Tuesday, October 28

Marburg virus disease (MVD) - Marburg hemorrhagic fever

Marburg virus disease (Marburg hemorrhagic fever) symptoms

What is Marburg virus disease?

Marburg virus disease, also known as Marburg hemorrhagic fever, is a severe and highly fatal disease caused by the filoviruses. The two filoviruses are Marburg virus (MARV) and Ravn virus (RAVV). The clinical symptoms are similar to Ebola virus disease. The typical symptoms are high fever, severe headache, malaise and severe haemorrhagic manifestations. The haemorrhagic symptoms include petechiae, purpura, hematomas, maculopapular rash and bleeding from multiple sites. The fruit bats in the endemic regions are considered to be carriers and reservoirs of the Marburg hemorrhagic fever virus. both MARV and RAVV have been isolated from bats.

The most common methods of diagnosis of Marburg virus disease are reverse transcription polymerase chain reaction (RT-PCR) and antigen-capture enzyme-linked immunosorbent assay (ELISA). Presently there is no effective treatment for Marburg virus disease. Early supportive treatment, care and hydration may help in the survival of the patient. Death occurs due to multiple organ dysfunction syndrome (MODS), previously known as multiple organ failure (MOF).
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Marburg hemorrhagic virus is transmitted among humans by direct contact with the body fluids, skin and tissues of the infected individuals. There is no evidence of marburgviruses getting transmitted by aerosol in MVD outbreaks. The medical personnel must strictly follow barrier nursing techniques while caring and treating Marburg virus disease patients. They should wear disposable face mask, gloves, goggles and gown. Many cases of Marburg hemorrhagic fever were reported in visitors to bat-infested mines or caves. Avoiding visit to caves and avoiding skin contact with bats, primates and their excretions in endemic regions is highly recommended.
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Marburg virus disease was first identified in 1967 epidemics in Marburg and Frankfurt in Germany and Belgrade in the former Yugoslavia. Of the 31 people infected seven died. The Marburg hemorrhagic fever was contracted from infected monkeys imported from Uganda. During the 1998–2000 outbreak in Congo, Of the 154 people who contracted Marburg virus, 128 died. During the 2004–2005 outbreak of hemorrhagic fever in Angola, Of the 252 people who contracted Marburg virus, 227 died.

Symptoms in clinical phases of Marburg Hemorrhagic Fever

A general list of observed symptoms as the hemorrhagic fever infection progresses is given below. Please note that the disease progression symptoms may vary among patients in respect to earlier health status.
Incubation: Incubation period of the hemorrhagic fever is usually 5-9 days. Variation in this period range from 2 days to 21 days.
Clinical onset of symptoms (1-5 days): The onset of the hemorrhagic fever symptoms are sudden with high fever and severe headache. The patient may also suffer from symptoms like serious bouts of chills and shivering followed by malaise and fatigue. Nausea, vomiting, diarrhea, loss of appetite, muscular pain, nonproductive cough, pharyngitis, relative bradycardia and abdominal pain may be present in Marburg virus disease. As the Marburg hemorrhagic fever progresses, symptoms like diffuse erythematous, non pruritic maculopapular rash may appear on the skin.
Symptoms of early organ phase: This phase of Marburg hemorrhagic fever may last from day 6 to day 13 from the day of clinical onset. The hemorrhagic fever symptoms include conjunctivitis, edema, shortness of breath and widespread rash. Central nervous system disease with symptoms like encephalitis, tremors, slurred speech, seizures, confusion, muscle fasciculations, delirium, apathy, paralysis and aggression may appear in Marburg viral disease. By the end of the early organ phase, hemorrhagic symptoms like blood in stools, bleeding from skin puncture sites, mucosal & visceral hemorrhaging appear.
Symptoms of late organ phase: From day 14 to day 21 the hemorrhagic fever survivors will go into convalescence phase. They may suffer from symptoms of fibromyalgia and hepatitis. In fatal Marburg virus disease cases the health continues to deteriorate, leading to symptoms like diffuse coagulopathy, convulsions, altered level of consciousness, coma, shock and death.

