Marburg fever

from Wikipedia, the free encyclopedia
Classification according to ICD-10
A98.3 Marburg virus disease
ICD-10 online (WHO version 2019)

The Marburg fever is a notifiable viral infectious disease .

Pathogen

Marburg virus

It is triggered by the Marburg virus , an enveloped single (-) - stranded RNA virus (ss (-) RNA) belonging to the Filoviridae family and the order Mononegavirales (single stranded RNA complementary to mRNA ). The Marburg virus is thus closely related to the Ebola viruses and the Cuevaviruses , which include the Lloviu virus, which was first detected in northern Spain in 2011.

The reservoir from which the virus originated has not yet been determined with certainty. It is believed to be the carrier of the Egyptian bat, a species of bat found in Europe and Africa. The theory that bats represent the natural reservoir of filoviruses is supported by the increased occurrence of Marburg fever as a result of visiting a cave. In Durba ( Congo , 1998–2000) 53% (75/142) of all infected miners were in frequent contact with bats.

Origin and Distribution

The virus presumably originates from central Africa . It is very likely that it was introduced in 1967 with experimental monkeys ( monkeys ) from Uganda to the laboratories of the pharmaceutical company Behringwerke in Marburg, Hesse . The secondary disease, Marburg fever, first appeared in the laboratory technicians employed there, and the virus was then identified for the first time in the Marburg Tropical Clinic. That is why it was given the name Marburg virus. The fever later also appeared in Frankfurt am Main and Belgrade . Of the 31 sick people at the time, seven died.

transmission

The Marburg virus is mainly transmitted through contact with body fluids (blood, stool, urine, saliva, breast milk, etc.). Human-to-human transmission via aerosols appears to play a minor role in its spread in natural outbreaks. In contrast, laboratory tests have shown that Marburg viruses are stable in aerosols and highly infectious for primates. In addition, the inhalation of bat excreta and the consumption of raw bat meat are seen as the primary means of transmission from animal to human.

In addition, there are differences between mortality depending on the route of infection. According to the current state of knowledge, parenteral infections with the Marburg virus show the greatest mortality.

Disease symptoms and course

Like the Ebola virus , Marburg viruses can infect many different cell types. These include: macrophages , dendritic cells , endothelial cells , fibroblasts , hepatocytes (liver cells), epithelial cells and adrenaline-producing cells in the adrenal cortex . Experimental studies have shown the preference for antigen presenting cells such as macrophages, dendritic cells and monocytes . Infected antigen-presenting cells spread from the primary site of infection via the lymphatic system to the liver and spleen . Additional antigen-presenting cells are attracted by an increased level of chemokines, such as MCP-1 (monocyte chemoattractive protein 1) or MIP-1α (macrophage inflammatory protein 1α).

After an incubation period of usually three to nine days, but no longer than 21 days , the first unspecific symptoms appear, which are similar to the initial symptoms of malaria , typhoid or yellow fever . These symptoms include severe, watery diarrhea , abdominal pain, vomiting , severe chest and lung pain, sore throat, and cough. In a high percentage of those infected, the virus triggers high hemorrhagic fever five to seven days after the onset of the disease , which predominantly affects the gastrointestinal tract and lungs. These hemorrhages are caused by soluble substances, such as nitric oxide , and not by lysis of the endothelial cells in the blood vessels. This is usually followed by various hemorrhages . Most of the patients also die within the last-mentioned time period, although no statistically significant connection between the occurrence of hemorrhages and a fatal outcome of the disease could be demonstrated; especially since it has been shown that the resulting blood loss is not lethal.

The mortality from this disease varies greatly, depending on medical care and the virus strain, between 22.6% (outbreak 1967) and 88.0% in Uige (Angola, 2004-2005). For example, the strain found in Angola had a higher virulence than the strain found in Germany in 1967. Even if the high mortality is rather disadvantageous for the spread of the virus, the virus is nonetheless well adapted to its ultimate host , humans, since a high level of contagiousness is reached due to the viral load that causes the high mortality .

Therapy and diagnostics

No specific antiviral drugs or vaccinations against the Marburg virus are currently approved, so that only supportive treatment with antipyretics , antibiotics , cardiac glycosides , electrolytes , infusions and, in other cases, specific medications and intensive care treatments such as dialysis is possible.

The Marburg virus can be detected by reverse transcription PCR (rtPCR) in a BSL4 laboratory. In this process, the viral RNA is transcribed into cDNA using a reverse transcriptase and then amplified using specific and complementary primers and a DNA-dependent DNA polymerase . In addition, a direct or indirect ELISA (enzyme-linked immunosorbent assay) can be used for detection . In Germany, the Marburg virus and Ebola virus diagnostics are handled by the Bernhard Nocht Institute in Hamburg as the national reference laboratory and the virology department of the Philipps University of Marburg as the consulting laboratory .

prevention

At the beginning of 2005, scientists working with Steven Jones and Heinz Feldmann ( University of Manitoba , Winnipeg, Canada) successfully vaccinated (active immunization) in long-tailed macaques ( Macaca fascicularis ) with a weakened, living, recombinant vesicular stomatitis virus (VSV) on its surface produces a so-called glycoprotein of the Marburg virus strain Musoke .

In April 2006, research results from researchers from the USA and Canada who succeeded in developing a vaccine against the Marburg virus were published. In animal experiments, the vaccine was also shown to be effective in post-exposure prophylaxis .

