Marburg virus infection
- Overview
- Theory
- Diagnosis
- Management
- Follow up
- Resources
Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
all patients
isolation and infection prevention and control
Once the diagnosis is suspected, patient isolation is a critical first step to prevent nosocomial transmission.[22]World Health Organization. Infection prevention and control guideline for Ebola and Marburg disease. Aug 2023 [internet publication]. https://www.who.int/publications/i/item/WHO-WPE-CRS-HCR-2023.1 [23]Centers for Disease Control and Prevention. Marburg (Marburg virus disease). Jun 2023 [internet publication]. https://www.cdc.gov/vhf/marburg
Infection prevention and control (IPC) is of immediate concern and local protocols should be followed. As soon as a clinician decides Marburg virus disease is a possible diagnosis for their patient’s illness, high-level precautionary isolation procedures and personal protective equipment (PPE) should be used until the infection is either confirmed or excluded. It is extremely important to minimise the risk of transmission while working up the patient.[21]Fletcher TE, Brooks TJ, Beeching NJ. Ebola and other viral haemorrhagic fevers. BMJ. 2014 Aug 11;349:g5079. http://www.bmj.com/content/349/bmj.g5079 http://www.ncbi.nlm.nih.gov/pubmed/25113010?tool=bestpractice.com Although 'wet symptoms' such as vomiting/diarrhoea may increase transmission risk, Marburg virus should be considered highly infectious and high-level precautions should be used regardless of symptoms at presentation.
The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) produce detailed guidance on IPC in healthcare settings:
WHO: infection prevention and control guideline for Ebola and Marburg disease Opens in new window
CDC: personal protective equipment (PPE) Opens in new window
Once a diagnosis of Marburg virus disease is suspected and isolation is initiated, a provider should wear full PPE and collect 4mL whole blood in a non-heparinised, preservative-coated tube, and refrigerate or freeze immediately for shipment to a reference lab. Outside of North America and Europe, either reverse transcriptase PCR (RT-PCR) blood tests or oral swabs are used to detect Marburg virus RNA.[43]Kurosaki Y, Magassouba N, Oloniniyi OK, et al. Development and evaluation of reverse transcription-loop-mediated isothermal amplification (RT-LAMP) assay coupled with a portable device for rapid diagnosis of Ebola virus disease in Guinea. PLoS Negl Trop Dis. 2016 Feb 22;10(2):e0004472. http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004472 http://www.ncbi.nlm.nih.gov/pubmed/26900929?tool=bestpractice.com These tests may return within a few hours or days depending on whether a local or reference lab is used. At this time, providers should consider obtaining good intravenous access with careful central catheter placement (where possible) or multiple peripheral intravenous catheters.[33]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. http://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com
Laboratory testing for possible differential diagnoses, malaria testing, FBC, renal function and electrolytes, and blood lactate level should be sent as soon as intravenous access is obtained, where possible.[33]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. http://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com [44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com
fluid and electrolyte management
Treatment recommended for ALL patients in selected patient group
Initial vital signs should guide initial treatment. Fluid resuscitation is the main supportive treatment, and in patients who have significant gastrointestinal volume loss, massive fluid repletion with strict attention to repleting ongoing losses may be required.[4]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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443859 http://www.ncbi.nlm.nih.gov/pubmed/26000499?tool=bestpractice.com [32]Leligdowicz A, Fischer WA 2nd, Uyeki TM, et al. Ebola virus disease and critical illness. Crit Care. 2016 Jul 29;20(1):217. http://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1325-2 http://www.ncbi.nlm.nih.gov/pubmed/27468829?tool=bestpractice.com [42]Clark DV, Jahrling PB, Lawler JV. Clinical management of filovirus-infected patients. Viruses. 2012 Sep;4(9):1668-86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499825 http://www.ncbi.nlm.nih.gov/pubmed/23170178?tool=bestpractice.com Adult patients usually require ≥ 5-10L/day of intravenous or oral fluids to maintain circulating blood volume in the setting of ongoing gastrointestinal loss.[33]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. http://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com
Monitoring and aggressive correction of potassium levels, acid-base disturbances, and other electrolyte abnormalities can help prevent life-threatening arrhythmias and metabolic complications.
