Marburg virus disease

Background

• Also known as Marburg hemorrhagic fever
• RNA virus of the filovirus family
  • The 5 species of Ebola are the other 5 members of the family
• First outbreak, 1967, in Marburg and Frankfurt Germany - due to research on African green monkeys
• Reservoir: African fruit bat, Rousettus aegyptiacus

Transmission

• Host animal to human unknown. Likely; contact with infected bat feces or aerosols, handling infected primates or their tissues
• Human to human: direct contact with droplets of body fluid or contaminated objects

Clinical Features

• Incubation period: 5-10 days
• Initial symptoms are vague:
  • Fever, headache, chills, myalgias, abdominal pain, diarrhea
  • Maculopapular rash, typically on the trunk, around 5 days after symptom onset
• Massive hemorrhage, shock, and multiorgan system failure
• 23-90% fatal

Differential Diagnosis

Fever in Traveler

• Normal causes of acute fever!
• Malaria
• Dengue
• Leptospirosis
• Typhoid Fever
• Typhus
• Viral Hemorrhagic Fevers
  • Ebola
  • Lassa fever
  • Marburg
• Chikungunya
• Yellow fever
• Rift Valley Fever
• Q fever

Diagnostic Evaluation

• Difficult diagnosis and very rare/unlikely outside of Central Africa
• Consider Marburg with typical symptoms and high risk exposure including:
  • Close contact with African fruit bats, infected humans, infected non-human primates
  • Lab researcher using African primates
  • Recent travel to Uganda or other Central African countries
  • Cave exploration in Africa

Work-up

• ELISA, PCR, and IgM ELISA for acute infection several days after symptom onset.
• IgG ELISA can be used later in the course of disease.

Management

• Supportive therapies are the hallmark of management
• Isolation precautions: standard, contact and droplet
  • Isolate in a single room with the door closed
  • Limit entry and maintain a log of people who enter the room
  • Use standard, contact, and droplet precautions
• Notify public health personnel
• Continue to test and treat for other possible diseases

Disposition

• Admit to ICU

See Also

• Fever in travelers
• Travel medicine
• Viral hemorrhagic fevers
• Ebola

External Links

• CDC Marburg Site