Marburg haemorrhagic fever

Hemorrhagic fever Marburg is an acute zoonotic highlethal viral disease, manifested by intoxication, expressed by the phenomena of universal capillarotoxicosis. Synonyms: fever hemorrhagic cercoprotein, disease of green monkeys, Marburg viral disease, hemorrhagic fever Maridi.

ICD-10 code

A98.3. The disease caused by the Marburg virus.

Epidemiology of hemorrhagic fever Marburg

The Marburg virus reservoir is currently not reliably established. The source of the pathogen is the monkey, in particular the African monkeys Cercopithecus aethiops. Mechanisms of transmission of the pathogen: aerosol, contact, artifical. Transmission ways: airborne, contact, injection. The virus is contained in the blood, nasopharyngeal mucus, urine and semen (up to 3 months). Infection of people occurs with direct contact with blood and organs of monkeys, also through damaged skin (with pricks, cuts), when the virus enters the conjunctiva. A sick person is contagious to others. The case of transmission of the causative agent by sexual way is described.

The susceptibility of people to the Marburg virus is high. Postinfectious immunity is long. Data on recurrent diseases are absent.

The distribution of the virus is the central and western territories of Equatorial Africa, as well as the south of the continent (Central African Republic, Gabon, Sudan, Zaire, Liberia, Kenya, Rhodesia, Guinea, South Africa). Seasonality and frequency of outbreaks are not revealed.

[1], [2], [3], [4],

What causes Marburg haemorrhagic fever?

Marburg haemorrhagic fever is caused by the Marburgvirus genus Marburgvirus family Filoviridae. Viral particles are polymorphic (filamentary, spiral or round) with an average length of 790 nm and a diameter of 80 nm. Contain negative single-stranded RNA, lipoprotein. The virion contains 7 proteins. The protein composition of the Marburg virus is close to its related filovirus Ebola, but it has some differences. It is believed that strain-specific antigens are concentrated in the region of the Gp protein, and the group-specific antigen is in the region of the Np protein. Hemagglutinins and hemolysins were not detected. The virus is isolated and passaged in vitro in transplantable cultures of kidney cells of the green monkey (Vero) and in vivo on guinea pigs. Replication occurs in the cytoplasm of the affected cells. The virus has an average resistance to environmental factors.

Pathogenesis of hemorrhagic fever Marburg

Entrance gate of hemorrhagic fever Marburg - damaged skin, mucous membranes of the mouth and eyes. Primary replication of the virus occurs in the cells of the monocyte-macrophage line. Then viremia develops, accompanied by suppression of immune system functions and generalized disorders of microcirculation, which leads to the emergence of the syndrome of disseminated intravascular coagulation and polyorganous lesions. In the lungs, myocardium, kidneys, liver, spleen, adrenal glands and other organs, there are foci of necrosis and hemorrhages.

Symptoms of hemorrhagic fever Marburg

The incubation period of hemorrhagic fever Marburg 3-16 days.

The onset of the disease is acute, patients notice symptoms of hemorrhagic fever Marburg: high fever for 2 weeks, severe intoxication, headache, myalgia, pain in the lumbosacral region. On examination, conjunctivitis, enanthemu, vesicular-erosive changes in the oral mucosa, bradycardia are detected. Muscle tone is increased, palpation is painful. From 3-4 days of the course of the disease, vomiting and watery diarrhea result, leading to rapid dehydration of the body. On the 5th-6th day, the appearance of maculopapular rash is possible, followed by skin peeling. From 6-7 days, hemorrhagic manifestations are revealed in the form of cutaneous hemorrhage, nasal, gastrointestinal and other bleeding, as well as signs of hepatitis, myocarditis, and kidney damage. For the defeat of the central nervous system are characterized by adynamy, inhibition and meningism. At the end of the first week, signs of infectious-toxic shock, dehydration are revealed. Deterioration of the condition of patients occurs on the 8-10th day and on the 15-17th day of the course of the disease (sometimes ending lethal).

In the period of convalescence, which lasts 3-4 weeks, long-term diarrhea, severe asthenia, mental disorders and alopecia can occur.

Mortality and causes of death

On average, 25%, but can reach 50%. Causes of death: edema of the lungs and the brain, hypovolemic shock, acute renal failure, development of the syndrome of disseminated intravascular coagulation.