General principles of management for children with Marburg or Ebola virus disease are the same as for adults, with a focus on supportive care and volume resuscitation.[52]Eriksson CO, Uyeki TM, Christian MD, et al. Care of the child with Ebola virus disease. Pediatr Crit Care Med. 2015 Feb;16(2):97-103. http://www.ncbi.nlm.nih.gov/pubmed/25647119?tool=bestpractice.com Care providers in the 2014 to 2016 West Africa Ebola virus outbreak advocate liberal use of oral rehydration solution (ideally flavoured to improve intake), and early, aggressive parenteral fluid resuscitation, even among those who are apparently well-hydrated.[53]Trehan I, Kelly T, Marsh RH, et al. Moving towards a more aggressive and comprehensive model of care for children with Ebola. J Pediatr. 2016 Mar;170:28-33.e1-7. http://www.sciencedirect.com/science/article/pii/S0022347615014663?np=y http://www.ncbi.nlm.nih.gov/pubmed/26778094?tool=bestpractice.com Obtaining intravenous access may be easiest at time of admission, before further fluid losses make vascular access difficult, and a second intravenous line should be considered in 'wet' patients with active vomiting or diarrhoea.[53]Trehan I, Kelly T, Marsh RH, et al. Moving towards a more aggressive and comprehensive model of care for children with Ebola. J Pediatr. 2016 Mar;170:28-33.e1-7. http://www.sciencedirect.com/science/article/pii/S0022347615014663?np=y http://www.ncbi.nlm.nih.gov/pubmed/26778094?tool=bestpractice.com Intra-osseous and subcutaneous routes of fluid resuscitation may be necessary in children unable to tolerate oral or intravenous rehydration.[53]Trehan I, Kelly T, Marsh RH, et al. Moving towards a more aggressive and comprehensive model of care for children with Ebola. J Pediatr. 2016 Mar;170:28-33.e1-7. http://www.sciencedirect.com/science/article/pii/S0022347615014663?np=y http://www.ncbi.nlm.nih.gov/pubmed/26778094?tool=bestpractice.com
analgesia/antipyretic
Treatment recommended for ALL patients in selected patient group
Should be treated with paracetamol first line (for pain and fever).[45]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. Feb 2016 [internet publication]. http://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
Opioid analgesics (e.g., morphine) are preferable for more severe pain.[45]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. Feb 2016 [internet publication]. http://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
Non-steroidal anti-inflammatory drugs (including aspirin) should be avoided due to their associated increased risk of bleeding and potential for nephrotoxicity.
Primary options
paracetamol: children: 10-15 mg/kg orally/rectally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 500-1000 mg orally/rectally every 4-6 hours when required, maximum 4000 mg/day
Secondary options
morphine sulfate: children: 0.2 to 0.4 mg/kg orally every 4-6 hours when required, or 0.05 to 0.1 mg/kg intravenously every 4-6 hours when required; adults: 2.5 to 10 mg orally/intravenously every 4 hours when required
antimalarial treatment
Treatment recommended for ALL patients in selected patient group
Empiric artesunate-based antimalarial treatment is recommended for all patients with suspected filovirus disease due to 31% lower risk of death in Ebola virus disease patients receiving these medications compared with other antimalarials. Increased survival may be due to treatment of malaria co-infection, prophylaxis preventing co-infection (especially in areas of high malaria-burden), or possibly even some of these drugs having a direct effect on filiovirus activity.[25]Gignoux E, Azman AS, de Smet M, et al. Effect of artesunate-amodiaquine on mortality related to Ebola virus disease. N Engl J Med. 2016 Jan 7;374(1):23-32. http://www.nejm.org/doi/full/10.1056/NEJMoa1504605 http://www.ncbi.nlm.nih.gov/pubmed/26735991?tool=bestpractice.com
anti-emetic and anti-diarrhoeal therapy
Treatment recommended for ALL patients in selected patient group
Early administration of an anti-emetic (e.g., metoclopramide, ondansetron) and anti-diarrhoeal therapy (e.g., loperamide) is recommended as long as diarrhoea is not bloody and other enteric pathogens are not suspected.[28]Chertow DS, Kleine C, Edwards JK, et al. Ebola virus disease in West Africa - clinical manifestations and management. N Engl J Med. 2014 Nov 27;371(22):2054-7. http://www.nejm.org/doi/full/10.1056/NEJMp1413084 http://www.ncbi.nlm.nih.gov/pubmed/25372854?tool=bestpractice.com [33]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. http://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com [44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com [59]Chertow DS, Uyeki TM, DuPont HL. Loperamide therapy for voluminous diarrhea in Ebola virus disease. J Infect Dis. 2015 Apr 1;211(7):1036-7. http://jid.oxfordjournals.org/content/211/7/1036 http://www.ncbi.nlm.nih.gov/pubmed/25573887?tool=bestpractice.com
