Marburg virus disease

Revision as of 07:02, 7 September 2015 by Mholtz (talk | contribs)

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 - most outbreaks have implicated contact with bats[1]
    • No documented cases of primate-human transmission outside laboratory setting
  • Human to human: direct contact with droplets of body fluid or contaminated objects

Clinical Features

  • Incubation period: 2-21 days (5-7 days more common)[2]
  • Initial symptoms are vague:
    • High 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
  • Death usually occurs 1-2 weeks after symptom onset[2] (23-90% fatal)
    • Patients alive at 2 weeks after symptom onset usually survive

Differential Diagnosis

Fever in Traveler

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

  • PCR and IgM ELISA for acute infection several days after symptom onset.[2]
  • IgG ELISA can be used later in the course of disease.

Management

  • Aggressive supportive care is the hallmark of management[2]
  • Strict Isolation precautions: standard, contact and droplet[3]
    • Limit entry and maintain a log of people who enter the room
  • Notify public health personnel
  • Continue to test and treat for other possible diseases

Disposition

  • Admit to ICU

See Also

External Links

References

  1. ↑ Pigott DM, Golding N, Mylne A, et al. Mapping the zoonotic niche of Marburg virus disease in Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2015;109(6):366-378. doi:10.1093/trstmh/trv024.
  2. ↑ 2.0 2.1 2.2 2.3 Bebell LM, Riley LE. Ebola virus disease and Marburg disease in pregnancy: a review and management considerations for filovirus infection. Obstet Gynecol. 2015 Jun;125(6):1293-8. doi: 10.1097/AOG.0000000000000853.
  3. ↑ California Health Alert Network. Alert Id: 35317. 9/10/2014
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