MARBURG VIRUS: WHAT WE KNOW SO FAR
The Marburg virus is the causative agent of the rare and highly fatal Marburg virus disease (MVD). The first two MVD outbreaks occurred in Marburg and Frankfurt in Germany and Belgrade, Serbia.
So far, Marburg virus disease outbreaks have been reported in Uganda, Kenya, Angola, the Democratic Republic of Congo, South Africa, and, more recently, Ghana.
The initial symptoms of illness caused by the Marburg virus include high fever, severe headaches, muscle aches, and body pain. As the disease progresses, patients may experience severe diarrhea, abdominal pain, nausea, vomiting, a rash, and some form of bleeding.
Currently, there is no cure or vaccine for Marburg virus disease; however, patient support through rehydration and symptom treatment can increase the chances of survival.
Continue reading to learn more about Marburg virus disease, how it originated, how it spreads, its symptoms, diagnosis, and treatment.
What Is the Marburg Virus?
The Marburg virus (MARV) is an RNA virus belonging to the Filoviridae family of viruses, which also includes the Ebola virus. It causes Marburg virus disease, previously known as Marburg hemorrhagic fever, in primates (mammals including humans, monkeys, and apes).
The Marburg virus disease (MVD) is a rare but severe form of viral hemorrhagic fevers (VHFs) - a group of infectious diseases that damage the body’s blood vessels, causing bleeding and reduced clotting ability.
The world health organization (WHO) has labeled this virus as “epidemic-prone” – if not prevented, it can easily spread throughout a population.
MVD has a case fatality rate as high as 88% – meaning almost 88% of the people diagnosed with Marburg virus disease die from it. However, more recently, good patient care decreased the case fatality rate from MVD to around 50%.
How Did Marburg Virus Disease Originate?
In August 1967, two large Marburg virus outbreaks took place simultaneously in Marburg and Frankfurt in Germany and Belgrade, Serbia (previously Yugoslavia). The virus was named after Marburg city since it had the most MVD cases and was the first to isolate a filovirus.
These outbreaks were traced to laboratories researching African green monkeys (Cercopithecus aethiops) imported from Uganda. The first reported cases of a Marburg virus infection were in researchers exposed to the Ugandan imported African green monkey or its tissues.
31 laboratory workers in Marburg, Frankfurt, and Belgrade were infected with the then unknown Marburg virus and developed severe disease. 7 of the 31 patients eventually died from the illness.
Later, other outbreaks and isolated cases were reported in Uganda, Kenya, Angola, the Democratic Republic of Congo, and South Africa.
More recently, in July 2022, WHO announced the first outbreak of Marburg virus disease in West African Ghana.
What Are the Symptoms Of Marburg Virus Disease?
The incubation period of the Marburg virus can last between 2 to 21 days (typically 5 to 10 days). After infection, it can take between 2 to 21 days before symptoms arise.
Sickness from Marburg virus starts suddenly with:
- High fever
- Severe headache
- Severe Malaise (general feeling of being sick)
Other common symptoms of Marburg virus disease include:
- Muscle aches
- Body pains
On the third day, patients may start experiencing the following MVD symptoms:
- Severe watery diarrhea (that can persist for a week)
- Abdominal pain and cramps
- Nausea and vomiting
2-5 days after the onset of initial symptoms, patients may develop a non-itchy rash, mainly on the chest and back.
Between days 5-7, many patients start to develop severe hemorrhagic manifestations (forms of bleeding), such as:
- Bloody vomit
- Blood in the stool
- Nose bleeds
- Vaginal bleeds
- Bleeding from the gums
- Bleeding at the site of a needle puncture
Fatal Marburg hemorrhagic fever cases usually have some form of bleeding.
During the severe phases of MVD, patients usually exhibit a persistent high fever that might be accompanied by:
- Confusion
- Irritability
- Aggression
- Inflammation of one or both testicles (Orchitis) – occasionally reported 15 days into the illness
Death from Marburg virus illness often happens 8-9 days after the onset of symptoms, usually preceded by severe blood loss and shock due to severe fluid loss.
How Do You Get the Marburg Virus?
The natural host for the Marburg virus is the Egyptian fruit bat (Rousettus aegyptiacus) found in Africa, the Middle East, the Mediterranean, and the Indian subcontinent – the virus can attach to and infect the cells of this species of bats.