Primary options
metoclopramide: children: consult specialist for guidance on dose; adults: 10 mg orally/intravenously every 8 hours, maximum 30 mg/day
OR
ondansetron: children: consult specialist for guidance on dose; adults: 4-8 mg orally/intravenously every 8-12 hours when required, maximum 24 mg/day
OR
loperamide: children: consult specialist for guidance on dose; adults: 4 mg orally initially, followed by 2 mg after each loose stool, maximum 16 mg/day
consider administration of broad-spectrum antibiotics
Treatment recommended for ALL patients in selected patient group
Empiric broad-spectrum antibiotics (e.g., ceftriaxone, ciprofloxacin, or ampicillin/sulbactam) should be started to treat possible bacterial translocation from the gut.[33]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. http://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com [44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com
consider transfusion of blood products
Treatment recommended for ALL patients in selected patient group
Transfusion of blood products including transfusion of platelets, packed red blood cells, and even plasma from convalescent donors may also be beneficial.[44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com
vasopressor
Treatment recommended for ALL patients in selected patient group
Patients developing hypotension should receive appropriate vasopressor support therapy as needed.[28]Chertow DS, Kleine C, Edwards JK, et al. Ebola virus disease in West Africa - clinical manifestations and management. N Engl J Med. 2014 Nov 27;371(22):2054-7. http://www.nejm.org/doi/full/10.1056/NEJMp1413084 http://www.ncbi.nlm.nih.gov/pubmed/25372854?tool=bestpractice.com [33]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. http://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com [44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com
supportive care
Treatment recommended for ALL patients in selected patient group
Multi-organ dysfunction is a common feature of advanced infection and may include acute kidney injury, pancreatitis, adrenal failure, and liver damage.
Liver damage (e.g., transaminitis) is common; however, jaundice is not a common feature.[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com [27]van Paassen J, Bauer MP, Arbous MS, et al. Acute liver failure, multiorgan failure, cerebral oedema, and activation of proangiogenic and antiangiogenic factors in a case of Marburg haemorrhagic fever. Lancet Infect Dis. 2012 Aug;12(8):635-42. http://www.sciencedirect.com/science/article/pii/S147330991270018X http://www.ncbi.nlm.nih.gov/pubmed/22394985?tool=bestpractice.com [46]Fletcher T, Fowler RA, Beeching NJ. Understanding organ dysfunction in Ebola virus disease. Intensive Care Med. 2014 Dec;40(12):1936-9. http://www.ncbi.nlm.nih.gov/pubmed/25366120?tool=bestpractice.com
Renal dysfunction is common in the advanced stages, but may be reversible in early stages with aggressive fluid resuscitation.[13]Mehedi M, Groseth A, Feldmann H, et al. Clinical aspects of Marburg hemorrhagic fever. Future Virol. 2011 Sep;6(9):1091-1106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201746 http://www.ncbi.nlm.nih.gov/pubmed/22046196?tool=bestpractice.com [46]Fletcher T, Fowler RA, Beeching NJ. Understanding organ dysfunction in Ebola virus disease. Intensive Care Med. 2014 Dec;40(12):1936-9. http://www.ncbi.nlm.nih.gov/pubmed/25366120?tool=bestpractice.com One Marburg virus disease patient with anuria not responsive to fluid resuscitation was treated with renal replacement therapy, an intervention which has also been used in patients with severe Ebola virus disease. However, there are no trial data to support the efficacy of this intervention. Of the five critically ill Ebola virus disease patients with multi-organ failure managed with both invasive mechanical ventilation and renal replacement therapy in Europe and North America, three died.