IntroductionCrimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease in Africa, Asia, the Balkan peninsula, the south-east of Europe and the Middle East, with mortality rates of 3-30%. Transmission can also occur through contact with infected animals or humans.AimThis observational, prospective case series aimed to investigate detectable viral genomic RNA in whole-body fluids and antibody dynamics in consecutive daily samples of patients diagnosed with CCHF until discharge from hospital.MethodsWe tested 18 patients and 824 swabs and sera with RT-PCR and 125 serum samples serologically.ResultsThe longest duration until clearance of viral RNA was 18 days from serum collection and 18, 15, 13, 19 and 17 days, respectively, from nasal, oral, genital (urethral or vaginal) and faecal swab, and urine. In seven patients, viral load decreased in serum at the same time as it increased in urine or persisted at the same logarithmic values. Despite clearance in serum, viral RNA was detected in faeces and genital swabs in two and three patients, respectively. Viral clearance from body fluids occurred earlier than from serum in eight patients on ribavirin treatment. The shortest seroconversion time was 3 days after symptom onset for IgM and IgG. Seroconversion of IgG occurred until Day 14 of symptoms.ConclusionWe report persistence of viral RNA in urine, faeces and genital swabs despite serum clearance. This may indicate a need for extending isolation precautions, re-evaluating discharge criteria and transmission risk after discharge, and considering oral swabs as a less invasive diagnostic alternative.

译文

简介克里米亚-刚果出血发热 (CCHF) 是非洲,亚洲,巴尔干半岛,欧洲东南部和中东的tick传播疾病,死亡率为3-30%。传播也可以通过与受感染的动物或人类接触而发生。针对这种观察,前瞻性病例系列旨在调查全身体液中可检测的病毒基因组RNA和连续每日确诊为CCHF患者的抗体动态,直至出院。方法我们用rt-pcr和125血清样本血清学检测了18例患者和824份拭子和血清。结果病毒RNA清除前的最长持续时间是血清采集18天,15、13、19和17天,分别来自鼻,口腔,生殖器 (尿道或阴道) 和粪便拭子以及尿液。在7名患者中,血清中的病毒载量与尿液中的病毒载量增加的同时降低,或者以相同的对数值持续存在。尽管血清清除,但分别在两名和三名患者的粪便和生殖器拭子中检测到病毒RNA。在八名接受利巴韦林治疗的患者中,体液中的病毒清除比血清中的病毒清除早。IgM和IgG症状发作后3天是最短的血清转换时间。IgG的血清转化一直持续到症状的第14天。结论我们报告了尽管血清清除率,但尿液,粪便和生殖器拭子中病毒RNA的持久性。这可能表明需要扩大隔离预防措施,重新评估出院标准和出院后的传播风险,并考虑将口服拭子作为侵入性较小的诊断选择。

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