Marburg virus disease

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

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

  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. 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. 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.
  4. Knust B, Schafer IJ, Wamala J, et al. Multidistrict Outbreak of Marburg Virus Disease-Uganda, 2012. J Infect Dis. 2015 Jul 23. pii: jiv351.
  5. California Health Alert Network. Alert Id: 35317. 9/10/2014

Authors:

Michael Holtz