[44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com [47]Kreuels B, Wichmann D, Emmerich P, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med. 2014 Dec 18;371(25):2394-401. http://www.nejm.org/doi/full/10.1056/NEJMoa1411677 http://www.ncbi.nlm.nih.gov/pubmed/25337633?tool=bestpractice.com [48]Lyon GM, Mehta AK, Varkey JB, et al; Emory Serious Communicable Diseases Unit. Clinical care of two patients with Ebola virus disease in the United States. N Engl J Med. 2014 Dec 18;371(25):2402-9. http://www.nejm.org/doi/full/10.1056/NEJMoa1409838 http://www.ncbi.nlm.nih.gov/pubmed/25390460?tool=bestpractice.com [49]Wolf T, Kann G, Becker S, et al. Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care. Lancet. 2015 Apr 11;385(9976):1428-35. http://www.ncbi.nlm.nih.gov/pubmed/25534190?tool=bestpractice.com [50]Connor MJ Jr, Kraft C, Mehta AK, et al. Successful delivery of RRT in Ebola virus disease. J Am Soc Nephrol. 2015 Jan;26(1):31-7. http://jasn.asnjournals.org/content/26/1/31.long http://www.ncbi.nlm.nih.gov/pubmed/25398785?tool=bestpractice.com
Where resources allow, respiratory supportive care may be helpful, including supplemental oxygen, non-invasive ventilation, or invasive mechanical ventilation if non-invasive ventilation fails.[44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com Full supportive care should be provided when possible, and can reduce filovirus disease mortality, with a reported survival rate of 82% in Ebola virus disease patients managed outside the West African setting.[44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com Historically, Marburg virus disease is often fatal, with death occurring in approximately 70% (range 23% to 100%) of historical cases.[5]Centers for Disease Control and Prevention. History of Marburg virus disease (MVD) outbreaks. Jun 2023 [internet publication]. https://www.cdc.gov/vhf/marburg/outbreaks/chronology.html High case fatality rates in Marburg and Ebola virus disease patients in sub-Saharan Africa may be related to the lack of full supportive care available in resource-poor, rural settings where outbreaks have occurred.[51]WHO Ebola Response Team. Ebola virus disease in West Africa - the first 9 months of the epidemic and forward projections. N Engl J Med. 2014 Oct 16;371(16):1481-95. http://www.nejm.org/doi/full/10.1056/NEJMoa1411100 http://www.ncbi.nlm.nih.gov/pubmed/25244186?tool=bestpractice.com
vitamin K, platelet transfusion, and cryoprecipitate
Treatment recommended for ALL patients in selected patient group
Haemorrhage and disseminated intravascular coagulation (DIC) are uncommon and are usually manifestations of late or severe disease. Vitamin K should be considered to improve coagulopathy, and can be given to patients developing haemorrhage.[28]Chertow DS, Kleine C, Edwards JK, et al. Ebola virus disease in West Africa - clinical manifestations and management. N Engl J Med. 2014 Nov 27;371(22):2054-7. http://www.nejm.org/doi/full/10.1056/NEJMp1413084 http://www.ncbi.nlm.nih.gov/pubmed/25372854?tool=bestpractice.com [33]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. http://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com [44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com Platelet transfusion and cryoprecipitate may also be helpful when platelet or fibrinogen levels are low.[28]Chertow DS, Kleine C, Edwards JK, et al. Ebola virus disease in West Africa - clinical manifestations and management. N Engl J Med. 2014 Nov 27;371(22):2054-7. http://www.nejm.org/doi/full/10.1056/NEJMp1413084 http://www.ncbi.nlm.nih.gov/pubmed/25372854?tool=bestpractice.com [33]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. http://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com [44]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. http://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com
obstetric interventions
Treatment recommended for ALL patients in selected patient group
For filovirus-infected pregnant women, the value of usual obstetric interventions such as fetal monitoring, caesarean delivery, induction of labour, or pregnancy interruption must be considered on a case-by-case basis.[4]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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443859 http://www.ncbi.nlm.nih.gov/pubmed/26000499?tool=bestpractice.com
In addition to careful deliberation about obstetric intervention, appropriate anticipatory guidance should be provided to all pregnant women. Towards this end, urine pregnancy testing should be considered as part of routine triage testing to appropriately counsel pregnant women on pregnancy complications and management options.
