Context: The deadly Marburg virus could overwhelm Rwanda’s fragile healthcare system. Since the east African country reported the first Marburg case late last month, at least 46 individuals have been infected and 12 Marburg deaths reported.
About Marburg virus
- Marburg virus is the causative agent of Marburg virus disease (MVD), a genetically unique zoonotic RNA virus.
- MVD is a severe hemorrhagic fever similar to Ebola. Marburg and Ebola viruses are both members of the Filoviridae family (filovirus). Though caused by different viruses, the two diseases are clinically similar. Both diseases are rare and have the capacity to cause outbreaks with high fatality rates ranging from 24% to 88% in past outbreaks.
- The first known outbreak of the virus occurred in 1967 in Marburg, Germany, hence the name and in Belgrade, Serbia, when laboratory workers were exposed to infected monkeys imported from Uganda. Since then, other outbreaks have occurred, primarily in Africa.
Transmission:
- Initially, human MVD infections were caused by prolonged exposure to mines or caves inhabited by colonies of Rousettus bats, most notably the Egyptian fruit bat.
- According to the World Health Organization (WHO), Marburg also spreads through human-to-human transition both directly (through contact with blood and other bodily fluids of infected people) and indirectly (through surfaces and materials like bedding, clothing, etc. contaminated with these fluids).
Symptoms:
- The incubation period ranges from 2 to 21 days, and symptoms include high fever, severe headache and severe malaise. Muscle aches and pains are a common feature.
- Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting can begin on the third day. Diarrhoea can persist for a week. The appearance of patients at this phase has been described as showing “ghost-like” drawn features, deep-set eyes, expressionless faces, and extreme lethargy.
- Many patients develop haemorrhagic symptoms (bleeding), often in many places including the digestive system (faeces and vomit often come with fresh blood), the nose, gums, and vagina. Haemorrhage leads to most MVD fatalities, with death in fatal cases occurring 8 to 9 days after the onset of symptoms, usually of severe blood loss and shock.
Diagnosis
- It can be difficult to clinically distinguish MVD from other infectious diseases such as malaria, typhoid fever and other viral haemorrhagic fevers.
- Confirmation that symptoms are caused by Marburg virus infection are made using the antibody-capture enzyme-linked immunosorbent assay (ELISA), antigen-capture detection tests, serum neutralization test, reverse transcriptase polymerase chain reaction (RT-PCR) assay, electron microscopy and virus isolation by cell culture.
Treatment:
- There is no specific antiviral treatment or vaccine available for Marburg virus disease. Treatment primarily involves supportive care like rehydration, pain management, and treating symptoms.