Crimean-Congo haemorrhagic fever — DTM&H MCQ

Correct answer: E — Crimean-Congo haemorrhagic fever

Crimean-Congo haemorrhagic fever (E) is correct because this is a tick-borne nairovirus endemic in Turkey, Balkans, Middle East and parts of Africa, with abattoir workers, farmers and vets who handle livestock or remove ticks representing the classic at-risk group. The vignette's combination of tick exposure while handling animals, fever, myalgia, bleeding, and thrombocytopenia with leukopenia is the textbook presentation of CCHF, reflecting viral marrow suppression and endothelial/coagulopathic injury. UKHSA guidance identifies occupational or recreational livestock exposure in endemic areas as the predominant risk factor for acquiring CCHF. No other option combines geography, tick-and-livestock exposure and haematological haemorrhagic fever features as tightly as this one. Why the other options are wrong: A. Kyasanur Forest disease: this is a tick-borne flavivirus restricted to forested areas of India (Karnataka), not Turkey, and is not linked to abattoir or livestock tick removal. D. Leptospirosis: transmitted via exposure to water or soil contaminated with infected animal urine, not tick bites, and typically causes jaundice, renal impairment and conjunctival suffusion rather than a tick-exposure haemorrhagic syndrome. C. Dengue fever: transmitted by Aedes mosquitoes, not ticks, and while it causes thrombocytopenia and can haemorrhage, there is no tick or livestock link and Turkey is not a typical dengue transmission setting. B. Yellow fever: also mosquito-borne (Aedes), confined to parts of Africa and South America, and not found in Turkey; livestock tick exposure is irrelevant to its transmission. Key point: tick exposure while handling livestock in an endemic country (Turkey, Balkans, Middle East, Africa) plus fever, bleeding and cytopenias points to Crimean-Congo haemorrhagic fever, not a mosquito-borne or waterborne alternative.

Reference: UKHSA, 'Crimean-Congo haemorrhagic fever: origins, reservoirs, transmission and guidelines', GOV.UK, https://www.gov.uk/guidance/crimean-congo-haemorrhagic-fever-origins-reservoirs-transmission-and-guidelines