Marburg virus disease (MVD), earlier known as Marburg hemorrhagic fever, is a highly fatal illness caused by the Marburg virus, which belongs to the Filoviridae family. It was first identified in 1967 following simultaneous outbreaks of severe febrile illness associated with hemorrhage and shock in Marburg and Frankfurt am Main in Germany and in Belgrade, Yugoslavia.

1. Fruit bats (Pteropodidae family) are considered to be natural hosts of Marburg virus.
2. The virus is transmitted to humans from fruit bats or through direct contact with body (blood, saliva and urine) of an infected person or animal or through unsterile injections when infection control precautions are not strictly practiced and through contaminated surfaces and materials e.g. bedding, clothing.
3. Transmission of the virus via infected semen has been reported up to 7 weeks after clinical recovery.
4. People remain infectious as long as their blood contains the virus
5. The virus can survive for several days on contaminated surfaces.
6. The case fatality rates vary from 24% to as high as 88% (average 50%).
7. The incubation period is 2-21 days.
8. Clinically, the disease presents with a sudden onset of high fever, severe headache, severe malaise and myalgia. On the third day of illness, severe watery diarrhea, abdominal pain and cramping, nausea and vomiting may occur. Patients are described as “ghost-like” characterized by drawn features, deep-set eyes, expressionless faces and extreme lethargy. A maculopapular rash may also occur.

Hemorrhage manifestations appear between 5^th and 7^th day of illness. Bleeding may occur from multiple sites – GIT, nose, gums, vagina and venepuncture sites.

Death occurs after 8-9 days of onset of illness, which is usually ascribed to severe blood loss and shock.

1. Marburg virus disease may be difficult to differentiate from other hemorrhagic fevers and other infectious diseases such as malaria, typhoid fever, shigellosis, meningitis.
2. Diagnosis in a clinically suspected patient of Marburg virus disease can be confirmed by antigen-capture enzyme-linked immunosorbent assay (ELISA), IgM ELISA, RT-PCR, serum neutralization test, electron microscopy and virus isolation by cell culture.
3. There is no specific treatment for the disease. Hence, treatment is mainly supportive i.e. rehydration with oral or intravenous fluids and treatment of specific symptoms.
4. The virus may persist in the testicles and the inside of the eye in some people who have survived the infection.
5. Preventive measures against Marburg virus infection are not well-defined, as transmission from wildlife to humans remains an area of ongoing research. However, avoiding fruit bats, and sick non-human primates in endemic areas may protect against acquiring the infection.
6. Barrier nursing techniques must be adopted when managing a suspected or confirmed case of Marburg virus disease, which include personal protective equipment, isolation of the patient, proper disposal of needles, equipment, and patient excretions.

(Source: Uptodate, WHO, CDC)

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA