Wednesday 2 October 2024, one student of medicine, 27 years old, returning by train to Germany from a trip to Rwandawas isolated with his girlfriend after showing symptoms compatible with the virus Marburg. The boy alerted the authorities while he was on the train, after showing the first symptoms. 275 passengers on the train were also brought under complete control precautionary. The student had served in a hospital in Kigaliwhere a outbreak of the Marburg virus, specifically have been identified 26 cases, of which 70% I am healthcare workers. The virus causes very high fever, gastrointestinal symptoms and subsequently presents a hemorrhagic phase. Although this virus causes a extremely lethal hemorrhagic disease (fatality rate is 50%), It is important to underline that it is transmitted via body fluids, but never by air. There are no specific treatments or vaccines, but isolation and early diagnosis increase the chances of survival. The WHO assesses the risk of an epidemic as very high in Rwanda, but low globally.
What is Marburg virus
The Marburg virus (Marburg marburgvirus -MARV-) is part of the dei family Filoviridaethe same family as the better-known Ebola virus. Although these two viruses are different from each other, the diseases caused are clinically very similar. The Marburg virus is, in fact, responsible for the “Marburg hemorrhagic fever” (also called “Marburg virus disease“).
This virus owes its name to German city of Marburgwhere it manifested itself for the first time in 1967when it caused three outbreaks in Marburg, in fact, and then in Frankfurt and Belgrade. It was then ascertained that the first humans to be infected in Marburg were researchers working closely with Ugandan green monkeysor grey-green vervet monkey (Cercopithecus aethiops), previously infected in turn by bats.
How the Marburg virus is transmitted
It is believed that the origin of the virus is probably one zoonoses (i.e. animal-to-human transmission) and which resulted from exposure to bats like that Rousettus (probably especially i Rousettus aegyptiacusthe African fruit bat), both by primates (who then transmitted it to humans), and by humans themselves directly, due to their prolonged stay in mines And caves inhabited by these bats.
Once the first person is infected, the virus can then be transmitted from human being to human beingthrough direct contact with blood, secretions, fluids and mucous membranes of the infected person, or by also coming into contact with contaminated objects, clothes or underwear. The virus, in fact, it can remain on surfaces and in fluids for many days, if not treated with disinfectants, boiling, exposure to temperatures starting from 60° or gamma rays.
Other possible routes of infection are the consumption of infected wild meat and contact with live or dead infected animals.
During the incubation period the risk of contagion is minimal, but during the advanced stages of the diseasewhen symptoms such as vomiting, diarrhea or bleeding occur, the risk of transmission it is very tall.
What are the symptoms
The incubation of Marburg virus varies from 2 to 21 daysalthough in most cases it manifests itself around the eighth/ninth day. THE’debut happens with fever very high which reaches even 40 °C, headache, sore throat and general malaise. From the third day they begin gastrointestinal symptoms: vomiting, watery diarrhea, abdominal cramps. This phase can last up to a week and lead the patient to lethargy.
There hemorrhagic phase start between the fifth and seventh dayIn this phase, petechiae, bleeding from the gums, presence of blood in the stool, vomiting with blood, weight loss may develop. In this they can also manifest themselves neurological symptomssuch as: convulsions, coma, confusion, agitation and disorientation. If action is not taken to address the symptoms immediately, death occurs in approximately 9 days.
If the patient survives, the virus remains latent in the body until 4 weeks and it is still transmissible. The fatality rate of this disease is about 50%, but it can happen up to 88%; We usually die from internal bleeding and of themultiple organ failure. Early identification increases the chances of survival.
Diagnosis, treatment and prevention
Since Marburg fever is similar, for many symptoms, to Ebola, and for some others to typhoid or malaria, we proceed with a differential diagnosistrying to understand if the patient has traveled and where, and what risks he has been exposed to. The antigens are then identified with ELISA and PCR tests, and blood counts, liver function and urinalysis are evaluated.
There are no vaccines or special treatments for Marburg hemorrhagic fever, but the patient must be kept safe isolatedstrictly under controlcontinuously rehydrated intravenously and orally and must be monitored and maintained electrolyte balance.
There are some precautions to be taken to avoid direct contagion, but above all to avoid the spread of outbreaks. AND recommended frequent hand washing, avoid touching potentially contaminated objects, avoid contact with sick people and even people who have already died from the disease, do not eat wild animal meat, use personal protective equipment if you come into contact with a presumed infected person, Avoid exposure to African bats and monkeys.
If outbreaks are identified, they must be declared and contained; Passengers by flight or by other means coming from that area must be checked.
