Northern Cape man in isolation with deadly but rare Congo fever

A case of deadly Crimean-Congo haemorrhagic fever has been confirmed in a 58-year-old man from Kimberley in the Northern Cape.

A day before falling ill, the man was bitten by a number of ticks in the Koopmansfontein area, 95km northwest of Kimberley, the National Institute for Communicable Diseases said on Wednesday.

He is being treated in isolation at Robert Mangaliso Sobukwe Hospital after the NCID confirmed his diagnosis with laboratory tests.

This is the second case of Crimean-Congo haemorrhagic fever reported in SA in 2019. The first victim was a Free State vet.

The disease has been known in SA since 1981, but is rare in humans and typically only a handful of cases are reported a year.

More than half of the 180 confirmed cases have occurred in the Northern Cape and Free State, though the disease has been reported in all nine provinces.

The NCID said it was caused by a virus usually transmitted to humans through bites by the hyalomma tick (or "bontpoot" tick), which has a red body and red-and-white striped legs. It can also be transmitted by contact with infected animal tissues and blood.

Victims develop a sudden fever, muscle and back pain, dizziness, headache, sore eyes and sensitivity to light, accompanied by nausea, vomiting, diarrhoea and abdominal pain. They also experience sudden mood swings and can be confused or aggressive.

The NCID said patients became lethargic after two to four days, developed a fine red and purple rash and suffered large areas of bleeding into the skin. Bleeding may also occur from or into the gut, in urine, and in the nose and gums.

Treatment includes administration of fluids and electrolytes and medication with the antiviral ribavirin. Most patients recover, but up to 30% develop severe illness with multi-organ failure and die around the fifth day of illness.

Health-care workers and relatives of victims should be followed up for 14 days after being exposed to a victim, with twice-daily temperature and symptom monitoring.

Crimean-Congo haemorrhagic fever is most commonly reported in farmers, vets, abattoir workers, hunters and other individuals at higher risk of exposure to the hyalomma ticks.

The NCID recommends the use of insect repellents containing diethyltoluamide (DEET) to reduce tick bites.