Marburg fever

Disease Description (Causes and Symptoms)

• Definition: Marburg hemorrhagic fever is an acute hemorrhagic fever infectious disease caused by infection with the Marburg virus (a negative-sense single-stranded RNA virus of the Filoviridae family).
• Cause and host: Fruit bats (Rousettus species) have been identified as the primary natural host.
• Route of transmission: Infection occurs through contact with body fluids such as the blood, vomit, and secretions of an infected person, or through exposure to contaminated syringes and equipment. (Airborne transmission is generally not a major route.)
• Incubation period: Primarily 5–10 days (may vary by case).
• Main symptoms: Begins with fever, chills, headache, muscle pain, and malaise → gastrointestinal symptoms such as pharyngitis, vomiting, and diarrhea within 2–3 days → may subsequently progress to bleeding (mucosal, skin, and internal-organ bleeding), shock, and multiple organ failure.
• Pathophysiology (brief): As the virus spreads throughout the body and damages endothelial and immune cells, increased vascular permeability and abnormalities in the coagulation system (disseminated intravascular coagulation) occur, which may lead to bleeding and organ failure.
• Prognosis: Based on the cited data, the case fatality rate is approximately 25%; in severe cases, death may occur within 7–10 days after onset.

Treatment

• Basic principles: No specific treatment has been established, and active supportive care (symptomatic treatment) is the main treatment.
• Supportive treatment:
  • Fluid and electrolyte replacement (intravenous fluids), hemodynamic monitoring, and blood pressure support when necessary (vasopressors).
  • In cases of severe bleeding, transfusion (including fresh frozen plasma and platelets) and correction of coagulation abnormalities.
  • Treatment of organ failure, including oxygen therapy, mechanical ventilation, and renal replacement therapy.
  • Appropriate administration of antibiotics in cases of secondary bacterial infection.
• Specific drugs and investigational treatments: Antiviral drugs (such as remdesivir and favipiravir in some studies) and monoclonal antibody treatments are under investigation but have not been established as standard treatments. Availability depends on the clinical situation, research, and approval status.
• Infection control:
  • Medical isolation (use of standard precautions and protective equipment to prevent contact and body-fluid exposure); management of contaminated items and specimens in hospitals at the BSL-4 level is recommended.
  • Use of personal protective equipment (PPE) when handling patients, safe injection and syringe management, and safe funeral procedures.
• Other: Because early detection and intensive treatment have a major impact on the survival rate, suspected cases should be transferred and isolated immediately.

Checkpoints Before an Outpatient Visit (Including Preparation Items and Example Questions)

Items to prepare (before visiting the hospital)

• A record of travel within the past 2 weeks (especially to high-risk areas of Africa) or contact with animals such as bats or monkeys
• The onset date and progression of symptoms such as recent fever, bleeding, vomiting, or diarrhea
• Information about contacts (people suspected of being infected) and details of exposure (whether there was contact with blood or body fluids)
• A list of currently used medications, underlying conditions (such as immunosuppression), and allergy information
• Previous test results (if available) and vaccination records (if applicable)

When Immediate Emergency Department Visit or Transfer Is Needed During Pre-Outpatient Assessment (Immediate Contact or Emergency Care Recommended)

• If high fever occurs (especially with hemorrhagic signs), or if there is low blood pressure, dizziness, reduced consciousness, or severe bleeding (vomiting or bleeding in the stool or from blood vessels), go to the emergency department immediately
• If symptoms occur after suspected exposure (direct contact with body fluids, contaminated syringes, etc.), immediately contact a medical institution and take isolation measures

Simple Example Questions (Items to Tell Medical Staff During Outpatient Registration)

• "Have you traveled to Africa (or another high-risk area) within the past 2 weeks? On what date did you return?"
• "Have you ever had contact with wild animals such as bats or monkeys?"
• "Have you recently had direct contact with blood, vomit, or secretions? Did you have any wounds?"
• "When did the fever start, and approximately how high was your temperature? Do you have any bleeding symptoms (nosebleeds, bleeding gums, bloody stool, etc.)?"

General Example Questions to Ask the Doctor

• "What is the meaning of my symptoms (or test results)? How severe might my condition be?"
• "What do you recommend regarding treatment options (supportive care, the need for hospitalization/transfer, and experimental treatment)?"
• "What complications are expected during treatment, and how can they be prevented and managed?"
• "Am I infectious, and what isolation and monitoring measures should be taken for my family members and cohabitants?"
• "When will the tests (blood PCR and antibody testing) be performed, and how long will the results take?"

Disease-Specific Example Questions

• "How likely are my current symptoms (fever, vomiting, diarrhea, etc.) to progress to hemorrhagic complications? What symptoms mean that I should go to the emergency department immediately?"
• "I believe there was a time when I may have been exposed. What is the isolation period for contacts, and how will follow-up testing be conducted (how many days and how many tests are needed)?"

Note: Suspected cases and exposure cases must be reported and managed immediately according to the guidelines of the local public health authorities and the hospital's infection-control regulations. If suspected symptoms occur, contact a medical institution without self-diagnosing or delaying, and follow its instructions.