Marburg and Ebola virus disease

Marburg and Ebola virus disease

Marburg and Ebola virus disease

Marburg and Ebola virus diseaseThese viruses also cause VHF. They are members of thefiloviridae. Marburg was first recognized in 1967 as causingan outbreak among staff at a laboratory in Marburg,Germany, as a result of handling a recently arrived shipmentof African green monkeys from Uganda. There werealso cases in former Yugoslavia as a result of exposure tomonkeys from the same shipment. The next outbreakswere of Ebola virus infection. These occurred in southernSudan and in what was then Zaire in 1976; despite thesimilar temporal occurrence these outbreaks were causedby different strains of the same virus. Subsequently therehave been outbreaks in Sudan, Gabon, Cote d'lvoire andZaire. There were also outbreaks of disease in non-humanprimates.Epidemiology and transmissionNo reservoir has been identified for filovirus infection,though it is likely to be an animal. Chimpanzees and arange of monkey species die of the disease and so are notthe reservoir. The average incubation period in one outbreakwas 7 days. During the 7 months of the outbreak80% died, with a decline in mortality over the 7 months.The mean duration from onset of disease to death was 10days. A quarter of all the cases were healthcare workersand this was largely due to contact with blood and bodyfluids. Reuse of contaminated needles and instruments andnot wearing gloves for procedures were also factors innosocomial transmission. Direct contact with body fluidsfrom patients and with the bodies of dead patients wereadditional factors in transmission. Aerosol transmissionwas not thought to be a major factor. Subclinical infectionis very uncommon. Seropositivity rates were only 2% inthe nearby town and 9% in surrounding villages.Clinical featuresThree manifestations present relatively early in the courseare conjunctival injection, a maculopapular rash, and sorethroat with marked pain on swallowing. Severe musclepain is often present. The rash appeared towards the endof the first week on flanks and in inguinal and axillary regions, then rapidly spread to cover the whole body apartfrom the face over hours. This is evident on white skins butnot on black skins. Bleeding from mucosae and puncturesites, anuria, hiccup and tachypnoea were features indicating that death was likely in days, with defervescence overthe last 2 days before death. Fever, asthenia, nausea,vomiting and diarrhoea - often dysenteric - and headachewere additional common symptoms.DiagnosisIntense viraemia is the rule in cases, and so antigen detection using ELISA-based technology is the most valuable diagnostic technique, particularly when processing large numbers of samples. Serology, PCR and virus isolation areother methods for diagnosis.ManagementThis is essentially supportive. Paracetamol and not aspirin should be used as antipyretic. Fluid intake and nutritionshould be maintained and blood transfusion given wherethere is anaemia. In an endemic situation there may bevery little that can be offered, and the major efforts needto go into protecting healthcare workers and family members from infection by caring for cases in hospital with strict barrier nursing precautions and attention to disinfection. No antiviral agents are effective in this infection.

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