The Marburg virus can be transmitted from a fruit bat to a person and then spread among people through human-to-human transmission.
Most human Marburg hemorrhagic fever infections result from the prolonged exposure of tourists or researchers to mines or caves inhabited by fruit bat colonies. Most likely, the Marburg virus first spread through unprotected contact between a person and an infected bat’s feces or aerosols.
The Marburg virus then spreads among humans by direct contact (through broken skin or the mouth, nose, or eyes) with the:
- Blood of an infected person
- Secretions of an infected person (saliva, urine, feces, sweat, mucus, semen)
- Organs of an infected person
- Other bodily fluids of an infected person (breast milk, vomit, amniotic fluid)
- Surfaces and material (e.g., clothes, bedsheets, needles, medical equipment) contaminated with the fluids of an infected person
- Semen of a male who has already recovered from Marburg disease
Moreover, direct contact with the dead body of an infected person, during burial ceremonies, for example, can also contribute to the transmission of the Marburg virus.
In brief, Marburg virus infection can occur by:
- Being exposed to a fruit bat carrying the Marburg virus
- Coming in contact with a person infected with the Marburg virus
- Coming in contact with material contaminated with the bodily fluids of a person infected with the Marburg virus
Nevertheless, people infected with MARV typically do not spread the disease while the virus is still incubating – they usually do not become contagious until symptoms develop.
How Is Marburg Virus Diagnosed?
The Marburg virus disease shares the same clinical symptoms as other infectious diseases such as Ebola, Malaria, Typhoid fever, shigellosis, and meningitis. Therefore, it can be challenging to diagnose a Marburg virus infection by clinical symptoms alone.
The following diagnostic methods can help confirm a Marburg virus infection:
- ELISA (Antibody-capture Enzyme-Linked ImmunoSorbent Assay)
- RT-PCR assay (Reverse transcriptase real-time polymerase chain reaction assay)
- Serum neutralization test
- Antigen-capture detection tests
- Electron microscopy
- Virus isolation by cell culture
How Do You Treat Marburg Virus Disease?
There are currently no approved antiviral treatments or vaccines for Marburg virus disease.
Nonetheless, the survival rates can be improved by providing patients with supportive care through:
- Rehydration with oral or intravenous (IV) fluids
- The treatment of specific symptoms such as fever
Although MVD cannot be cured yet, there are vaccines and antivirals for Ebola virus disease (EVD) that can also be tested for Marburg virus disease.
- Remdesivir and Favipiravir are monoclonal antibodies used in clinical studies as antivirals for EVD and can also be tested for MVD.
- Zabdeno and Mvabea are two EMA-authorized Ebola virus vaccines that could potentially protect against MVD. However, clinical trials to prove their efficacy are needed.
Is the Marburg Virus the Same As Ebola?
Marburg and Ebola are two different viruses belonging to the Filoviridae virus family.
The diseases caused by these two viruses are clinically similar. Both the Marburg virus disease and Ebola virus disease are rare, share common symptoms, and can cause outbreaks with high death rates.
Nevertheless, the Ebola virus is slightly more contagious than the Marburg virus.
FAQs
How long does the Marburg virus survive on surfaces? Research has shown that the Marburg virus can survive up to 4-5 days on contaminated surfaces. Whereas it can only last around a minute suspended in the air. Therefore, to catch the Marburg virus from another person, you would have to be in relatively close contact with the infected individual.
How long do you have to stay away from someone with Marburg? It is usually safe to have face-to-face contact with a person previously infected with the Marburg virus after they have recovered from all their symptoms and/or tested negative for the virus. However, MARV can persist in patients who have recovered from MVD in their amniotic fluid, breast milk, placenta, fetus, and semen. The transmission of Marburg virus disease through infected semen can happen up to 7 weeks after the patient has recovered from clinical symptoms.
Is there a PCR test for the Marburg virus? Polymerase chain reaction (PCR), ELISA, and IgM-capture ELISA testing can all be performed after the onset of symptoms to confirm a Marburg virus disease diagnosis.
Is the Marburg virus a DNA or RNA virus? The Marburg virus (MARV) is a highly pathogenic virus belonging to the nonsegmented negative-strand RNA viruses of the Filoviridae family.
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