Marburg and Ebola viruses are filoviruses that lead to hemorrhage, multiple organ failure and high mortality rates. The diagnosis is made by an enzyme-linked immunosorbent assay, PCR or electron microscopy. Treatment is supportive. In order to limit outbreaks strict isolation and quarantine measures are required.
(See also Overview of infections by Arbovirus, Arena virus and filovirus.)
Marburg and Ebola viruses are filoviruses that lead to hemorrhage, multiple organ failure and high mortality rates. The diagnosis is made by an enzyme-linked immunosorbent assay, PCR or electron microscopy. Treatment is supportive. In order to limit outbreaks strict isolation and quarantine measures are required. (See also Overview of infections by Arbovirus, Arena virus and filovirus.) Marburg and Ebola viruses are filamentous filoviruses, which differ from one another but causing clinically similar diseases that are characterized by hemorrhagic fever and capillary leakage. The Ebola virus infection is slightly more contagious than the Marburg virus infection. Ebola virus isolates have been divided into five species: Zaire Ebola virus Sudan Ebola virus Tai Forest Ebola virus (formerly Ivory Coast Ebola virus [the Tai Forest, Ivory Coast) Bundibugyo Ebola virus Reston-Ebola virus (which is found in Asia, but no disease in humans caused) most recent outbreaks of Marburg and Ebola virus infections began in sub-Saharan Central and West Africa. Past outbreaks were rare and sporadic; they were partly limited because they occurred in remote areas. The spread to other regions, if they occurred, resulting usually from travelers who returned from Africa. However, it came in 1967 to a small outbreak of Marburg hemorrhagic fever in Germany and Yugoslavia among laboratory technicians who imported fabrics were exposed to green monkeys. In December 2013, a major Ebola outbreak in rural Guinea began (West Africa) and then spread to highly urbanized regions of Guinea and neighboring Liberia and Sierra Leone. He was first recognized in March, 2014. He affected so far thousands of people and had a mortality rate of about 59%. Infected people spread the Ebola virus to Europe and North America. Cases of Ebola were further held in the first months of 2016; Sierra Leone was finally declared in March 2016 Ebola-free, Guinea in May 2016 and Liberia in June 2016. Most transmission index cases based on exposure to non-human primates in sub-Saharan Africa. The vector and reservoir are not precisely known, although the Marburg virus was identified in bats, and cases have occurred in people who were exposed to bats (z. B. in mines and caves). Ebola outbreaks have been associated with the consumption of meat from wild animals in affected areas (bush meat) or soups that are made from bats in conjunction. Ebola and Marburg virus infections have also occurred after handling tissues of infected animals. Filoviruses are highly contagious. A transmission from humans to humans comes about through a contact of skin and mucous membranes with body fluids (saliva, blood, vomit, urine, feces, sweat, breast milk, semen) of an infected symptomatic person or in rare cases of non-human primates. People are not contagious until they develop symptoms. Symptoms and signs exist in patients surviving as long as it takes to develop an effective immune response. Usually surviving patients not eliminate the virus completely and transfer it. However, the Ebola virus can survive in certain immune-privileged sites (eyes, brain, testes). The virus can emerge from these places again and cause late effects or relapse. Sperm can transmit for up to seven months a Ebola and Marburg virus infection, unlike other body fluids. Transmission by aerosols has been postulated; However, if it occurs, it is probably rare. The actual transfer takes place mainly from person to person and the result of close contact with blood, secretions, other body fluids or organs of infected persons. Burial ceremonies where mourners have direct contact with the deceased, played an important role in the transmission of infection. Symptoms and signs The symptoms of Marburg and Ebola virus infections are very similar. After an incubation period of 2-20 days there is fever, myalgia and headache, often with abdominal pain, nausea and symptoms of upper respiratory tract (cough, chest pain, pharyngitis). Photophobia, conjunctival injection, jaundice and lymphadenopathy occur. Vomiting and diarrhea may soon follow. Delirium, stupor and coma may occur, suggesting a CNS involvement. Hemorrhagic symptoms begin within the first few days and include petechiae, ecchymosis and open bleeding at injection sites and mucous membranes. About 5 days a maculopapular rash starts to spread, primarily on the trunk. A severe hypovolemia may develop, resulting from extensive fluid