Marburg viral disease is caused by the Marburg virus and can cause haemorrhagic fever in humans with an average fatality rate of 50%. The virus is transmitted through contact with infected bats, humans, or contaminated materials. Clinical features include high fever, headache, rash and potential haemorrhagic manifestations between days 5-7. Diagnosis involves ELISA, RT-PCR or virus isolation. Management focuses on supportive care like hydration, electrolyte balance and blood replacement. Survivors may require long term monitoring due to potential viral persistence in immune privileged sites.

1. Marbug Viral Disease
OLIVER-COMMEY J
GIDC/GHS
ID PHYSICIAN

2. OUTLINE
CARE FOR THE
SURVIVOR
CLINICAL
MANAGEMENT
CLINICAL
FEATURES
OVERVIEW

3. MVD
• Virus belongs to the filoviridae group
• Considered extremely dangerous , considered BSL 4 pathogen. Listed as a
category A bioterrorism agent.
• Causes a haemorrhagic fever in humans
• Average case fatality is around 50%. CFRs have varied between 24%-84% in
past outbreaks . Dependent on virus strain and case management .
• Fruit bat Rosusettus aegyptiacus considered to be the natural hosts .
• Transmission to humans from fruit bats and spread via contact amongst
humans.
• Community engagement is key to successfully controlling out breaks

4. CURRENT OUTBREAK
• The current outbreak in Ghana is the second in the W. African region over
the last 2 years .
• 2 regions , 3 cases CFR -66.7%
• The first was in Guinea in 2020.
• Uganda seems to be the country with more outbreaks in the AFRO region.

5. TRANSMISSION
• Human – human
• Contact ( broken skin or mucous membranes) with blood, secretions, organs
or other bodily fluids from infected people .
• Contact with formites ( bedding, clothing) contaminated with these fluids .
• HCW usually infected whilst treating patients with suspected or
confirmed MVD without appropriate PPE.
• Documented transmission via needle stick injuries, usually associated
with more severe, rapid deterioration .
• Burial ceremonies may also contribute when there is direct contact
with the body
• People remain infectious as long as their blood contain the virus .

6. Clinical Features
Varied incubation period ( 2-21 days). 5-10 days
• High fever
• Severe headache
• Severe malaise
• Myalgia
Abrupt onset
• Watery diarrhoea
• Abdominal cramping with pain
• Nausea and vomiting
• Appearance of patients described as ‘ghost-like’
• Possible non itchy rash maculopapular rash prominent on the
trunk
Days 3-7
• Days 5-7
• Devpt of haemorrhagic
manifestations
• Sustained fevers
• Irritability
• Aggression
• Confusion
• Days 8-9
• Shock
• Death
• Day 15
• Orchitis

7. DIAGNOSIS
• Very difficult to clinically distinguish MVD from other ID such as malaria,
typhoid , shigellosis, Covid 19 and other VHFs.
• Other differentials when presenting with haemorrhagic manifestations
include UGI bleeds, Envenomination etc.
Clinical diagnosis
• ELISA
• RT-PCR
• Virus isolation by cell culture
Lab diagnosis

8. WET SYMPTOMS
• Diarrhea, vomiting
• Bleeding (in vomit, stool, urine, gums,
nose, etc.)
• Pregnancy loss (e.g., miscarriage).
• The bleeding is unusual and non-
traumatic.
DRY SYMPTOMS
• High fever (≥38°C) or history of fever in
the last 48 hours
• headache
• extreme tiredness, loss of appetite
• nausea, abdominal pain
• sore throat, muscle and joint pain red
eyes, skin rash
• hiccups
• difficulty in breathing and drowsiness

9. Triaging
• Please remember not to cohort patients with wet and dry symptoms
together .
• Not all patients with symptoms have MVD.
• This will help reduce cross infection in the isolation area.

10. Management
• Treatment
• No vaccines
• No antivirals
• Main stay of treatment is supportive care
• Adequate hydration
• Correction of electrolyte imbalances
• Restoration of blood volume
• Management of co-morbidities
• Diabetes , hypertension , mental illness , SCDx, HIV etc

11. Keys to ensuring good prognosis
• At the isolation units patients should be managed symptomatically
• Most poor outcomes are as a result of neglect once the case is
labelled as suspect and isolated .
• Dehydration must be corrected
• Shock corrected ( R/L preferred fluid for correction, N/S can be used
in its absence.
• Blood volume must be replaced ( appropriate blood products)
• Labs should be notified when samples for routine tests are sent so
they are appropriately handled .

19. Discharge from a treatment unit

20. Viral persistence post recovery
• Virus may persist in some immune privileged sites , namely testes and
eye.
• Documented transmission via infected semen 7 weeks after clinical
recovery.
• Documented evidence of persistence of virus in placenta, amniotic
fluid and foetus of women who were infected whilst pregnant .
• May persist in breast milk too.
• Documentation of relapse – symptomatic illness in the absence of
reinfection .

21. WHO Recommendation for male survivors
• Enrol into semen testing programmes after discharge . ( 2 consecutive
negative results )
• Offer semen testing within 3 months of disease onset . ( patient must
be mentally and physically ready ).
• Safe sex practices until semen has twice tested negative for Marbug
virus , this can continue for up to close to 12 months .

23. Summary
• MVD may carry a high CFR , however with early intervention ,
outcomes may be better .
• Clinical care of MVD begins with close monitoring to recognise
warning signs of critical illness.
• For critically ill patients , careful provision of supportive care ,
including use of antimicrobials if needed can be life saving
• Survivors also need long term care .

24. THANK YOU