Marburg Hemorrhagic Fever

Alternative names

Marburg disease; Marburg Virus; Marburg

Definition

Marburg hemorrhagic fever is a rare viral disease that occurs primarily in countries in East and Central Africa. The virus has the potential to spread from person to person, especially among health-care staff and family members who care for patient with Marburg VHF. After an incubation period of 5-10 days, the disease usually presents with sudden fever, chills, and muscle aches. Around the fifth day after onset of symptoms, a skin rash can occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may follow. Symptoms become increasingly severe and may include jaundice, severe weight loss, mental confusion, shock, and multi-organ failure.

The Marburg virus, together with the four known Ebola viruses, makes up the virus family known as filoviruses. These viruses cause a rare type of serious illness known as hemorrhagic (bleeding) fever. Marburg hemorrhagic fever can occur in both humans and other primates.

Marburg virus is a member of the family of filoviruses. It behaves similarly to Ebola and is readily detectable in the blood and tissues of infected individuals. An early positive PCR test may confirm the diagnosis, but a negative, test does not refute it. IgM antibodies are detectable by ELISA within the first week of illness, and cell culture in VERO cells can be performed using blood, urine or fresh tissue samples.

What is the Marburg virus?

It is a severe and highly contagious form of haemorrhagic fever caused by a virus from the same family - the filoviruses - as Ebola, although it is not as deadly as its cousin.

Causes

Cause details for Marburg virus: As with Ebola virus, the actual animal host for Marburg virus also remains a mystery. Both of the men infected in 1980 in western Kenya had traveled extensively, including making a visit to a cave, in that region. The cave was investigated by placing sentinels animals inside to see if they would become infected, and by taking samples from numerous animals and arthropods trapped during the investigation. The investigation yielded no virus: The sentinel animals remained healthy and no virus isolations from the samples obtained have been reported.

Just how the animal host first transmits Marburg virus to humans is unknown. However, as with some other viruses which cause viral hemorrhagic fever, humans who become ill with Marburg hemorrhagic fever may spread the virus to other people. This may happen in several ways. Persons handling infected monkeys who come into direct contact with them or their fluids or cell cultures, have become infected. Spread of the virus between humans has occurred in a setting of close contact, often in a hospital. Droplets of body fluids, or direct contact with persons, equipment, or other objects contaminated with infectious blood or tissues are all highly suspect as sources of disease.

Symptoms

This symptom information has been gathered from various sources, may not be fully accurate, and may not be the full list of symptoms of Marburg virus. Furthermore, symptoms of Marburg virus may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of symptoms and whether they are indeed symptoms of Marburg virus.

List of symptoms of Marburg virus: The list of symptoms mentioned in various sources for Marburg virus includes:

     
  • Phase 1:       o Sudden onset       o Fever       o Chills       o Headache       o Myalgia  
  • Phase 2:       o Maculopapular rash       o Trunk rash       o Nausea       o Vomiting       o Chest pain       o A sore throat       o Abdominal pain       o Diarrhea       o Jaundice       o Pancreas inflammation       o Severe weight loss       o Delirium       o Shock       o Liver failure       o Massive hemorrhaging       o Multi-organ dysfunction

Symptoms of Marburg virus: After an incubation period of 5-10 days, the onset of the disease is sudden and is marked by fever, chills, headache, and myalgia. Around the fifth day after the onset of symptoms, a maculopapular rash, most prominent on the trunk (chest, back, stomach), may occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea then may appear.  Symptoms become increasingly severe and may include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction. 1

More symptoms of Marburg virus: In addition to the above information, to get a full picture of the possible symptoms of this condition and its related conditions, it may be necessary to examine symptoms that may be caused by complications of Marburg virus, underlying causes of Marburg virus, associated conditions for Marburg virus, risk factors for Marburg virus, or other related conditions.

Clinical Features

The incubation period of Marburg disease in the European outbreak was 3-9 days. The course of the illness is similar to that of Ebola, though Marburg virus infection tends to be less severe and has a lower case fatality rate.

Methods of Transmission

As with Ebola virus, the natural reservoir of Marburg virus is unknown but acquisition of the infection by monkeys may bring it into contact with man. Once successfully transmitted to humans, Marburg is capable of person-to-person spread, most commonly by contact with infected blood. Aerosol transmission has not been described in the clinical setting, but it would be unwise to disregard the possibility of this occurring when the patient is seriously ill with pulmonary involvement. Similarly, in the laboratory and other experimental settings, aerosol transmission between animals has not been entirely excluded.

Treatment

No specific treatments (antiviral drug, cytokine or vasoactive agent) have been shown to date to influence the course of Marburg infection. Treatment is generally a matter of applying intensive supportive measures.

Risk Factors

Risk factors for Marburg virus are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for Marburg virus makes the chances of getting a condition higher but does not always lead to Marburg virus. Also, the absence of any risk factors or having a protective factor does not necessarily guard you against getting Marburg virus. For general information and a list of risk factors, see the risk center.

Risk factor list: The list of risk factors mentioned for Marburg virus in various sources includes:

     
  • Exposure to infected person  
  • Hospital staff of infected person  
  • Family members of infected person  
  • Primates  
  • Animal laboratory workers  
  • Animal quarantine facility workers

Risk factors discussion: People who have close contact with a human or non-human primate infected with the virus are at risk. Such persons include laboratory or quarantine facility workers who handle non-human primates that have been associated with the disease. In addition, hospital staff and family members who care for patients with the disease are at risk if they do not use proper barrier nursing techniques.

Prognosis

The ‘prognosis’ of Marburg virus usually refers to the likely outcome of Marburg virus. The prognosis of Marburg virus may include the duration of Marburg virus, chances of complications of Marburg virus, probable outcomes, prospects for recovery, recovery period for Marburg virus, survival rates, death rates, and other outcome possibilities in the overall prognosis of Marburg virus. Naturally, such forecast issues are by their nature unpredictable.

Mortality rate for Marburg virus: The case-fatality rate for Marburg hemorrhagic fever is between 23-25%.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.