A Equatorial Guinea recorded this week the first outbreak of the disease caused by marburg virus . Preliminary tests carried out after the death of at least nine people in Kie Ntem province, in the west of the country, confirmed the viral hemorrhagic fever.
Equatorial Guinea health authorities sent samples to the Institut Pasteur reference laboratory in Senegal with the support of the World Health Organization (WHO) to determine the cause of the disease following an alert from a district health official on 7 February.
Of the eight samples tested at the Institut Pasteur, one tested positive for the virus. So far, nine deaths and 16 suspected cases with symptoms including fever, fatigue, bloody vomiting and diarrhea have been reported, according to the WHO.
Marburg is a hemorrhagic fever, caused by a highly infectious virus in the same family as the Ebola virus. The virus is transmitted to people by fruit-eating bats and spreads among humans through direct contact with contaminated body fluids, surfaces and materials.
The illness, which starts abruptly, presents high fever, severe headache and malaise. The incubation period of the disease ranges from 2 to 21 days. Patients develop severe bleeding signs within seven days.
According to the WHO, case fatality rates have ranged from 24% to 88% in previous outbreaks, depending on the virus strain and capacity for case management.
While there are no approved vaccines or antiviral treatments to treat the virus, supportive care — such as rehydration with oral or intravenous fluids — and treatment of specific symptoms reduce the risks of death.
A number of potential treatments, including blood products, immune and drug therapies, as well as vaccine candidates with phase 1 data, are being evaluated.
Historical context
The initial recognition of the disease followed two major outbreaks that occurred simultaneously in Marburg and Frankfurt, Germany, and in Belgrade, Serbia, in 1967.
The episode was associated with laboratory work with African green monkeys (Cercopithecus aethiops) imported from Uganda. According to the Centers for Disease Control and Prevention (CDC), in the United States, 31 people became ill, initially laboratory professionals, followed by several doctors and family members. Seven deaths were recorded.
Subsequently, outbreaks and sporadic cases have been reported in Angola, Democratic Republic of the Congo, Kenya, South Africa (in a person with recent travel history to Zimbabwe), Uganda, and Ghana. In 2008, two independent cases were reported in travelers who visited a cave inhabited by colonies of Rousettus bats in Uganda.
Cases of the disease outside Africa are rare.
How does the transmission
The reservoir host for Marburg virus is the bat of the species Rousettus aegyptiacus, which lives in caves and is widely distributed throughout Africa. Infected bats do not show characteristic signs of the disease. Primates, such as humans and monkeys, can be infected and develop severe disease with high mortality.
Human infection happens from contact with infected bats.
Once an individual is infected, the virus can be spread through person-to-person transmission by direct contact (through breaks in the skin or through mucous membranes) with blood, secretions or other body fluids from infected people.
Objects contaminated with bodily fluids from a person who is sick or has died from the disease, such as bedding, needles and medical equipment, are also sources of transmission.
Those most at risk are family members and health professionals who care for infected patients without using adequate preventive measures. Veterinarians and laboratory specialists or researchers working with non-human primates in Africa may also be at increased risk of exposure to the virus.
Signs and symptoms
After an incubation period of 2 to 21 days, the onset of symptoms is sudden and marked by fever, chills, headache and body ache. Around the fifth day after the onset of symptoms, a rash may occur, especially on the chest, back, stomach area.
Patients may experience nausea, vomiting, chest pain, sore throat, abdominal pain, and diarrhea. Worsening of the disease leads to symptoms such as jaundice (yellowing of the eyes and skin), inflammation of the pancreas, significant weight loss, delirium, shock, liver failure, hemorrhage, and multiple organ dysfunction.
Diagnosis
As the signs and symptoms of the disease caused by the Marburg virus are similar to the clinical pictures of other infectious diseases, the diagnosis may be delayed.
The identification of early symptoms characteristic of the disease and data relating to possible exposure to the virus indicate the need for patient isolation and notification of health authorities.
Diagnosis can be performed in the laboratory from patient samples. Techniques include molecular diagnostics (RT PCR), which allows the identification of the genetic material of the virus, and antigen tests.
Treatment
There are no specific treatments for Marburg virus disease.
Patients admitted to hospitals can receive supportive therapy, with the aim of controlling the impacts of the infection on the body. Measures include maintaining oxygen status, controlling blood pressure, replacing lost blood, and treating possible complications.
Prevention
Preventive measures against Marburg virus infection include avoiding areas with fruit-eating bats and contact with sick non-human primates.
In the face of suspicion or confirmation of the disease, infection prevention and control measures must be adopted to avoid direct physical contact with the patient.
In addition to isolation, care includes the use of protective aprons, gloves and masks, sterilization and proper disposal of needles, equipment and patient waste.
Source: CNN Brasil
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