Marburg hemorrhagic fever.

Marburg hemorrhagic fever is an acute zoonotic highly lethal viral disease, manifested by intoxication, pronounced phenomena of universal capillary toxicosis. Synonyms: cercopithecus hemorrhagic fever, green monkey disease, Marburg virus disease, Maridi hemorrhagic fever.

ICD-10 code

A98.3. Marburg virus disease.

Epidemiology of Marburg hemorrhagic fever

The reservoir of Marburg virus has not been reliably established at present. The source of the pathogen is monkeys, in particular African monkeys Cercopithecus aethiops. Mechanisms of pathogen transmission: aerosol, contact, artificial. Transmission routes: airborne, contact, injection. The virus is contained in blood, nasopharyngeal mucus, urine and sperm (up to 3 months). Infection of people occurs through direct contact with the blood and organs of monkeys, also through damaged skin (with injections, cuts), when the virus gets on the conjunctiva. A sick person is contagious to others. A case of sexual transmission of the pathogen has been described.

Human susceptibility to Marburg virus is high. Post-infection immunity is long-lasting. There is no information on recurrent infections.

The area of 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 periodicity of outbreaks have not been identified.

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What causes Marburg hemorrhagic fever?

Marburg hemorrhagic fever is caused by Marburgvirus of the genus Marburgvirus of the family Filoviridae. The viral particles are polymorphic (thread-shaped, spiral-shaped or round) with an average length of 790 nm and a diameter of 80 nm. They contain negative single-stranded RNA and lipoprotein. The virion contains 7 proteins. The protein composition of the Marburg virus is similar to that of the related Ebola filovirus, but has some differences. Strain-specific antigens are believed to be concentrated in the Gp protein region, and the group-specific antigen is in the Np protein region. Hemagglutinins and hemolysins have not been identified. The virus is isolated and passaged in vitro in continuous cultures of green monkey kidney cells (Vero) and in vivo in guinea pigs. Replication occurs in the cytoplasm of affected cells. The virus has moderate resistance to environmental factors.

Pathogenesis of Marburg hemorrhagic fever

The entry gates of Marburg hemorrhagic fever are damaged skin, mucous membranes of the oral cavity and eyes. Primary replication of the virus occurs in cells of the monocyte-macrophage lineage. Then viremia develops, accompanied by suppression of the immune system and generalized microcirculation disorders, which leads to the development of disseminated intravascular coagulation syndrome and multiple organ damage. Foci of necrosis and hemorrhage are found in the lungs, myocardium, kidneys, liver, spleen, adrenal glands and other organs.

Symptoms of Marburg hemorrhagic fever

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

The onset of the disease is acute, patients note the symptoms of Marburg hemorrhagic fever: high fever for 2 weeks, severe intoxication, headache, myalgia, pain in the lumbosacral region. During examination, conjunctivitis, enanthem, vesicular-erosive changes in the oral mucosa, bradycardia are detected. Muscle tone is increased, their palpation is painful. From the 3rd-4th day of the disease, vomiting and watery diarrhea occur, leading to rapid dehydration of the body. On the 5th-6th day, maculopapular rash may appear with subsequent peeling of the skin. From the 6th-7th day, hemorrhagic manifestations are detected in the form of skin hemorrhages, nasal, gastrointestinal and other bleeding, as well as signs of hepatitis, myocarditis, kidney damage. CNS damage is characterized by adynamia, inhibition, and meningism. At the end of the first week, signs of infectious-toxic shock and dehydration are detected. The patients' condition worsens on the 8th-10th day and on the 15th-17th day of the disease (sometimes ending fatally).

During the recovery period, which lasts 3-4 weeks, prolonged diarrhea, severe asthenia, mental disorders and baldness may occur.

Mortality and causes of death

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

Complications of Marburg hemorrhagic fever

Marburg hemorrhagic fever may be complicated by the following diseases: hepatitis, myocarditis, orchitis with testicular atrophy, shock, transverse myelitis, uveitis; less commonly, pneumonia and psychosis.

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Diagnosis of Marburg hemorrhagic fever

Clinical diagnosis of Marburg hemorrhagic fever is difficult due to the lack of pathognomonic symptoms. Epidemiological data (staying in areas with natural foci of Marburg fever, working with tissues of African monkeys, contact with patients) and the results of serological, virological, electron microscopic studies are of primary importance.

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Specific and non-specific laboratory diagnostics of Marburg hemorrhagic fever

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

Non-specific laboratory diagnostics of Marburg hemorrhagic fever include a complete blood count (revealing anemia, anisocytosis, poikilocytosis, basophilic granularity of erythrocytes, leukopenia, left shift in the neutrophil formula, atypical lymphocytes, thrombocytopenia); biochemical blood test (increased activity of transferases, amylase, azotemia); determination of the coagulogram (pronounced hypocoagulation) and acid-base balance of the blood (revealing signs of decompensated metabolic acidosis); complete urine analysis (proteinuria is characteristic).

Instrumental diagnostics of Marburg hemorrhagic fever

Chest X-ray, ECG, ultrasound.

Differential diagnosis of Marburg hemorrhagic fever

Marburg fever is differentiated from the same diseases as Ebola fever (other hemorrhagic fevers, typhoid-paratyphoid diseases, malaria, septicemia, measles, meningococcal infectious disease).

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Indications for consultation with other specialists

When conducting differential diagnostics with diseases that have a similar clinical picture or that aggravate the course of hemorrhagic fever, consultations with relevant specialists are necessary: 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 Marburg hemorrhagic fever

Regime, Diet

The patient requires strict bed rest and round-the-clock medical supervision.

The diet corresponds to table No. 4 according to Pevzner without limiting the amount of proteins and table salt (NaCl).

Etiotropic treatment of Marburg hemorrhagic fever

Etiotropic treatment for Marburg hemorrhagic fever has not been developed.

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Pathogenetic treatment of Marburg hemorrhagic fever

Petogenetic treatment of Marburg hemorrhagic fever is of primary importance. It is aimed at combating dehydration, infectious-toxic shock, hemorrhagic syndrome. There is evidence of the effectiveness of convalescent serum, plasmapheresis and high doses of interferon.

Approximate periods of incapacity for work

Taking into account the severity of the disease, convalescents are considered incapacitated for several months after discharge from the hospital.

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Clinical examination

There is no regulation for follow-up observation of those who have recovered from the disease.

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Prevention of Marburg hemorrhagic fever

Specific prophylaxis of Marburg hemorrhagic fever

Not developed.

Non-specific prophylaxis of Marburg hemorrhagic fever

Prevention of Marburg hemorrhagic fever consists of identifying patients and isolating them in boxes, transporting patients in transport isolators, using individual means of personal protection against infection when working with patients, following WHO recommendations for importing monkeys and working with them. Specific immunoglobulin is used for emergency prevention of Marburg fever.

Patient information sheet

It is recommended to eat a complete diet using easily digestible products without any special restrictions; adherence to a physical regimen.

Prognosis for Marburg hemorrhagic fever

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