Early clinical management of CCHF in resource-limited rural settings: a case series from a secondary hospital in Türkiye

Abstract

Introduction: Crimean-Congo hemorrhagic fever (CCHF) remains a major public health concern in endemic regions such as Türkiye. Early triage and management of patients presenting to secondary-level hospitals, where most cases seek care initially, are insufficiently documented.

Methodology: This retrospective case series study was conducted at Kelkit State Hospital, a secondary-level healthcare facility in northeastern Türkiye. Eighteen patients with confirmed CCHF admitted between 8 August 2022 and 30 November 2023 were included. Demographic characteristics, clinical presentation, laboratory findings, treatment, and referral status were reviewed. Referral decisions were primarily based on severe thrombocytopenia (platelet count < 50,000/mm³) due to limited local resources. Clinical and laboratory characteristics were compared between referred and non-referred patients. Chi-square or Fisher’s exact test was used for categorical variables, and the Mann–Whitney U test was used for continuous variables.

Results: The patients had a mean age of 44 ± 18 years and 72% were male. Most were engaged in animal husbandry (66%) and 56% had a history of tick exposure. Two-thirds of the patients were referred to tertiary care; all of them had platelet counts below 50,000/mm³. Polymerase chain reaction (PCR) positivity was more frequent among referred patients. The length of stay at the secondary-level hospital was longer among non-referred patients (p = 0.01), while total hospitalization duration was greater in the referred group. No deaths occurred.

Conclusions: Selected patients with mild to moderate CCHF can be safely managed at secondary-level hospitals, potentially reducing unnecessary tertiary referrals and healthcare system burden.