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Volume 14
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10.3390/pathogens14080785
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Molecular and Clinical Characterization of Crimean–Congo Hemorrhagic Fever in Bulgaria, 2015–2024

by
Kim Ngoc
1,
Ivan Stoikov
1,
Ivelina Trifonova
2,
Elitsa Panayotova
1,
Evgenia Taseva
1,
Iva Trifonova
1 and
Iva Christova
1,*
1
Department of Microbiology, National Center of Infectious and Parasitic Diseases, Sofia 1504, Bulgaria
2
Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia 1233, Bulgaria
*
Author to whom correspondence should be addressed.
Pathogens 2025, 14(8), 785; https://doi.org/10.3390/pathogens14080785
Submission received: 7 July 2025 / Revised: 23 July 2025 / Accepted: 30 July 2025 / Published: 6 August 2025
Versions Notes

Abstract

Crimean–Congo hemorrhagic fever (CCHF) is a zoonotic viral disease endemic to parts of Africa, Asia and southeastern Europe. Bulgaria is one of the few European countries with the consistent annual reporting of human CCHF cases. This study provides a descriptive overview of 24 confirmed CCHF cases in Bulgaria between 2015 and 2024. Laboratory confirmation was performed by an enzyme-linked immunosorbent assay (ELISA) and/or real-time reverse transcriptase polymerase chain reaction (RT-qPCR) testing. Common findings included fever, fatigue, gastrointestinal symptoms, thrombocytopenia, leukopenia, liver dysfunction and coagulopathy. Two fatal cases were recorded. Two samples collected in 2016 and 2024 were subjected to whole-genome sequencing. Phylogenetic analysis showed that both strains clustered within the Turkish branch of the Europe 1 genotype and shared high genetic similarity with previous Bulgarian strains, as well as strains from neighboring countries. These findings suggest the long-term persistence of a genetically stable viral lineage in the region. Continuous molecular and clinical surveillance is necessary to monitor the evolution and public health impact of CCHFV in endemic areas.
Keywords: Crimean–Congo hemorrhagic fever; Bulgaria; tick-borne infections Crimean–Congo hemorrhagic fever; Bulgaria; tick-borne infections

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MDPI and ACS Style

Ngoc, K.; Stoikov, I.; Trifonova, I.; Panayotova, E.; Taseva, E.; Trifonova, I.; Christova, I. Molecular and Clinical Characterization of Crimean–Congo Hemorrhagic Fever in Bulgaria, 2015–2024. Pathogens 2025, 14, 785. https://doi.org/10.3390/pathogens14080785

AMA Style

Ngoc K, Stoikov I, Trifonova I, Panayotova E, Taseva E, Trifonova I, Christova I. Molecular and Clinical Characterization of Crimean–Congo Hemorrhagic Fever in Bulgaria, 2015–2024. Pathogens. 2025; 14(8):785. https://doi.org/10.3390/pathogens14080785

Chicago/Turabian Style

Ngoc, Kim, Ivan Stoikov, Ivelina Trifonova, Elitsa Panayotova, Evgenia Taseva, Iva Trifonova, and Iva Christova. 2025. "Molecular and Clinical Characterization of Crimean–Congo Hemorrhagic Fever in Bulgaria, 2015–2024" Pathogens 14, no. 8: 785. https://doi.org/10.3390/pathogens14080785

APA Style

Ngoc, K., Stoikov, I., Trifonova, I., Panayotova, E., Taseva, E., Trifonova, I., & Christova, I. (2025). Molecular and Clinical Characterization of Crimean–Congo Hemorrhagic Fever in Bulgaria, 2015–2024. Pathogens, 14(8), 785. https://doi.org/10.3390/pathogens14080785

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