Marburg virus disease
Revision as of 04:14, 28 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Diagnostic Evaluation==" to "==Evaluation==")
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