Marburg virus disease: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Incubation period: 5-10 | *Incubation period: 2-21 days (5-7 days more common)<ref name="Bebell">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.</ref> | ||
*Initial symptoms are vague: | *Initial symptoms are vague: | ||
** | **High fever, headache, chills, myalgias, abdominal pain, diarrhea | ||
**Maculopapular rash, typically on the trunk, around 5 days after symptom onset | **Maculopapular rash, typically on the trunk, around 5 days after symptom onset | ||
*Massive hemorrhage, shock, and multiorgan system failure | *Massive hemorrhage, shock, and multiorgan system failure | ||
*23-90% fatal | *Death usually occurs 1-2 weeks after symptom onset<ref name="Bebell" /> (23-90% fatal) | ||
**Patients alive at 2 weeks after symptom onset usually survive | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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===Work-up=== | ===Work-up=== | ||
*ELISA, PCR, and IgM ELISA for acute infection several days after symptom onset. | *ELISA, PCR, and IgM ELISA for acute infection several days after symptom onset.<ref name="Bebell" /> | ||
*IgG ELISA can be used later in the course of disease. | *IgG ELISA can be used later in the course of disease. | ||
==Management== | ==Management== | ||
* | *Aggressive supportive care is the hallmark of management<ref name="Bebell" /> | ||
*[[Isolation precautions]]: standard, contact and droplet<ref name="CAHealth">California Health Alert Network. Alert Id: 35317. 9/10/2014</ref> | *Strict [[Isolation precautions]]: standard, contact and droplet<ref name="CAHealth">California Health Alert Network. Alert Id: 35317. 9/10/2014</ref> | ||
**Limit entry and maintain a log of people who enter the room | **Limit entry and maintain a log of people who enter the room | ||
*Notify public health personnel | *Notify public health personnel | ||
*Continue to test and treat for other possible diseases | *Continue to test and treat for other possible diseases | ||
Revision as of 07:01, 7 September 2015
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
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid Fever
- Typhus
- Viral Hemorrhagic Fevers
- 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.[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
- ↑ 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.
- ↑ 2.0 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.
- ↑ California Health Alert Network. Alert Id: 35317. 9/10/2014