loss due to capillary of diarrhea and vomiting leak that results from hypoalbuminemia and loss of fluid from the intravascular space, the loss of electrolytes can lead to severe hyponatremia, hypokalemia and hypocalcemia. Cardiac arrhythmias may follow. During the second week of illness occurs either for afebrile, and patients begin to recover, or become a deadly failure of multiple organs. The recovery period is long and can by recurrent hepatitis, uveitis, transverse myelitis and orchitis are complicated. The mortality rate moves between 25 and 90%. Diagnostic evaluation and testing in accordance with the guidelines of the Centers for Disease Control and Prevention (CDC) “Enzyme-linked immunosorbent assay” (ELISA) and reverse transcriptase (RT) PCR The suspicion of Marburg or Ebola virus infection arises in patients with bleeding, fever, other symptoms that fit an early Fibola virus infection, and travel to endemic regions. The CDC has an algorithm and guidelines for evaluating travelers returning from endemic areas, edited (s Algorithm for Evaluation of the Returned Traveler and Think Ebola. Early recognition). A similar approach can be used when the suspected Marburg virus exists. The WHO has also guidelines related to the Ebola outbreak in 2014 in West Africa published (WHO Ebola situation reports: archives). The cases should be discussed with health authorities that can help with all administrative matters, including the decision to pursue the diagnosis, the establishment of the transport of test samples The treatment, including transportation to selected centers and, if indicated, the use of novel therapies Des finding of contacts For testing, including blood count, routine parameters, liver and coagulation parameters and urine tests. The diagnostic tests include ELISA and RT-PCR. The gold standard is the detection of characteristic virions by electron microscopy of infected tissue (particularly liver) or blood because of the use of this method is non-specific, not only in terms of Ebola or Marburg virus possible. Supportive therapy Treatment There is no effective antiviral therapy. Treatment consists of supportive measures unf comprising: maintaining blood volume and electrolyte imbalance, replace reduced clotting factors minimizing invasive procedures treat the symptoms, including the use of analgesics drugs are currently being tested (some in accelerated procedure), but none has been reasonably effective and safe found. Prevention Several vaccines and antiviral drugs are being developed, but it is unlikely that they will soon be available. To prevent the spread, symptomatic patients must be with a possible Ebola or Marburg virus infection isolated in special containment facilities. Standard intensive care in public hospitals are not suitable. Special containment facilities ensure total control of liquid sewage and respiratory products. Employees who are in contact with the patient must be completely covered with protective suits with internal perception containment of respiratory gases. Trained staff should be available to those who are in contact with the patient to help remove the protective clothing. Protocols for donning mask, goggles or face shields, gowns and gloves must be observed (s. Sequence for Donning Personal Protective Equipment CDC). Effective sterilization of medical devices, hospital closures and the education of the population could abbreviate previous outbreaks. All suspected cases, including the deceased, require strict isolation measures and special measures for the handling. For more information, s. WHO’s interim recommendations for infection prevention and control. Important points Ebola and Marburg viruses cause hemorrhagic fevers like, although they differ from each other; Outbreaks are held mainly sustained by human-to-human transmission via contact with infected body fluids. The transmission during the Ebola virus outbreak of 2013-2014 took place mainly from person to person through close contact with blood, secretions, organs or other bodily fluids of infected people or corpses. The suspicion of Marburg or Ebola virus infection, patients with bleeding, fever, other compatible symptoms and a travel history to endemic regions. Patients with possible infections are isolated and strict measures for employees who take care of these patients are used. Diagnosis, management and transfer prevention are planned with health authorities. For more information procedures for the investigation of the returning traveler CDC’S ongoing work to contain Ebola in West Africa Think Ebola: Early recognition sequence for applying the personal protective equipment WHO’s Ebola situation reports: Archive WHO’s Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed filovirus haemorrhagic Fever in Health-Care Settings, with Focus on Ebola