Treatment and management of the hemorrhagic fever

There is no standard treatment for the hemorrhagic infection. Early detection, diagnosis and providing supportive care may save lives. Some of the supportive measures for Marburg hemorrhagic fever are:
  • balancing the patient's fluids and electrolytes of patients with symptoms
  • maintaining blood pressure
  • supporting breathing
  • pain management in patients with symptoms
  • administration of anticoagulants early in infection
  • replacing lost blood and clotting factors of patients with the symptoms
  • treatment for opportunistic infections in patients of the hemorrhagic fever disease

Risks of contracting Marburg virus

The following are are high-risk factors in contracting MVD:
  • skin contact with patients with the symptoms of Marburg virus disease
  • direct skin contact with the hemorrhagic fever patients
  • direct contact with body fluids, excretions, tissues of the patients with symptoms
  • handling blood and secretions of Marburg hemorrhagic fever patients
  • direct contact with equipment, beddings, utensils etc of the patients
  • placing of intravenous lines in patients
  • inserting catheters and using suction devices on Marburg virus disease patients
  • handling the dead bodies in the endemic zone
  • handling ill or dead fruit bats, monkeys and other wild animals
  • accidental infection of workers in any facility investigating the virus
  • handling contaminated injection equipment
  • accidental needle injuries

Prognosis

The average fatality is 60%. In outbreaks fatality was as high as 80%. In the surviving patients, recovery may be protracted and many systemic ailments may linger on.
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Though the surviving Marburg hemorrhagic fever patient develops antibodies, the virus is known to persist in seminal fluids and breast milk and cause secondary infection and disease. No approved vaccines are available to prevent the spread of Marburg infection.


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    References:
    1.http://www.who.int/csr/disease/marburg/en/
    2.http://www.cdc.gov/vhf/marburg/
    3.https://www.gov.uk/marburg-virus-disease-origins-reservoirs-transmission-and-guidelines


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  • Wednesday, October 15

    What is Ebola virus disease (EVD) - Ebola definition

    What is Ebola virus disease and its definition

    What is Ebola virus disease?

    Ebola disease is a hemorrhagic fever caused by a type of RNA virus. Ebola is highly contagious and often fatal. Ebola is transmitted through contact with the body fluids of an infected person. It was discovered in 1976 in Africa and is named after a river in the Democratic Republic of the Congo. There are four subtypes of this virus of which one type appears to affect only primates. The rest of three can infect and spread from human to human.

    In an outbreak, the first infection is usually occurs from an affected animal to humans. The virus infection can spread through contaminated needles, body fluids, vomit, blood, faeces, urine and direct skin contact. The infection becomes highly contagious in its later stages. The incubation period spans between 2-21 days. There is high mortality rate among the infected. Even the dead body may remain contagious up to three days. Health care personnel attending EVD patients are required to wear protective equipment. There is no standard treatment for this disease.
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    Definition of Ebola virus disease
    Definition by merriam-webster.com: "the hemorrhagic fever caused by the Ebola virus —called also Ebola Fever."
    Definition by thefreedictionary.com: "a severe and often fatal disease in humans and nonhuman primates (monkeys and chimpanzees) caused by the Ebola virus; characterized by high fever and severe internal bleeding; can be spread from person to person; is largely limited to Africa."
    Definition by yourdictionary.com: "Ebola hemorrhagic fever, is a type of RNA virus that causes Ebola hemorrhagic fever. It is highly contagious and is often fatal in humans and some primates, like monkeys and gorillas."

    What are the symptoms of Ebola disease

    The early symptoms include high fever, sore throat, chest pain, shortness of breath, fatigue, body aches, muscle pain, joint pain, severe headaches, vomiting, diarrhea, hiccups, difficulty in swallowing and abdominal pain. This phase is followed by bleeding phase.
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    There is both internal and external bleeding. Blood may be coughed up, vomited or excreted in stool. Bleeding of skin can form petechiae and purpura. The blood loss can lead to death.

    What is the treatment for Ebola disease

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    There is no standard treatment for this disease and early supportive care and hydration can help in survival. In some cases antiviral medicines were found to be helpful. Vaccines for this disease are under development in many research centres.

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    References:
    1.http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/definition/con-20031241


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    Image source: http://en.wikipedia.org/wiki/File:Ebola_virus_virion.jpg
    Author: CDC/Cynthia Goldsmith | License: Public domain