Marburg Haemorrhagic Fevers
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Marburg virus belongs to the family Filoviridae, divided into three genera: ebola viruses, marburg viruses, and cueva viruses. The reservoir host of Marburg virus is the African fruit bat, Rousettus aegyptiacus. Fruit bats infected with Marburg virus do not to show obvious signs of illness. Primates (including humans) can become infected with Marburg virus, and may develop serious disease with high mortality. The disease can spread rapidly within the health care setting. The virus enters through broken skin, mucous membrane or exchange of bodily fluids or ingestion, inhalation and injection of infectious material.
Case Definition
Suspected case: Illness with onset of fever and no response to treatment of usual causes of fever in the area, and at least one of the following signs: bloody diarrhea, bleeding from gums, bleeding into skin (purpura), bleeding into eyes and urine.
Confirmed case: A suspected case with laboratory confirmation (positive IgM antibody, positive PCR or viral isolation), or epidemiologic link to confirmed cases or outbreak.
In an outbreak setting, the following standard case definitions apply;
Suspected case: Any person, alive or dead, suffering or having suffered from a sudden onset of high fever and having had contact with: - a suspected, probable or confirmed Marburg case; - a dead or sick animal
OR
- Any person with sudden onset of high fever and at least three of the following symptoms: - headaches - lethargy - anorexia /loss of appetite - aching muscles or joints - stomach pain - difficulty swallowing - vomiting - difficulty breathing - diarrhoea - hiccups; OR
- Any person with inexplicable bleeding OR
- Any sudden, inexplicable death; OR
- A person (alive or dead) suffering or having suffered from a sudden onset of high fever and having had contact with a dead or sick animal
Non-Pharmacological Treatment:
- Supportive therapy includes:
- Mechanical ventilation, renal dialysis, and anti-seizure therapy may be required
- Management of complications symptomatically
- Maintaining Oxygen status and Blood Pressure
Pharmacological Treatment
There is no specific treatment for Marburg Haemorrhagic Fever.
A: paracetamol (PO/IV) 15mg/kg 8hourly for 3days
B: Give oxygen and manage hypoglycaemia if present
If there is Fluid and electrolyte imbalance:
A: compound sodium lactate (Ringers Lactate), NS intravenously if cannot take fluids orally
B: Give Oxygen therapy to maintain oxygen status
A: sodium lactate compound (Ringers Lactate), NS intravenously if cannot take fluids orally. Provide IV fluids and electrolytes (body salts) through infusion into the vein (intravenously)
A: Manage hypoglycaemia with 5% DNS or 25% Dextrose Solution if hypoglycaemia is shown by RBG testing
A: Using medication to support blood pressure, reduce vomiting and diarrhea and to manage fever and pain
A: Treating other infections or any complicating infection and co-morbid condition
A: Psychological support is given to patient and family
D: Refer for Provision of Mechanical ventilation, renal dialysis, and anti-seizure therapy may be required