Acute Complicated Brucellosis Mimicking Crimean-Congo Hemorrhagic Fever (CCHF) and Vice Versa

Abstract

Crimean-Congo hemorrhagic fever (CCHF), endemic to Asia, Africa, and southern Europe, is a tick-borne disease caused by the CCHF virus (Orthonairovirus in Nairoviridae family). The main route of transmission is tick bite, and close contact with virus-infected blood/tissues of humans or animals may also transmit the infection. CCHF is considered a significant public health problem with case fatality rate (CFR) of 5.4-80% [1]. CCHF remains a seasonal disease and is rare in winter. In the case of similar epidemiologic and clinical presentation, brucellosis should be taken into consideration in endemic regions for the differential diagnosis of thrombocytopenia associated bleeding (with or without hemophagocytosis), because this picture is not rare in the latter illness [2]. After a few days (usually 2 to 14 days) incubation period, CCHF presents with nonspecific symptoms of fever, headache, body pain, and vomiting. During the hemorrhagic phase, petechia, ecchymosis, and bleeding from the various mucosal surface of the body, including respiratory tracts, genitourinary, and gastrointestinal tract can occur [3]. Severe CCHF can result in disseminated intravascular coagulation (DIC), shock, and death. Brucellosis, a prevalent zoonotic infection, is endemic to different regions of Mediterranean countries, the Balkans, the Persian Gulf, the Middle East, and Central and South America with a predominance of the agricultural and rural population [4]. This infection, caused by Brucella spp. a Gram-negative bacteria mimics different non-infectious and