Hemorrhagic fever Marburg( Fever Marburg) - Causes, symptoms and treatment. MF.

Hemorrhagic fever Marburg( GL Marburg) is considered the "native sister" of Ebola fever due to the similarity of the causes of the disease, clinical symptoms and treatment. The epidemiological situation with this disease is also serious due to the possibility of transmitting the virus from person to person, and the lack of specific treatment and prevention explains the high mortality and the impossibility to prevent the mass destruction.

Marburg virus

Marburg hemorrhagic fever Marburg, Marburg disease is an extremely dangerous highly infectious viral disease with the presence of natural foci, capable of being transmitted from person to person, characterized by a severe course with the defeat of many organs and systems and high detailfrom 25 to 85%).

For the first time the Marburg virus was spoken after the 1967 outbreaks in Germany( Marburg and Frankfurt am Main) and in Serbia( Belgrade).In Germany, 29 people fell ill, 7 of them died( 24% of deaths).In Serbia, 2 people fell ill, both survived. The cause of the disease was the tissue of African green marmosets, brought from Uganda for laboratory research. It is by the name of the city where the first cases of the disease are registered, and a fever is called. In subsequent years, with varying frequency of outbreaks, fevers were recorded in Kenya, Angola, Uganda, Congo, South Africa. The largest outbreaks arose in 1998-2000 in the Congo( 154 people fell ill, 128 of them lethal, lethality 83%) and in 2005 in Angola( 374 people fell ill and 329 died, 88% mortality).The last 2 cases, not related to each other, are dated 2008 after visiting caves in Uganda with the bats that lived there( in the Netherlands, the patient died, in the US he survived).

Geographically, the Marburg virus circulates in the natural foci of Africa, both the equatorial and southern parts of Africa. The prevalence of the Marburg virus includes countries such as the Democratic Republic of the Congo( Zaire), Kenya, Sudan, Liberia, Guinea, Gabon, Central African Republic, South African Republic and others.

Causes of Fever Marburg

Pathogen GL Marburg is a virus belonging to the family Filoviridae( Filoviridae), the genus Lissavirus. This is an RNA-containing virus with a characteristic polymorphism from the shape of the spiral to a slightly rounded shape, with a virion length from 665 to 1200 nm. The composition of the virion is represented by 7 proteins, which brings the Marberg virus closer to the "fellow" - the Ebola virus. The Marburg virus is sufficiently resistant to high temperatures, withstands heating to 60º for 30 minutes. Ultraviolet rays cause the virus to die in 2 minutes. Sensitive to a number of disinfectants - ether, chloroform, acetone, formaldehyde, methyl and ethyl alcohols. The virus belongs to the I pathogenicity group( like the Ebola virus, the Marburg virus represents a high individual and social danger).

Source of infection in the Marburg Fever are African green monkeys Cerospithecus aethiops and carnivorous bats Rousettus aegypti. Animals can tolerate the disease asymptomatically( inpatiently), but do not lose the ability to infect humans. A certain danger is represented by animals transported with different purposes to other countries.

Marburg fever. Source of infection

A sick person is contagious to others. From the patient, the virus can be secreted with nasopharyngeal contents, urine, blood and other body fluids. As with Ebola GL, the patient GL Marburg is contagious from the first hours of the onset of the symptoms of the disease, continues to be actively contagious for 3 weeks. There is evidence that the virus can persist in the body that has been ill for 2 months( transmission factor is infected sperm).

The infection mechanisms of are similar to those of GL Ebola. The leading mechanism is contact-household, and the path is contact. If the patient gets into the skin and mucous membranes, the virus through the microtrauma can penetrate the body. The sexual way of transmission of the Marburg virus is proved. The aerogenic mechanism is not excluded in terms of the spread of the virus with nasopharyngeal mucus during sneezing, coughing.

Primary infection can often occur after visiting mines, lazy caves with bats that lived there. Among people, ritual burials in African families are of special importance, where all relatives have a direct unprotected contact with the body of the deceased from Marburg. Also, the transfer factor may be a reusable medical tool, as well as occasional injections or punctures with used medical needles.

The susceptibility of the human body is high regardless of age and sex. Most of the people who are in close contact with sick people get sick. Any patterns of outbreaks in humans, as well as the seasonality of the infection, have not been identified.

Immunity after transferred GL Marburg persistent and prolonged, repeated cases of illness do not occur.

