Marburg Virus Infection
Marburg virus causes severe hemorrhagic fever: In a 1967 outbreak in Marburg, Germany, mortality rates reached 23%. Hemorrhagic fevers caused by Ebola and Marburg are considered the most severe viral hemorrhagic fevers, with overall 25% to 100% mortality rates. Hemorrhage and widespread necrosis, varying from mild to massive, occur in many organs. Effusions may occur in serous cavities as well. The systems most commonly involved are the liver, lung, and lymphoid systems. Usually the lung shows varying degrees of interstitial pneumonitis, diffuse alveolar damage, and hemorrhage. Acute tubular necrosis and microvascular thrombosis may also be observed.
Marburg virus belongs to the Filoviridae family of viruses. The vector is unknown, but the infection is thought to be spread by direct contact with infected patients, their blood, or their secretions or excretions. Aerosol transmission is suspected. Animal reservoirs may be primates; in other types of hemorrhagic fevers, rats, mice, domestic livestock, and monkeys serve as intermediate hosts.
Complications of Marburg virus infection include myalgia and arthralgia, headache, fatigue, bulimia, amenorrhea, hearing loss, tinnitus, unilateral orchitis, and suppurative parotitis. Hemorrhagic fever commonly produces ocular pain, photophobia, increased lacrimation, and decreased visual acuity. Late complications include uveitis, transverse myelitis, and recurrent hepatitis.
Initial symptoms begin after an incubation of 2 to 14 days and may include progressive fever (that may be biphasic), chills, malaise, generalized myalgia and arthralgia, headache, anorexia, cough, severe sore throat, epigastric pain, vomiting, and diarrhea. On about the fifth day of illness, a distinct morbilliform rash develops on the trunk and the patient may exhibit an expressionless ghostlike facies. Patients with progressive disease hemorrhage from mucous membranes, venipuncture sites, and body orifices, with disseminated intravascular coagulation (DIC) a feature of late disease.
Typical findings on examination may include conjunctival injection, facial and truncal flushing, petechiae, purpura, ecchymoses, icterus, epistaxis, GI and genitourinary bleeding, and lymphadenopathy. In severe hemorrhagic fever, hypotension and shock occur, as well as bradycardia, pneumonitis, pleural and pericardial effusions, hemorrhage, encephalopathy, seizures, coma, and death.