View source for Marburg virus disease

==Background==
*Also known as Marburg [[Viral hemorrhagic fevers|hemorrhagic fever]]
*RNA virus of the [[Filovirus|filovirus]] family
**The 5 species of Ebola are the other 5 members of the family 
*First outbreak, 1967, in Marburg and Frankfurt Germany - due to research on African green monkeys
*Reservoir: Egyptian fruit bat (''Rousettus aegyptiacus'')

===Transmission===
*Host animal to human - most outbreaks have implicated contact with bats as the source<ref name="Pigott">Pigott DM, Golding N, Mylne A, et al. Mapping the zoonotic niche of Marburg virus disease in Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2015;109(6):366-378. doi:10.1093/trstmh/trv024.</ref>
**No documented cases of primate-human transmission outside laboratory setting
*Human to human: direct contact with droplets of body fluid or contaminated objects
**Humans can transmit the virus as soon as they are febrile.<ref name="Martines">Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses. J Pathol. 2015 Jan;235(2):153-74. doi: 10.1002/path.4456.</ref>

==Clinical Features==
*Incubation period: 2-21 days (5-7 days more common)<ref name="Bebell">Bebell LM, Riley LE. Ebola virus disease and Marburg disease in pregnancy: a review and management considerations for filovirus infection. Obstet Gynecol. 2015 Jun;125(6):1293-8. doi: 10.1097/AOG.0000000000000853.</ref>
*Initial symptoms are vague:
**High fever, headache, chills, myalgias, abdominal pain, diarrhea
**Maculopapular rash, typically on the trunk, around 5 days after symptom onset
*Massive hemorrhage, shock, and multiorgan system failure
*Death usually occurs 1-2 weeks after symptom onset<ref name="Bebell" /> (23-90% fatal<ref name="Knust">Knust B, Schafer IJ, Wamala J, et al. Multidistrict Outbreak of Marburg Virus Disease-Uganda, 2012. J Infect Dis. 2015 Jul 23. pii: jiv351.</ref>)
**Patients alive at 2 weeks after symptom onset usually survive

==Differential Diagnosis==
===Fever in Traveler===
*'''Normal causes of acute [[fever]]!'''
*[[Malaria]]
*[[Dengue]]
*[[Leptospirosis]]
*[[Typhoid Fever]]
*[[Typhus]]
*[[Viral Hemorrhagic Fevers]]
**[[Ebola]]
**[[Lassa fever]]
**[[Marburg]]
*[[Chikungunya]]
*[[Yellow fever]]
*[[Rift Valley Fever]]
*[[Q fever]]

==Evaluation==
*Difficult diagnosis and very rare/unlikely outside of Central Africa
*Consider Marburg with typical symptoms and high risk exposure including:
**Close contact with African fruit bats, infected humans, infected non-human primates
**Lab researcher using African primates
**Recent travel to Uganda or other Central African countries
**Cave exploration in Africa

===Work-up===
*PCR and IgM ELISA for acute infection several days after symptom onset.<ref name="Bebell" />
*IgG ELISA can be used later in the course of disease.

==Management==
*Aggressive supportive care is the hallmark of management<ref name="Bebell" />
*Strict [[Isolation precautions]]: standard, contact and droplet<ref name="CAHealth">California Health Alert Network. Alert Id: 35317. 9/10/2014</ref> 
**Limit entry and maintain a log of people who enter the room
*Notify public health personnel
*Continue to test and treat for other possible diseases

==Disposition==
*Admit to ICU

==See Also==
*[[Ebola virus disease]]
*[[Viral hemorrhagic fevers]]
*[[Fever in traveler]]
*[[Travel medicine]]

==External Links==
*[http://www.cdc.gov/vhf/marburg/index.html CDC Marburg Site]

==References==
<references/>

[[Category:ID]]
[[Category:Tropical Medicine]]