Marburg virus disease
Background
- RNA based 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
- Viral hemorrhagic fever
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
- Chikungunya
- Yellow fever
- Rift Valley Fever
- Q fever
Workup
- 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
Diagnostics
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
- Isolation precautions: standard, contact and droplet[1]
- 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
- Supportive management
- Experimental treatment has never been used in humans
Disposition
Admit, isolation, possible ICU for serologic results and clinical observation/supportive care.
See Also
External Links
Sources
- Marburg Hemorrhagic Fever http://www.cdc.gov/vhf/marburg/index.html
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