Marburg virus disease: Difference between revisions
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==Background== | ==Background== | ||
*RNA | *Also known as Marburg [[Viral hemorrhagic fevers|hemorrhagic fever]] | ||
** | *RNA virus of the [[Filovirus|filovirus]] family | ||
*First outbreak, 1967, in Marburg and Frankfurt Germany- due to research on African green monkeys | **The 5 species of Ebola are the other 5 members of the family | ||
*Reservoir: | *First outbreak, 1967, in Marburg and Frankfurt Germany - due to research on African green monkeys | ||
*Reservoir: Egyptian fruit bat (''Rousettus aegyptiacus'') | |||
==Transmission== | ===Transmission=== | ||
*Host animal to human | *Host animal to human - most outbreaks have implicated contact with bats as the source<ref name="Pigott">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.</ref> | ||
**No documented cases of primate-human transmission outside laboratory setting | |||
*Human to human: direct contact with droplets of body fluid or contaminated objects | *Human to human: direct contact with droplets of body fluid or contaminated objects | ||
**Humans can transmit the virus as soon as they are febrile.<ref name="Martines">Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses. J Pathol. 2015 Jan;235(2):153-74. doi: 10.1002/path.4456.</ref> | |||
==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<ref name="Knust">Knust B, Schafer IJ, Wamala J, et al. Multidistrict Outbreak of Marburg Virus Disease-Uganda, 2012. J Infect Dis. 2015 Jul 23. pii: jiv351.</ref>) | ||
**Patients alive at 2 weeks after symptom onset usually survive | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 29: | Line 32: | ||
**[[Ebola]] | **[[Ebola]] | ||
**[[Lassa fever]] | **[[Lassa fever]] | ||
**[[Marburg]] | |||
*[[Chikungunya]] | *[[Chikungunya]] | ||
*[[Yellow fever]] | *[[Yellow fever]] | ||
| Line 34: | Line 38: | ||
*[[Q fever]] | *[[Q fever]] | ||
== | ==Evaluation== | ||
*Difficult diagnosis and very rare/unlikely outside of Central Africa | *Difficult diagnosis and very rare/unlikely outside of Central Africa | ||
*Consider Marburg with typical symptoms and high risk exposure including: | *Consider Marburg with typical symptoms and high risk exposure including: | ||
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**Cave exploration in Africa | **Cave exploration in Africa | ||
=== | ===Work-up=== | ||
*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. | |||
==Management== | ==Management== | ||
*[[Isolation precautions]]: standard, contact and droplet<ref name="CAHealth"></ref> | *Aggressive supportive care is the hallmark of management<ref name="Bebell" /> | ||
*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 | |||
==Disposition== | ==Disposition== | ||
Admit | *Admit to ICU | ||
==See Also== | ==See Also== | ||
*[[ | *[[Ebola virus disease]] | ||
*[[ | *[[Viral hemorrhagic fevers]] | ||
*[[ | *[[Fever in traveler]] | ||
*[[ | *[[Travel medicine]] | ||
==External Links== | ==External Links== | ||
*[http://www.cdc.gov/vhf/marburg/index.html CDC Marburg Site] | |||
== | ==References== | ||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Tropical Medicine]] | ||
Latest revision as of 04:14, 28 July 2016
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: Egyptian fruit bat (Rousettus aegyptiacus)
Transmission
- Host animal to human - most outbreaks have implicated contact with bats as the source[1]
- No documented cases of primate-human transmission outside laboratory setting
- Human to human: direct contact with droplets of body fluid or contaminated objects
- Humans can transmit the virus as soon as they are febrile.[2]
Clinical Features
- Incubation period: 2-21 days (5-7 days more common)[3]
- 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[3] (23-90% fatal[4])
- 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
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.[3]
- IgG ELISA can be used later in the course of disease.
Management
- Aggressive supportive care is the hallmark of management[3]
- Strict Isolation precautions: standard, contact and droplet[5]
- 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.
- ↑ Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses. J Pathol. 2015 Jan;235(2):153-74. doi: 10.1002/path.4456.
- ↑ 3.0 3.1 3.2 3.3 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.
- ↑ Knust B, Schafer IJ, Wamala J, et al. Multidistrict Outbreak of Marburg Virus Disease-Uganda, 2012. J Infect Dis. 2015 Jul 23. pii: jiv351.
- ↑ California Health Alert Network. Alert Id: 35317. 9/10/2014