就既往而言,马尔堡病毒病经常致命,大约 70% 的既往病例死亡,但报道的病例死亡率为 23%-100%。[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
平均病死率为 50%,在小规模暴发(1-3 例)中,报告的病死率为 100%。[2]World Health Organization. Marburg virus disease fact sheet. Aug 2021 [internet publication].
https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease
在撒哈拉以南的非洲,马尔堡和埃博拉病毒病患者的高病死率可能与疾病暴发的农村地区资源匮乏、缺乏全面的支持性治疗有关。[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
在幸存者中,被认为常见的并发症包括肌痛、关节痛、无力、肝炎、眼病、精神病和排斥。[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
幸存者产生长期抗体应答,并被认为对相同的纤丝病毒毒株再感染具有免疫力。
孕妇
从历史来看,患有纤丝病毒病的孕妇存活率非常低,且预后不良与妊娠有关。[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
[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
然而,2014 年至 2016 年西非埃博拉病毒病暴发期间的数据表明,孕妇的存活率可能与其他育龄期女性相当。[61]Henwood PC, Bebell LM, Roshania R, et al. Ebola virus disease and pregnancy: a retrospective cohort study of patients managed at 5 Ebola treatment units in West Africa. Clin Infect Dis. 2017 Jul 15;65(2):292-9.
https://academic.oup.com/cid/article/65/2/292/3097901
http://www.ncbi.nlm.nih.gov/pubmed/28379374?tool=bestpractice.com
在适当的积极支持性治疗下,患有埃博拉或马尔堡病毒病的孕妇可能与其他育龄期女性的预后相似。
胎儿和新生儿
妊娠期间感染马尔堡病毒后自然流产和死产的发生率接近 100%。[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
已知仅一名感染埃博拉病毒的母亲所产婴儿的产后存活时间超过了 19 天。[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
[62]Médecins Sans Frontières (MSF). Nubia: first newborn to survive Ebola. Dec 2015 [internet publication].
https://msf.exposure.co/nubia
因此,先天感染的胎儿和新生儿的预后极差。
儿童
关于马尔堡病毒感染儿科人群的存活相关数据有限。然而,首例经证实的儿科马尔堡病毒病存活病例为一名 8 月龄的婴儿,由其母亲哺乳喂养及进行照护。[63]Borchert M, Muyembe-Tamfum JJ, Colebunders R, et al. Short communication: a cluster of Marburg virus disease involving an infant. Trop Med Int Health. 2002 Oct;7(10):902-6.
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.2002.00945.x/full
http://www.ncbi.nlm.nih.gov/pubmed/12358627?tool=bestpractice.com