Marburg virus disease, also known as Marburg hemorrhagic fever, is a severe illness with a high mortality rate. The responsible pathogen, Marburg virus, is a member of the filoviridae family along with the Ebola virus [1]. The first documented outbreak of this disease was in 1967 in Germany and Yugoslavia (which is currently known as Serbia) [2]. Outbreaks have also occurred between 1998 to 2000 in the Democratic Republic of Congo, Angola in 2004 to 2005 [3] [4] and most recently in Uganda in 2012. Additionally, there have been sporadic cases over the years. The African fruit bat acts as a reservoir for this zoonotic virus affecting human as well as non-human primates. The transmission occurs from human to human contact. The incubation period may range from 2 days to 3 weeks [5].

There are three stages of this illness, which are described as the 1) generalization phase, 2) early organ phase, and 3) late organ or convalescence phase [6]. The first phase lasts about 5 days and is characterized by a high fever, headache, chills, malaise, myalgia, and possibly nausea, emesis, watery diarrhea, abdominal pain, pharyngitis, conjunctivitis, and a rash [2] [7] [8]. As the illness progresses, the patient enters the early organ phase, which involves the liver, kidneys, and pancreas. It features neurological symptoms, impaired mental status, hematemesis, bloody diarrhea, and bleeding from other sites [2] [9]. The final phase is critical and often leads to death secondary to critical manifestations such as multiorgan failure, seizures, coagulopathy, cardiovascular collapse, and shock [1].

Physical exam

Assessment of the vital signs typically reveals fever, hypotension and other abnormalities. Also, the patient appears ill and exhibits mental status changes such as confusion, delirium, and dementia [1]. Other notable findings include conjunctival injection, pharyngitis, petechia, ecchymoses, and palatal exanthem. Bleeding from mucosal sites and orifices is observed in severe cases.

Patients presenting with the above symptoms warrant a thorough evaluation consisting of a detailed personal and travel/exposure history, physical exam, and the appropriate studies.

Laboratory tests

A complete blood count (CBC) and complete metabolic panel (CMP) including liver function tests (LFTs) will feature typical findings such as leukopenia, thrombocytopenia, and elevated liver transaminases. Furthermore, a coagulation panel and disseminated intravascular coagulation profile will reveal abnormalities about the patient's critical state.

Diagnostic tests

Viral detection studies such as reverse transcription polymerase chain reaction (RT–PCR) and enzyme-linked immunosorbent assay (ELISA) are the first-line tests [10]. In addition to conventional RT-PCR, quantitative real-time RT-PCR is also used [1] [11].

Other studies such as immunoglobulin (Ig) M and IgG ELISA are used to identify antibodies against the virus [1]. Moreover, IgM–capture ELISAs are commonly performed for the diagnosis of acute disease while IgG antibodies are used retrospectively post-disease [12]. Additionally, there is a promising future for the reverse transcription–loop–mediated isothermal amplification method in diagnosing Marburg virus [13].

There are two other techniques, virus isolation, and electron microscopy, but these are limited to specialized sites [1].

There is no specific antiviral treatment for Marburg Virus Disease. Management focuses on supportive care to maintain hydration, electrolyte balance, and blood pressure. Patients may require intensive care, including oxygen therapy and blood transfusions. Experimental treatments, such as monoclonal antibodies and antiviral drugs, are under investigation but are not yet widely available. Early supportive care can improve survival rates.

The prognosis for Marburg Virus Disease varies, with mortality rates ranging from 24% to 88%, depending on the outbreak and available medical care. Early diagnosis and supportive treatment can improve outcomes, but the disease remains highly lethal. Survivors may experience long-term complications, including fatigue, joint pain, and vision problems.

Marburg Virus Disease is caused by the Marburg virus, a zoonotic pathogen that is transmitted from animals to humans. The primary reservoir is the African fruit bat (Rousettus aegyptiacus), which can carry the virus without showing symptoms. Human infection occurs through direct contact with bat excreta or through handling infected animals. Human-to-human transmission occurs via contact with bodily fluids of infected individuals.

Marburg Virus Disease is primarily found in Africa, with outbreaks reported in countries such as Uganda, Angola, and the Democratic Republic of the Congo. The disease is rare, with sporadic outbreaks linked to specific regions. Factors contributing to outbreaks include human encroachment into bat habitats and inadequate healthcare infrastructure. Global travel and trade can facilitate the spread of the virus beyond endemic areas.

The Marburg virus enters the body through mucous membranes, breaks in the skin, or parenterally. Once inside, it targets immune cells, leading to widespread inflammation and immune system dysfunction. The virus causes damage to blood vessels, resulting in increased permeability and bleeding. Organ failure occurs due to direct viral damage and the body's inflammatory response, which can lead to shock and death.

Preventing Marburg Virus Disease involves minimizing exposure to the virus. This includes avoiding contact with fruit bats and infected animals, using protective equipment when handling potentially infected materials, and implementing strict infection control measures in healthcare settings. Public health education and surveillance are crucial in preventing and controlling outbreaks. Vaccines are under development but are not yet available for widespread use.

Marburg Virus Disease is a rare but deadly hemorrhagic fever caused by the Marburg virus. It presents with sudden onset of fever, muscle aches, and bleeding, progressing rapidly to severe illness. Diagnosis relies on specialized laboratory tests, and treatment focuses on supportive care. The disease has a high mortality rate, with prevention centered on reducing exposure to the virus and improving healthcare responses during outbreaks.

If you suspect exposure to Marburg Virus Disease, it is important to seek medical attention immediately. Symptoms can appear suddenly and progress rapidly, so early intervention is crucial. Avoid contact with bats and other potential carriers, and follow public health guidelines during outbreaks. While there is no specific treatment, supportive care can improve outcomes. Stay informed about the disease and follow preventive measures to protect yourself and others.

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