Summary about Disease
Marburg Virus Disease (MVD), formerly known as Marburg hemorrhagic fever, is a severe and often fatal illness in humans. It is caused by the Marburg virus, a genetically unique zoonotic (animal-borne) RNA virus of the filovirus family, which also includes Ebola virus. The disease is characterized by fever, bleeding, and multi-organ failure. Outbreaks are sporadic and typically associated with exposure to caves or mines inhabited by Rousettus bat colonies, or from contact with infected individuals.
Symptoms
The incubation period (the time from infection to the onset of symptoms) varies from 2 to 21 days. Symptoms typically begin abruptly and include:
High fever
Severe headache
Muscle aches and pains
Watery diarrhea
Abdominal pain
Nausea and vomiting As the disease progresses, typically around days 5-7, more severe symptoms can develop:
Severe bleeding (hemorrhagic manifestations) from multiple sites (nose, gums, eyes, and internal organs)
Skin hemorrhages (petechiae, purpura, ecchymoses)
Jaundice (yellowing of the skin and eyes)
Inflammation of the pancreas (pancreatitis)
Weight loss
Delirium
Shock
Liver failure
Multi-organ dysfunction
Causes
MVD is caused by the Marburg virus. The virus is maintained in nature in Rousettus aegyptiacus fruit bats. Human infection occurs through:
Prolonged exposure to mines or caves inhabited by Rousettus bat colonies.
Direct contact with the blood, secretions, organs, or other bodily fluids of infected people.
Contact with surfaces and materials (e.g., bedding, clothing) contaminated with these fluids.
In rare cases, laboratory workers handling samples without proper personal protective equipment (PPE).
There has been some suggestion of contact with infected animal reservoirs, but this is not well understood.
Medicine Used
There are currently no specific vaccines or antiviral treatments approved for Marburg Virus Disease. Treatment is primarily supportive and aims to:
Rehydrate the patient with oral or intravenous fluids.
Replace lost blood and clotting factors.
Maintain oxygen levels and blood pressure.
Treat specific symptoms and complications as they arise. Experimental therapies, such as monoclonal antibodies and antiviral drugs, have shown promise in laboratory and animal studies and may be considered in clinical trials or under compassionate use protocols during outbreaks, but availability is limited.
Is Communicable
Yes, MVD is communicable (contagious). Transmission occurs through direct contact with the blood, secretions, organs, or other bodily fluids of infected people or animals. It can also spread through contact with contaminated materials, such as bedding or clothing. The virus can persist in some bodily fluids (including semen) even after recovery, potentially leading to sexual transmission. Airborne transmission is not considered a primary route, but close contact with infected individuals poses a high risk of transmission.
Precautions
Preventing the spread of MVD requires strict adherence to infection control practices and public health measures:
Avoid contact with bats and wild animals: Especially in areas known to harbor the virus.
Practice meticulous hand hygiene: Wash hands frequently with soap and water or use an alcohol-based hand sanitizer.
Avoid contact with sick individuals: Particularly those displaying symptoms of MVD.
Use personal protective equipment (PPE): Healthcare workers and others caring for infected individuals must wear appropriate PPE, including gloves, gowns, masks, and eye protection.
Safe burial practices: Ensure safe and dignified burial of individuals who have died from MVD, involving trained personnel using PPE.
Isolation of infected individuals: Isolate confirmed or suspected cases of MVD to prevent further spread.
Contact tracing: Identify and monitor contacts of confirmed cases to detect new infections early.
Public health education: Educate communities about the disease, its transmission, and prevention measures.
How long does an outbreak last?
The duration of a Marburg outbreak is highly variable. It depends on several factors, including:
The effectiveness of public health interventions: Rapid detection, isolation, contact tracing, and implementation of control measures can shorten an outbreak.
The extent of the initial exposure: A single introduction of the virus may lead to a limited number of cases, while multiple exposures could fuel a more prolonged outbreak.
Community behavior and adherence to control measures: Public cooperation with prevention efforts is crucial.
Resources available for outbreak response: Access to diagnostic testing, treatment facilities, and trained personnel can significantly impact the duration. Some outbreaks have been contained within a few months, while others have persisted for several months or even longer.
How is it diagnosed?
Diagnosis of MVD can be challenging in the early stages, as the symptoms resemble those of other infectious diseases. Diagnostic methods include:
Real-time polymerase chain reaction (RT-PCR): To detect the presence of viral RNA in blood or other bodily fluids. This is the most common and reliable diagnostic test.
Antibody-capture enzyme-linked immunosorbent assay (ELISA): To detect antibodies against the Marburg virus in blood samples. This is useful for confirming past infection or for diagnosing cases later in the course of the illness.
Antigen detection tests: To detect viral antigens in blood or tissue samples.
Virus isolation: Growing the virus in cell culture. This is typically performed in specialized laboratories.
Electron microscopy: To visualize the virus particles in tissue samples.
Post-mortem testing: Tissue samples can be tested after death to confirm the diagnosis.
Timeline of Symptoms
The timeline of symptoms can vary, but a general pattern is observed:
Days 2-21 (Incubation Period): Asymptomatic.
Days 1-3: Abrupt onset of fever, severe headache, muscle aches, and malaise.
Days 3-5: Watery diarrhea, abdominal pain, nausea, and vomiting. Increasing severity of symptoms.
Days 5-7: Hemorrhagic manifestations (bleeding from multiple sites), skin hemorrhages, jaundice, pancreatitis.
Days 7-14: Continued bleeding, multi-organ dysfunction (liver failure, kidney failure), delirium, shock. Fatality often occurs during this period.
Survivors: Recovery is slow and may involve prolonged fatigue, muscle weakness, and other complications. The virus can persist in some bodily fluids for months.
Important Considerations
High Mortality Rate: MVD has a high case fatality rate, ranging from 24% to 88% in past outbreaks, depending on virus strain and quality of care.
Lack of Specific Treatment: The absence of approved vaccines or antiviral drugs necessitates a focus on supportive care and experimental therapies.
Potential for Re-emergence: Marburg virus can re-emerge in areas with suitable bat populations, posing a continuous threat.
Global Health Security: MVD outbreaks pose a risk to global health security, requiring international cooperation for surveillance, prevention, and response.
Stigma and Fear: MVD outbreaks can generate significant fear and stigma within affected communities, hindering control efforts. Community engagement and education are critical.