First-ever Marburg virus infection outbreak in Equatorial Guinea
Equatorial Guinea has confirmed its first-ever outbreak of Marburg virus infection. Nine cases have been reported including one confirmed case, four probable cases, and four suspected cases (as of 21 February 2023). Further investigations are ongoing. So far, all cases have been detected in the Kie-Ntem province.
Marburg virus infection is often fatal, with death occurring in approximately 70% of cases, although case fatality rates of 23% to 100% (in smaller outbreaks) have been reported. There are no vaccines or antivirals approved to treat the infection, but supportive care improves the chances of survival. Various vaccines and therapeutics are currently in development.
Marburg virus infection is a notifiable condition. High-level isolation precautions must be used when infection is suspected. Highly infectious and transmissible person-to-person by contact with body fluids, contaminated objects, and corpses.
Endemic to East and Central Africa and associated with fruit bat, cave, and mining exposure, or close contact with infected persons in the last 21 days.
Most common presentation includes high fever and headache, often with gastrointestinal symptoms (nausea/vomiting). Signs of bleeding are rare and associated with late disease.
Diagnosis is made by reverse transcriptase polymerase chain reaction (RT-PCR) from blood or buccal (oral) swab, often by a reference laboratory. A positive test confirms current infection, but a negative test does not rule out infection until symptoms have been present for at least 72 hours.
There is no specific treatment; historical fatality rates have been high and, based on recent experience with Ebola, may be improved with aggressive supportive care and fluid resuscitation.
A rare but severe, zoonotic infection caused by an RNA virus of the Filoviridae family (genus Marburgvirus). There are two strains of the virus, Marburg virus (MARV) and Ravn virus (RAVV). It is related to, but distinct from, Ebola virus infection. Marburg virus was discovered in 1967 after simultaneous outbreaks in several European laboratories, including one in Marburg, Germany.
Marburg virus infection is part of the group of conditions known as viral haemorrhagic fevers. Since Marburg virus infection presents with similar features to Ebola virus infection, and because there is more information published on Ebola virus infection, some general statements and conclusions on the best type of care for Marburg virus infection are based on current knowledge of Ebola.
Also known as Marburg virus disease and Marburg haemorrhagic fever.
BMJ talk medicine podcast: Marburg virus Opens in new window
History and exam
Key diagnostic factors
- exposure to Marburg virus in previous 21 days
Other diagnostic factors
- severe headache
- abdominal pain
- sore throat
- maculopapular rash
- difficulty breathing
- neurological signs
- living or working in, or arrival from, endemic area in previous 21 days
- contact with infected body fluids
- occupational exposure
1st investigations to order
- reverse transcriptase polymerase chain reaction (RT-PCR)
- malaria investigations
Investigations to consider
- serum electrolyte levels
- serum creatinine and urea
- blood lactate
- coagulation studies
- serum amylase level
- blood cultures
- antigen-capture enzyme-linked immunosorbent assay (ELISA)
- IgG antibodies
Lisa Bebell, MD
Infectious Diseases Division
Massachusetts General Hospital
LB is the author of a reference cited in this topic.
Mark Kortepeter, MD, MPH
Professor of Epidemiology
University of Nebraska Medical Center
MK declares that he has no competing interests.
Vanessa Raabe, MD, MSc
Adult and Pediatric Infectious Disease Fellow
VR declares that she has no competing interests.
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