What is Marburg Hemorrhagic Fever?

Marburg hemorrhagic fever is a rare, severe type of hemorrhagic fever which affects both humans and non-human primates. Caused by a genetically unique zoonotic (that is, animal-borne) RNA virus of the filovirus family, its recognition led to the creation of this virus family. The four species of Ebola virus are the only other known members of the filovirus family.

The virus is believed to be transmitted from an unknown animal host to humans. Humans may spread the virus to others through extremely close contact with a patient and body fluid (blood, faeces, vomitus, urine, saliva, sweat, respiratory secretions). Close contact with a severely ill patient, during care at home or in hospital, and certain burial practices are common routes of infection. Transmission through needle-stick injuries is associated with more severe disease, rapid deterioration, and possibly higher fatality. Humans may also be infected after close contact with infected primates or their body fluids.

Marburg virus was first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany and in Belgrade, Yugoslavia (now Serbia). A total of 37 people became ill; they included laboratory workers as well as several medical personnel and family members who had cared for them. The first people infected had been exposed to African green monkeys or their tissues. In Marburg, the monkeys had been imported for research and to prepare polio vaccine.

Patients who are at greatest risk of dying experience diffuse or extensive hemorrhage into the skin, mucous membranes, internal organs, stomach, and intestines.  Swelling of the spleen, lymph nodes, kidneys, sometimes pancrease, and especially brain occurs.  Patients finally experience coma and convulsions, followed by death.  Death from shock usually occurs 6-9 days after clinical onset of symptoms.

Marburg haemorrhagic fever is a severe and highly fatal disease caused by a virus from the same family as the one that causes Ebola haemorrhagic fever. These viruses are among the most virulent pathogens known to infect humans. Both diseases are rare, but have a capacity to cause dramatic outbreaks with high fatality. Illness caused by Marburg virus begins abruptly, with severe headache and severe malaise. Many patients develop severe haemorrhagic manifestations between days 5 and 7, and fatal cases usually have some form of bleeding, often from multiple sites.

Symptoms of Marburg hemorrhagic fever (MHF), to summarize the treatments applied, and to assess the quality of clinical documentation. Surveillance and clinical records of 77 patients with MHF cases were reviewed. Initial symptoms included fever, headache, general pain, nausea, vomiting, and anorexia (median day of onset, day 1-2), followed by hemorrhagic manifestations (day 5-8+), and terminal symptoms included confusion, agitation, coma, anuria, and shock. Treatment in isolation wards was acceptable, but the quality of clinical documentation was unsatisfactory. Improved clinical documentation is necessary for a basic evaluation of supportive treatment.

There is no drug treatment or vaccination for MHF. Generally, patients receive supportive therapy which consists of balancing the patient’s fluids and blood chemistries, maintaining their oxygen status and blood pressure, and treating them for any complicating infections. Sometimes treatment also has used transfusion of fresh-frozen plasma and other preparations to replace the blood proteins important in clotting. One controversial treatment is the use of heparin (which blocks clotting) to prevent the consumption of clotting factors. Some researchers believe the consumption of clotting factors is part of the disease process.