Pregnant filovirus patients are at high risk of spontaneous, pre-term labour and healthcare providers should be prepared for delivery at any time. Pregnancy outcomes can include spontaneous abortion, stillbirth, or delivery of a live fetus, and appropriate precautions should be taken. Regardless of the pregnancy outcome, all products of delivery should be considered potentially infectious and handled accordingly.
Neonatal survival from Ebola virus-infected mothers is almost universally poor, and high fetal loss rates underscore the need to focus efforts on treatment of the pregnant mother, caveats which likely also apply to Marburg virus disease.
cessation of breastfeeding
Treatment recommended for ALL patients in selected patient group
Ebola virus has been cultured from breast milk 15 days after symptom onset and Ebola virus RNA has been detected in breast milk by reverse transcriptase PCR (RT-PCR) 26 days after disease onset.[55]Nordenstedt H, Bah EI, de la Vega MA, et al. Ebola virus in breast milk in an Ebola virus-positive mother with twin babies, Guinea, 2015. Emerg Infect Dis. 2016 Apr;22(4):759-60. http://wwwnc.cdc.gov/eid/article/22/4/15-1880_article http://www.ncbi.nlm.nih.gov/pubmed/26982461?tool=bestpractice.com [56]Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis. 2007 Nov 15;196 Suppl 2:S142-7. https://academic.oup.com/jid/article/196/Supplement_2/S142/858852 http://www.ncbi.nlm.nih.gov/pubmed/17940942?tool=bestpractice.com This evidence suggests that theoretically Ebola virus might be transmitted through breast milk, though frequent intimate contact between mothers and their children leaves open other possible modes of transmission.
One study of Ebola virus survivors in Sierra Leone demonstrated no excess risk of Ebola virus transmission to infants during breast feeding.[57]Bower H, Johnson S, Bangura MS, et al. Effects of mother's illness and breastfeeding on risk of Ebola virus disease in a cohort of very young children. PLoS Negl Trop Dis. 2016 Apr 8;10(4):e0004622. http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004622 http://www.ncbi.nlm.nih.gov/pubmed/27058346?tool=bestpractice.com Despite this, it is recommended that mothers with suspected or confirmed infection should not breastfeed. There is insufficient evidence on when it is safe to resume breastfeeding.[58]Centers for Disease Control and Prevention. Care of a neonate born to a mother who is confirmed to have Ebola, is a person under investigation, or has been exposed to Ebola. Feb 2023 [internet publication]. https://www.cdc.gov/vhf/ebola/clinicians/evd/neonatal-care.html The same caveats likely apply to Marburg virus infection, though there are no studies of breast milk or breastfeeding in Marburg virus disease to provide evidence-based guidelines.
nutrition
Treatment recommended for ALL patients in selected patient group
Children should be managed by teams of healthcare workers with paediatric expertise, and early involvement of intensivists has been advocated whenever feasible.[52]Eriksson CO, Uyeki TM, Christian MD, et al. Care of the child with Ebola virus disease. Pediatr Crit Care Med. 2015 Feb;16(2):97-103. http://www.ncbi.nlm.nih.gov/pubmed/25647119?tool=bestpractice.com
Nutrition should be a high priority in children with filovirus disease, using prepared or ready-to-use therapeutic food, and treating malnourished children according to therapeutic feeding protocols for acute malnutrition.[53]Trehan I, Kelly T, Marsh RH, et al. Moving towards a more aggressive and comprehensive model of care for children with Ebola. J Pediatr. 2016 Mar;170:28-33.e1-7. http://www.sciencedirect.com/science/article/pii/S0022347615014663?np=y http://www.ncbi.nlm.nih.gov/pubmed/26778094?tool=bestpractice.com
Choose a patient group to see our recommendations
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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