROUND
  Crimean-Congo hemorrhagic fever (CCHF), a tick-borne disease caused by Crimean-Congo hemorrhagic fever virus (CCHFV), is a member of the genus Nairovirus in the family Bunyaviridae. Recently, CCHFV has been reported as an important emerging infectious viral pathogen in Sudan. Sporadic cases and multiple CCHF outbreaks, associated with nosocomial chain of transmission, have been reported in the Kordufan region of Sudan.
  
  
  OBJECTIVE
  To confirm CCHF in an index patient and attending physician in North Kordufan region, Sudan, and to provide some information on virus genetic lineages.
  
  
  METHODS
  Antibody captured ELISA, reverse transcription PCR, partial S segment sequences of the virus and subsequent phylogenetic analysis were used to confirm the CCHFV infection and to determine the virus genetic lineages.
  
  
  RESULTS
  CCHF was confirmed by monitoring specific IgM antibody and by detection of the viral genome using RT-PCR. Treatment with oral ribavirin, replacement with fluid therapy, blood transfusion and administration of platelets concentrate resulted in rapid improvement of the health condition of the female physician. Phylogenetic analysis of the partial S segment sequences of the 2 CCHFV indicates that both strains are identical and belong to Group III virus lineage, which includes viruses from Africa including, Sudan, Mauritania, South Africa and Nigeria.
  
  
  CONCLUSIONS
  Further epidemiologic studies including, CCHFV complete genome analysis and implementation of improved surveillance are urgently needed to better predict and respond to CCHF outbreaks in the Kordufan region, Sudan.
authors.affiliation: Molecular Biology Laboratory (MBL), Department of Clinical Medicine, Faculty of Veterinary Medicine, University of Khartoum, Khartoum North, Sudan.
authors.forename: Afraa T
authors.initials: AT
authors.lastname: Elata
authors.forename: Mubarak S
authors.initials: MS
authors.lastname: Karsany
authors.forename: Rehab M
authors.initials: RM
authors.lastname: Elageb
authors.forename: Marwa A
authors.initials: MA
authors.lastname: Hussain
authors.forename: Kamal H
authors.initials: KH
authors.lastname: Eltom
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Elbashir
authors.forename: Imadeldin E
authors.initials: IE
authors.lastname: Aradaib
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage; D003428:Cross Infection / Q000188:drug therapy / Q000635:transmission*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D003225:Hemorrhagic Fever Virus, Crimean-Congo / Q000302:isolation & purification*; D006479:Hemorrhagic Fever, Crimean / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008969:Molecular Sequence Data; D010802:Phylogeny; D010820:Physicians; D012367:RNA, Viral / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012254:Ribavirin / Q000008:administration & dosage; D017422:Sequence Analysis, DNA; D013397:Sudan; D016896:Treatment Outcome; D015678:Viral Structural Proteins / Q000235:genetics
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D007075:Immunoglobulin M; D012367:RNA, Viral; D015678:Viral Structural Proteins; D012254:Ribavirin