I. Introduction
Marburg Virus (MARV), which is an enveloped, non-segmented, single-stranded RNA virus belongs to the family Filoviridae. Marburg virus disease is a severe hemorrhagic fever, average fatality rate is around 50%, making it one of the deadly pathogens. As awareness about emerging infectious diseases grows, understanding Marburg fever is essential for global health.
II. What is Marburg Fever?
Marburg virus disease’s (MVD) first outbreak was reported in 1967 in Marburg, Frankfurt and Germany, These outbreaks were linked to laboratory work with African green monkeys (Cercopithecus aethiops) imported from Uganda, where laboratory workers became infected after handling tissues from the infected animals. Since the majority of cases were reported in the Marburg, the virus was named after this city. It was formerly referred to as green monkey disease.
III. Causes Transmission and Pathophysiology
Rousettus aegyptiacus, a fruit bat belonging to the Pteropodidae family, is the natural reservoir of the Marburg virus.
Animal Hosts: Infection can occur through direct contact with bats or their secretions.
Human-to-Human Transmission: This happens via the bodily fluids (blood, saliva, sweat) of infected individuals, particularly during caregiving or burial practices.
Through direct exposure to the infected animals or a person’s body fluid, the virus enters into the blood or lymphatic system and infects monocytes, macrophages, and dendritic cells. Which further extends to the liver and spleen. An inflammatory response occurs that includes the release of inflammatory cytokines, along with lymphoid depletion in the spleen. The release of those cytokines and chemokines (prostacyclin and nitric oxide) activates coagulation cascades. This process will result in the dissemination of intravascular coagulation, leading to abnormal blood clotting throughout the body and causing severe complications.
IV. Symptoms and Diagnosis
The interval from infection to onset of symptoms (incubation period) is varied from 2 to 21 days.
In the early phase, the patients will be experiencing symptoms such as high-grade fever, severe headache, chills and severe malaise. Some patients will also experience gastrointestinal symptoms (Severe watery diarrhea, abdominal pain and cramping). In second phase of the disease shows the Symptoms of hemorrhagic fever including mucosal bleeding, vomiting of blood (hematemesis), blood in the stool (hematochezia), and bleeding from puncture sites where intravenous access is established for administering fluids or collecting blood samples. In the advanced stages of the disease, the patient will develop neurological symptoms such as confusion, irritability, seizures and aggression. In critical cases, death is typically preceded by significant hemorrhage and shock.
Diagnosis
Clinically differentiating Marburg virus disease (MVD) from other infectious diseases like Ebola, shigellosis, meningitis, and other viral hemorrhagic fevers can be challenging, even though antigen-capture enzyme-linked immunosorbent assay (ELISA) testing, polymerase chain reaction (PCR), and IgM-capture ELISA can be used within a few days of symptom onset. Virus isolation by cell culture needs to be completed in a high-containment laboratory.
V. Treatment and Management
Currently, there are no approved treatment options as well as vaccines, even though providing early intensive supportive care, rehydration and addressing specific symptoms, can increase the chances of survival.
Several pharmaceutical agents targeting Marburg are currently under development. Galidesivir (BCX4430) is a synthetic nucleoside analog that inhibits viral RNA polymerase. Favipiravir is a synthetic guanidine nucleoside analog that exhibits broad-spectrum activity against various RNA virus families. Remdesivir is a prodrug of an adenosine analog that has demonstrated in vitro activity against Marburg.
Researchers are working on experimental treatments and vaccines, which have shown promise in trials. Early intervention is crucial for enhancing survival rates, highlighting the need for prompt medical attention. Increasing awareness of risk factors for Marburg virus disease (MVD) and the protective measures individuals can take, is an effective strategy to reduce human transmission.
VI. Prevention Strategies
Preventing Marburg fever depends on a combination of public health strategies and individual precautions.
A. Public health measures
Educating the community about recognizing signs and symptoms of the disease and safe burial practices can help reduce transmission. A rapid response to outbreaks is essential for effective containment. Additionally, it is important to stress quarantine protocols and the isolation of affected individuals once the disease has been contracted.
B. Personal protective measures
Utilizing appropriate personal protective equipment (PPE), practicing frequent hand hygiene, monitoring and managing personnel who may have been exposed, and restricting visitor access to the rooms are all important measures.
VIII. Healthcare Team Outcomes
The Marburg virus continues to pose a public health challenge, with recurring epidemics highlighting the necessity for ongoing research and awareness of the disease for future treatment possibilities. Currently, supportive care is the only primary method of treatment, however numerous treatment options are under investigation. It's crucial for healthcare providers to stay informed as new findings emerge. Healthcare workers should consistently implement standard precautions when treating patients, regardless of their suspected diagnosis.
IX. Conclusion
In a world with the growing threat of infectious diseases, grasping the nuances of Marburg fever is more important than ever. By prioritizing awareness, education, and preventive strategies, we can significantly lower the transmission risks and enhance recovery chances for those affected. Staying informed and proactive is vital as we combat this formidable virus together.
X. References and Resources
Kortepeter MG, Dierberg K, Shenoy ES, Cieslak TJ; Medical Countermeasures Working Group of the National Ebola Training and Education Center's (NETEC) Special Pathogens Research Network (SPRN). Marburg virus disease: A summary for clinicians. Int J Infect Dis. 2020 Oct;99:233-242. doi: 10.1016/j.ijid.2020.07.042. Epub 2020 Aug 3. PMID: 32758690; PMCID: PMC7397931.
https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease Assessed and Endorsed by the MedReport Medical Review Board