Marburg hemorrhagic fever
Marburg virus disease (MVD) is a severe and highly contagious viral illness endemic to sub-Saharan Africa, characterized by intense hemorrhaging and high mortality rates. First identified in 1967 in Marburg, Germany, the disease is caused by the Marburg virus, which is linked to the Egyptian fruit bat as its primary reservoir, though the exact transmission pathway to humans remains unclear. Symptoms typically manifest 5 to 10 days after exposure, beginning with flu-like signs such as fever and chills, progressing to severe complications including delirium, multiorgan failure, and massive hemorrhaging.
Diagnosis can be challenging, as MVD symptoms may mimic other endemic diseases like malaria and typhoid fever. Current treatment options are limited to supportive care, as there is no specific cure; however, some success has been noted with blood transfusions in severe cases. Preventative measures focus on avoiding contact with infected individuals and their bodily fluids, as well as steering clear of areas where bats are prevalent. Despite its rarity, outbreaks can occur sporadically, underscoring the importance of awareness and caution, particularly for medical personnel and researchers in affected regions.
Marburg hemorrhagic fever
- ANATOMY OR SYSTEM AFFECTED: All
Definition
Marburg virus disease, also known as MVD and formerly known as Marburg hemorrhagic fever, is a highly infectious, deadly viral disease endemic to sub-Saharan Africa. The disease is characterized by massive hemorrhaging from all body orifices and by high mortality.
Causes
Marburg virus disease was first identified in 1967 in Marburg, Germany, from which it gets its name. It arose among personnel in a laboratory using African green monkeys to prepare polio vaccine. The agent for the disease is Marburg virus, characterized by a single linear negative-sense ribonucleic acid (RNA) genome and a filamentous appearance of the virion particles in the electron microscope. Marburg virus disease arises sporadically every couple of years. The normal viral reservoir is the Egyptian fruit bat (Rousettus aegyptiacus) and possibly some other bat species. How the virus is passed from bats to humans is not understood.
Risk Factors
The Marburg virus is highly infective and is spread by direct contact with the bodily fluids of an infected person. Anyone in contact with such persons is at risk. The African episodes often occur near caves or mines that harbor bats. In 2008, two cases in the Western world were reported, one in the Netherlands and another in the state of Colorado. Both cases involved tourists who had recently visited Python Cave in Uganda. No other cases have been reported in the United States.
Medical personnel who treat persons with Marburg virus disease must exercise extreme caution. Research staff who work with primates or primate tissues from African species are at risk. Because of the high infectivity of Marburg virus, related research must be done in a level-P4 containment laboratory.
Symptoms
The incubation period is five to ten days, with a sudden onset of flulike symptoms (fever, chills, headache, sore throat, and myalgia). The symptoms get progressively worse, and by the fifth day, persons infected will experience symptoms such as anorexia; the development of a rash, especially on the trunk; nausea; vomiting; diarrhea; and chest pain. These symptoms progress to moderate weight loss, anuria, delirium, hypovolemic shock, coma, multiorgan failure, and severe hemorrhaging from all body orifices. Those persons who recover from the infection often continue to have one or more conditions, including orchitis, recurrent hepatitis, uveitis, myelitis, and inflammation of the parotid gland.
Screening and Diagnosis
In Africa, the symptoms may be confused with other endemic diseases such as malaria or typhoid fever. Medical personnel must be particularly cautious of mine workers and those persons living near caves. The virus can be identified through various testing methods, including enzyme-linked immunoabsorbent assay (ELISA), polymerase chain reaction, and virus isolation. Upon autopsy, diagnosis is confirmed by immunohistochemistry.
Treatment and Therapy
Treatment includes supportive hospital therapy with barrier nursing in isolation. The disease will run its course, as there is no cure or effective treatment. In some cases, transfusion of fresh-frozen plasma to replace blood-clotting proteins has had some limited success in reducing hemorrhaging. An experimental vaccine has been developed. Mortality has ranged from 23 percent (in a 1967 incident in Europe) to 88 percent (in a 2005 outbreak in urban Angola). According to the World Health Organization's 2025 estimate, mortality rates for the disease are typically around 50 percent. In 2024, Rwanda received more than seven hundred experimental Marburg vaccines to help combat an ongoing outbreak, with many of the vaccines slated for health-care workers.
Prevention and Outcomes
One should avoid caves and mining areas in Africa and avoid contact with the bodily fluids of persons with Marburg virus disease.
Bibliography
Mahanty, Siddhartha, and Mike Bray. “Pathogenesis of Filoviral Haemorrhagic Fevers.” The Lancet: Infectious Diseases 4 (2004): 487–98.
“Marburg (Marburg Virus Disease).” Centers for Disease Control and Prevention, 24 Feb. 2023, www.cdc.gov/vhf/marburg/index.html. Accessed 4 Feb. 2025.
“Marburg Virus Disease.” World Health Organization, 20 Jan. 2025, www.who.int/news-room/fact-sheets/detail/marburg-virus-disease. Accessed 4 Feb. 2025.
Schnirring, Lisa. "Rwanda's Marburg Total Rises as Vaccine Trial Launches." University of Minnesota, 7 Oct. 2024, www.cidrap.umn.edu/marburg/rwanda-s-marburg-total-rises-vaccine-trial-launches. Accessed 4 Feb. 2025.
Slenczka, Werner, and Hans Dieter Klenk. “Forty Years of Marburg Virus.” Journal of Infectious Diseases 196 (2007): S131-135.