Pathogenic effect of the Marburg virus on the human body

1. The entrance gates of the infection are microtraumed skin and mucous membranes of the eyes,
of the oral cavity, to which the virus has fallen. Primary affect( there are no characteristic changes in the entrance gates).Then the virus lymphogenically reaches the regional lymph nodes, and then penetrates into the general bloodstream( viremia, toxemia), which manifests itself in the form of a pronounced common infectious-toxic syndrome( fever and symptoms of intoxication).

2. With the blood flow the virus is entered into various organs and systems, causing damage to the liver, kidneys,
myocardium, brain, bone marrow, testes, lungs, spleen and others. The virus can be detected for a long time in the sperm, blood - on average up to 8 weeks, and according to some data up to 12 weeks. In the affected organs, the virus multiplies and causes an inflammatory reaction, necrosis of cells leading to a disruption of their function( multiple organ failure).

3. Virus tropen to the endothelium of blood vessels, which leads to the launch of DIC-syndrome(
syndrome of disseminated intravascular coagulation), which is clinically manifested by hemorrhagic syndrome of varying severity( from skin manifestations in the form of petechiae to internal bleeding, including in vitalimportant organs).Lethal outcome can come from hemorrhage in the brain, myocardium, adrenal glands.

Clinical Symptoms GL Marburg

The incubation period( from the moment of infection to the appearance of the first symptoms of the disease) lasts from 1 to 9 days. There are no signs or precursors.

1. The initial period of the is quite pronounced. The onset of the disease is acute - the
temperature rises sharply to febrile figures( above 39º), a tremendous chill. The temperature is accompanied by symptoms of intoxication: severe headache of intense and diffuse nature, pain in the chest, difficulty in breathing, dry coughing, sore throat. Upon examination, reddening( hyperemia) of the mucous membrane of the pharynx, there may appear enanthema( rash on the oral mucosa) in the form of vesicles( vesicles), erosions. The tenderness of the muscles of the jaws and neck is noted during chewing, movement of the head.

2. symptoms of affect on day 3-4 of the disease:
nausea, vomiting, abdominal pain of a different nature with a predominance of cramping, stools with watery appearance, with pathological impurities( blood and mucus).Some patients complain of blood and bile in the vomit, blood clots in the stool( melena).Violations of the stool are marked by the vast majority of patients( up to 85%), this syndrome lasts about a week from the time of its appearance. With the delay of care, a complication may develop: dehydration of varying severity.

3. Approximately the same terms( from 3-6 days) symptoms of hemorrhagic syndrome
appear( nasal, uterine, gastrointestinal bleeding).

4. On the 5th-7th day of the disease, of the exanthema ( rash on the skin) appears on the face, limbs, trunk,
, which has a koreid-like character( spotted-papular), sometimes with the appearance of single vesicles( vesicles).A rash appears in ½ patients. Patients are troubled by itchy skin. Most patients develop petechiae( pinpoint hemorrhages on the skin) - a sign of the onset of hemorrhagic syndrome, but there may be ecchymoses( large hemorrhagic elements).At the same time, hemorrhages on the mucous membranes( oral cavity, conjunctiva of the eyes) are visible.

GL Marburg, rash

5. The maximum severity of symptoms of Marburg GAB is manifested at the beginning or end of the 2nd week.
patients develop complications, sometimes incompatible with life: infectious-toxic encephalopathy with edema of the brain, convulsive syndrome, stopping vital functions( breathing, palpitations);severe dehydration;infectious-toxic shock;mental disorders;myelitis;orchitis;the maximum severity of DIC syndrome with hemorrhage in the brain, adrenal glands, myocardium and other organs. A lethal outcome can occur on week 2 from the onset of the disease. Mortality to 50-85%.

In case of recovery, the disease lasts up to 12-14 days. In the period of convalescence, weakness, minor stool disorders, hair loss may persist.

In the general analysis of blood: a decrease in the number of leukocytes, platelets, changes in the shape of blood cells( the result of the toxic effect of the virus), basophilic granularity of erythrocytes.

Diagnosis GL Marburg

Preliminary diagnosis - clinical epidemiological. In the first place is an epidemiological anamnesis( the presence of a natural focus of the disease - living in it or for a short stay, contact with animals in the outbreak, as well as contact with febrile patients without any protective equipment).Clinically, the disease must be differentiated with hemorrhagic fevers of another etiology( Ebola, Lassa, yellow), malaria, typhoid fever, typhus, meningococcal infection, measles, diphtheria, other causes of angina and other diseases.

