Monday, 16 February 2009

Marburg Hemorrhagic Fever

Given that there have been a recent reports of a case of Marburg hemorrhagic fever arriving in the USA, I thought I would make it the next pathogen top trump.

Marburg hemorrhagic fever is rare hemorraghic fever that affects both humans and non-human primates. Caused by a genetically unique zoonotic (that is, animal-borne) RNA virus of the filovirus family, after its identification in 1967 it led to the creation of this virus family. The More recent additions to the filovirus family include the four species of Ebola virus, which are the only other known members of the filovirus family.

Marburg was identified 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. The more recent outbreak Within the USA was due to the infected individual being infected from contaminated fruit bat droppings after visiting python cave in Maramagambo Forest, Queen Elizabeth Park, Uganda. Fruit bats are also believed to a vector for Ebola virus but a true animal reservoir has still to be identified. Marburg virus is indigenous to Africa. While the geographic area to which it is native is unknown, this area appears to include at least parts of Uganda and Western Kenya, and perhaps Zimbabwe.

There is a prolonged incubation period of 5-10 days, yet after incubation the onset of the disease is sudden and is marked by fever, chills, headache, and myalgia. After 5 days of being sypmtomatic, a maculopapular rash, most prominent on the trunk (chest, back, stomach), may occur. There may be one or all of the following symptoms; Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea. Symptoms will then become increasingly severe and may include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction. Marburg hemorrhagic fever is fatal in 23-25% of cases and there is no known cure or treatment other than the usual supportive hospital therapies.
After the infection has passed recovery is slow and prolonged and may be accompanied by the onset of orchititis, recurrent hepatitis, transverse myelitis or uvetis. Other possible complications include inflammation of the testis, spinal cord, eye, parotid gland, or by prolonged hepatitis.
Bausch DG, Borchert M, Grein T, Roth C, Swanepoel R, Libande ML, Talarmin A, Bertherat E, Muyembe-Tamfum JJ, Tugume B, Colebunders R, Kondé KM, Pirad P, Olinda LL, Rodier GR, Campbell P, Tomori O, Ksiazek TG, Rollin PE. (2003). Risk factors for Marburg hemorrhagic fever, Democratic Republic of the Congo. Emerging infectious diseases DOI: 14720391

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