Medical Site Briefing Session

MARBURG VIRUS DISEASE

NOT A DEEP DIVE, Just A Tip of the Iceberg: Open Discussion

By: dr. Ezra Hans Soputra

Outline
• Introduction
• Epidemiology
• Etiology
• Pathophysiology
• Clinical Manifestation
• Diagnosis
• Treatment and Prevention
• Complication
• Prognosis Le Virus
Introduction

• 7 February 2023, Death of a

number of individual
suspected Hemorrhagic Fever
in Equatorial Guinea
• 12 February 2023, Positive
Marburg Virus from RT-PCR
from one sample
• Investigations are ongoing
Indonesia
• 20 February 2023 Indonesia
Ministry of Health conducted
a Rapid Risk Assessment 
Low probability of Viral
Marburg case Import
Marburg Virus Disease/Marburg Hemorrhagic Fever

• Fatal  88% fatality rate

• Initially detected in 1967 in Marburg and Frankfurt Germany and
Belgrade Serbia
• Caused by Marburg Virus
• Derived from the same family as Ebola Virus (Filoviridae) and is a rare
case of hemorrhagic fever.
• Affects both people and Non-human primates
Epidemiology
Apparent or suspected Reported number of Reported number (%) of
Year(s) Country origin human cases deaths among cases Situation
2023 Tanzania Kagera Region 8 5 On March 21, 2023,
Tanzania government
officials declared the
country’s first-ever
outbreak of Marburg
disease. The cases have
been reported in the
country’s northwest
Kagera region.
Information on additional
suspect cases is limited at
this time.

2023 Equatorial Guinea Kie-Ntem Province 9 7 On February 13, 2023,

government officials in
Equatorial Guinea
declared an outbreak of
Marburg disease. The
Ministry of Health initially
reported one confirmed
case and additional
suspect cases in Kie-
Ntem Province, in the
northeast corner of the
country. Information on
the additional suspect
cases is limited at this
time.
 Etiology
• Marburg Virus
• Order: Mononegavirales
• Family: Filoviridae
• Genus: Marburgvirus
• Species: Marburg Marburgvirus

• Synonyms: Marburg disease, Marburg

Hemorrhagic fever, African Hemorrhagic fever,
Green Monkey Disease
 Etiology
• Marburg Virus
• Enveloped, single stranded, unsegmented, negative
sense RNA virus
• Has filamentous structure, appear like U, 6, or spiral
shape.
• Viral fragments: pleomorphic
• Complexed with the protein NP, VP35, VP30 and L
 Etiology
• Zoonotic, Animal Host: African Fruit Bats (Rousettus
aegyptiacus)
• May infect people and Nonhuman Primates,
Unknown mechanism.
• Human-to-human transmission via direct contact
• Blood
• Secretion
• Organs or other bodily fluid
• Surfaces and materials contaminated with this fluid
• Virus may still be shed in patient’s semen for up to 3-
4 months after illness. But no data suggesting it can
spread through sexual activity
Transmission
Pathophysiology

• Unknown mechanism as with Ebola

• It is presume that the surface spikes bind to receptors and mediate
entry
• It has 22 potential N-linked glycosylation sites on its surface
• Virus replicates in cytoplasm, and envelopment is the result of
budding preformed nucleocapsid

• Incubation Periods: Varies from 2 to 21 days

Signs and Symptoms

• Incubation 2-21 days

• 3rd - 5th day • Severe cases >5th day:

• Maculopapular rash may • Jaundice
• Onset: Sudden occur especially on the • Inflammation of pancreas
• Abrupt Fever trunk • Severe weight loss
• Chills • Nausea, vomiting • Delirium
• Headache • Chest pain • Shock
• Myalgia • Soar throat • Liver Failure
• Abdominal pain • Massive hemorrhaging
• diarrhea • Multi organ dysfunction

TIME
Diagnosis
• From Anamnesis  in early course may be hard to distinguish from other
tropical febrile illnesses
• History of possible exposure to Marburg virus
• Laboratory findings:
• Reduction in lymphocyte and increased neutrophil
• Thrombocytopenia
• Elevated SGOP SGPT
• Lab confirmation can be made by different test through blood or tissue
specimen:
• ELISA
• RT-PCR
• Electron microscopy
Patient Risk Category

• Unlikely to have VHF

• Low possibility of VHF
• High possibility of VHF
• Confirmed VHF
Treatment and Prevention

• No specific treatment only supportive therapy

• Balancing Fluid and electrolyte
• Maintaining oxygen status and blood pressure
• Replacing loss blood and clotting factors
• Consider antimalarial treatment
• ORS if vomiting vomiting and diarrhoea or any sign of dehydration or
not drinking well, start IV fluids.
• Antibiotics (Empirical antibiotic s.a ciprofloxacin or cefixime or
amoxicillin-clavulanate or IV s.a Ceftriaxon)
• No Vaccine ready Yet.
Management for sign and symptoms
• Fever (>38.0oC): Paracetamol, NO NSAID
• Acute significant bleeding/severe pallor:
• fresh whole blood or red blood cell components considered
• Multivitamin and/or vitamin K administration (e.g. 10 mg orally daily for 3 days) at
admission OR vitamin K 10 mg intravenously
• FFP guided by INR/PT for significant bleeding
• Antifibrinolytic (Tranexamid acid): reasonable, but no evidence from filoviridae
patients
• PAIN
• 1st line: paracetamol (PO, IV) 2nd line: tramadol (PO, IV) 3rd line: morphine (PO, IV)
• Respiratory distress: Oxygen, Titrate to SpO2 >90%
Management for sign and symptoms
• Diarrhoea, vomiting, sign of dehydration: ORS. Monitor signs of
dehydration. No, some or severe use plan A, B, and C respectively
Management of sign and symptoms

• Dyspepsia: Omeprazole 20-40 mg PO or magnesium trisilicate 2

tabs/8hours
• Convulsion  Diazepam maintained with phenobarbital
• Signs of hypoglycemia  Monitor blood glucose, give 125 to 250 ml
D10 rapidly (or 25 to 50 ml of D50) for adult. Use D5 in all
maintenance fluids.
Prevention(?)

• Primary Prevention  intervening before health effect occur.

• Use of PPE for those who are at risk and increase awareness in the
community
• Secondary Prevention  screening to identify disease before earliest
stage
• Tertiary prevention  Managing disease to slow or stop disease
progression, screening for complication
Complications

• Hemorrhage
• Shock
• Multi Organ Failure
Prognosis

• As 88% fatality Rate, the prognosis of MVD is bad if not detected or

treated early.
• Management of disease is emphasized in the prevention of the
disease
DISCUSSION SESSION?