The final diagnosis of is made using laboratory diagnostics, which includes:
1. General blood test( leukopenia, thrombocytopenia, anisicitosis, poikilocytosis, basophilic granulosis of erythrocytes);biochemical studies( bilirubinemia, hyperfermentemia in liver pathology, increased urea and creatinine in kidney damage, and others);changes in cerebrospinal fluid during meningitis, encephalitis.
2. Instrumental diagnostics( radiography, ultrasound, ECG)
3. Specific analyzes are carried out in specially equipped laboratories for work with
infectious agents of the first hazard class. All personnel in special protective clothing, after taking the material, are specially packaged, labeled and delivered to the laboratory in metal bixes with an attendant, who is instructed that the biomaterial represents a high biological hazard to others. The analysis includes a blood test for the antigen and antibodies to the Marburg virus using ELISA, pH, PCR, ELISA, and detection of the virus in cell cultures.

GL Marburg, laboratory

Treatment of Marburg fever( similar to that of GL Ebola)

Treatment activities include a number of basic principles:

Organizational-regime measures - immediate hospitalization of patients in
infectious hospital, rapid isolation of patient, compliance with epidemiological safety requirements - allstaff should be instructed on the mechanism of transfer, work in special suits with maximum protection of skin and mucous membranes( anti-plague suit Iipa, there are now modern versions), chemically and physically light diet for a patient, sufficient water and drinking regime.

Treatment. There is no specific treatment for GL Marburg. All therapeutic
measures are reduced to pathogenetic and symptomatic treatment: maintenance of the vital functions of the patient's body by performing detoxification( reducing fever and intoxication with intravenous detoxification of cocktails, preventing the development of shock), rehydration( replenishment of lost fluid volumes), correction of thrombotic hemorrhagic syndrome, hormone therapy, immunotherapy and much more.

Patient discharge is performed with full clinical recovery and 3-fold results of virologic examination, but not earlier than 21 days after the onset of the disease.

GL Marburg, work with patient

Prevention GL Marburg

- Carrying out anti-epidemic measures in natural foci of the disease:
• if there is a suspicion of GL outbreak, Marburg closure of the area to quarantine( the entry and exit of the population within the territory of quarantine, export and import of animals is prohibited),
• the work of all medical personnel in special suits forespecially dangerous highly contagious infectious diseases( mandatory mask or face shield, goggles, long-sleeved dressing gowns, gloves),
• active identification of patients, isolation of patients with adherence• All the items of everyday use for the patient must be individual,
• Timely cremation of those who died from GL Marburg or burial after thorough disinfection of the remains,
• Identification of patients' contact with patients, establishment of quarantine measures - Monitoring of contact for 21 days( measurement of temperature, examination of objective status), and this period is set for all highly contagious hemorrhagic fevers, which include GL Marburg,
• allm contact specific immunoglobulin is introduced, which should be introduced as soon as possible,
• information work with the local population in the endemic focus( informing about the causes of the disease, the mechanisms of infection, the need to seek medical help, preventing the shelter of patients in family foci, precautions to prevent furtherspread of infection, all products of animal origin - meat, blood, milk to be subjected to thorough heat treatment),
• current disinfection in the outbreaksis produced with a 2% solution of phenol with the addition of 0.5% sodium hydrogencarbonate 1: 500, iodoform 450 g per 1 ml of active iodine supplemented with 0.2% sodium nitrate,
• when working in mines and caves inhabited by batsneglect personal protective equipment( masks, gloves).

GL Marburg, work on the outbreak in Angola

- Activities are also being carried out to prevent the import of infection from Africa to other
continents( control of visitors from Central and South Africa, the risk of infection, if there is a risk of infection with the Marburg virus, 21 days of quarantine).
- Work of veterinary surveillance in endemic regions( control of pig and
monkey farms - cleaning and disinfection using disinfectants, slaughter of infected and sick animals).
- Prevention of laboratory contamination - work with material from patients should
specially trained personnel in specially equipped laboratories and with the availability of personal protective equipment.

Specific prophylaxis( vaccine) is not available.

Doctor infectious diseases Bykova N.I.