Complications of hemorrhagic fever Marburg

Hemorrhagic fever Marburg can be complicated by the following diseases : Hepatitis, myocarditis, orchitis with testicular atrophy, shock, transverse myelitis, uveitis; less often - pneumonia and psychosis.

[5], [6], [7]

Diagnosis of hemorrhagic fever Marburg

Clinical diagnosis of hemorrhagic fever Marburg is difficult due to the absence of pathognomonic symptoms. Epidemiological data (stay in areas with natural foci of Marburg fever, work with African monkey tissues, contact with patients) and the results of serological, virologic, and electron microscopic studies are of major importance.

[8], [9]

Specific and nonspecific laboratory diagnostics of hemorrhagic fever Marburg

Specific laboratory diagnosis of hemorrhagic fever Marburg is carried out using the same virological and serological methods (isolation of the culture of the virus, PCR, RNIF, ELISA, RN, RSK, etc.). As with the Ebola fever. In the deceased, the virus is detected by electron microscopy or by RNIF. All studies are conducted in the laboratory with the maximum level of protection.

Nonspecific laboratory diagnostics of hemorrhagic fever Marburg includes a general blood test (detect anemia, anisocytosis, poikilocytosis, basophilic granulosis of erythrocytes, leukopenia, a shift of the neutrophilic formula to the left, atypical lymphocytes, thrombocytopenia); biochemical blood test (increased activity of transferases, amylases, azotemia); definition of coagulogram (expressed hypocoagulation) and acid-base state of blood (show signs of decompensated metabolic acidosis); general urine analysis (typical of proteinuria).

Instrumental diagnosis of hemorrhagic fever Marburg

Radiography of the chest, ECG, ultrasound.

Differential diagnosis of hemorrhagic fever Marburg

Marburg fever differentiates from the same diseases as with Ebola fever (other hemorrhagic fevers, typhoparathyphoid diseases, malaria, septicemia, measles, meningococcal infectious disease).

[10], [11], [12], [13], [14]

Indications for consultation of other specialists

When conducting differential diagnosis with diseases that occur with a similar clinical picture or aggravate the course of hemorrhagic fever, consultations of the relevant specialists are required: gastroenterologist, nephrologist, neurologist, hematologist.

Indications for hospitalization

Patients with Marburg fever are subject to mandatory immediate hospitalization and strict isolation in a separate box.

Treatment of hemorrhagic fever Marburg

Mode, Diet

The patient needs strict bed rest and 24-hour medical supervision.

The diet corresponds to table number 4 according to Pevzner without restriction of the amount of proteins and table salt (NaCl).

Etiotropic treatment of hemorrhagic fever Marburg

Etiotropic treatment of hemorrhagic fever Marburg has not been developed.

[15], [16], [17],

Pathogenetic treatment of hemorrhagic fever Marburg

The pathogenetic treatment of Marburg hemorrhagic fever is of primary importance. It is aimed at combating dehydration, infectious-toxic shock, hemorrhagic syndrome. There are data on the effectiveness of serum convalescents, plasmapheresis and large doses of interferon.

Approximate terms of incapacity for work

In view of the severity of the disease, convalescents are considered incapacitated for several months after discharge from the hospital.

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Clinical examination

Clinical follow-up for those who have recovered is not regulated.

[22], [23], [24], [25], [26], [27]

Prevention of hemorrhagic fever Marburg

Specific prophylaxis of hemorrhagic fever Marburg

Not developed.

Nonspecific prophylaxis of hemorrhagic fever Marburg

Prevention of Marburg hemorrhagic fever consists in the identification of patients and their isolation in boxes, transportation of patients in transport isolators, the use of personal protective equipment against infection when working with patients, the implementation of WHO recommendations for the importation of monkeys and work with them. For emergency prophylaxis of Marburg fever, specific immunoglobulin is used.

Memo for the patient

It is recommended full-fledged nutrition using easily digestible products without special restrictions; compliance with the physical regime.

Forecast for hemorrhagic fever Marburg

Hemorrhagic fever Marburg has a serious prognosis. Mortality - 25%, death usually occurs on the 8-17th day of the course of the disease. The period of convalescence is protracted.