Reporting requirement

In Switzerland, the disease is Marburg fever notifiable and that after the Epidemics Act (EpG) in connection with the epidemic Regulation and Annex 1 of the Regulation of EDI on the reporting of observations of communicable diseases of man . Doctors, hospitals etc. are required to report. Criteria for reporting are clinical suspicion and consultation with a specialist in infectious diseases and the initiation of a pathogen-specific laboratory diagnosis.

In Germany, the Infection Protection Act (IfSG) prescribes in Section 6 IfSG a general obligation to report by name in the event of suspected diseases or deaths from viral hemorrhagic fevers . In addition, according to this law, direct or indirect evidence of other pathogens causing haemorrhagic fever is subject to notification in accordance with Section 7 IfSG if the evidence indicates an acute infection. In contrast to almost all other infections in the case of hemorrhagic fevers that can be transmitted from person to person, immediate isolation is mandatory for the sick person ( Section 30 (1) sentence 1 IfSG [quarantine], together with pulmonary plague).

In Austria, virus-related hemorrhagic fever is notifiable in the event of suspicion, illness or death in accordance with Section 1 Paragraph 1 Number 1 of the 1950 Epidemic Act . Doctors and laboratories, among others, are obliged to report this ( Section 3 Epidemics Act).

history

Outbreaks of the disease were the one in Europe from 1967 and the one in the Democratic Republic of the Congo that lasted from 1998 to 2000, with a total of 149 infected people, of whom 123 died.

The disease has been occurring in the northern part of Angola since October 2004 . According to information from the Angolan Ministry of Health from April 2005, 210 of the 231 previously registered sick people have already died, including mainly children under five years of age. The refusal of the population to isolate those infected is particularly problematic. Since the funeral includes a personal farewell with a hug, etc. for families, it is extremely difficult to guarantee the burial that is actually necessary immediately, which increases the risk of infection considerably.

In July 2008 a woman from the Netherlands fell ill and died shortly after the infection was detected. She probably got infected on a trip to Uganda , where she visited a cave where many bats stayed. The year before, the Marburger pathogen was found in cave flying foxes in Uganda .

In September 2014, the Marburg virus broke out in Uganda after the two Ebola outbreaks in West Africa and the Congo (Central Africa) . According to previous knowledge, a 30-year-old man died. 79 people were placed under surveillance and one isolated who was in contact with the dead person.

See also

Web links

Commons : Marburgfieber  - Collection of pictures, videos and audio files

Individual evidence

  1. ↑ A. Negredo, G. Palacios, S. Vázquez-Morón et al.: Discovery of an Ebolavirus-Like Filovirus in Europe. In: PLoS Pathog. No. 7, 2011, p. E1002304.
  2. ↑ K. Olival, D. Hayman: Filoviruses in Bats: Current Knowledge and Future Directions. In: Viruses. No. 6, 2014, pp. 1759–1788.
  3. ↑ Jonathan S. Towner, Xavier Pourrut, César G. Albariño and others: Marburg Virus Infection Detected in a Common African Bat. In: PLoS ONE. August 22, 2007, Volume 2, No. 8, pp. E764, doi: 10.1371 / journal.pone.0000764
  4. ↑ DG Bausch, ST Nichol, JJ Muyembe-Tamfum et al .: Marburg Hemorrhagic Fever Associated with Multiple Genetic Lineages of Virus. In: N Engl J Med. No. 355, pp. 909-919.
  5. ↑ MI Lub, AN Sergeev, OV P'iankov and others: Nekotorye patogeneticheskie kharakteristiki zabolevaniia obez'ian, aérogenno infitsirovannykh virusom Marburg. In: Vopr. Virusol. No. 40, 1995, pp. 158-161.
  6. ↑ DA Alves, AR Glynn, KE Steele et al .: Aerosol exposure to the angola strain of marburg virus causes lethal viral hemorrhagic Fever in cynomolgus macaques. In: Vet. Pathol. No. 47, 2010, pp. 831-851.
  7. ↑ A. Sanchez, T. Geisbert, H. Feldmann: Filoviridae: Marburg and Ebola viruses. In: BN Fields, DM Knipe: Fields' virology. 2006, pp. 1409-1448.
  8. ↑ a b c T. W. Geisbert, KM Daddario-DiCaprio, JB Geisbert et al .: Marburg virus Angola infection of rhesus macaques: pathogenesis and treatment with recombinant nematode anticoagulant protein c2. In: J. Infect. Dis. No. 196, Supplement 2, 2007, pp. 372-381.
  9. ↑ M. Mehedi, A. Groseth, H. Feldmann, H. Ebihara: Clinical aspects of Marburg hemorrhagic fever. In: Future Virology. No. 6, 2011, pp. 1091-1106.
  10. ^ A b A. K. McElroy, BR Erickson, TD Flietstraet et al: Ebola Hemorrhagic Fever: Novel Biomarker Correlates of Clinical Outcome. In: Journal of Infectious Diseases. (J Infect Dis) August 15, 2014, Volume 210, No. 4, pp. 558-566, doi: 10.1093 / infdis / jiu088
  11. ^ A b D. V. Clark, PB Jahrling, JV Lawler: Clinical Management of Filovirus-Infected Patients. In: Viruses. No. 4, 2012, pp. 1668-1686.
  12. ↑ M. Mehedi, A. Groseth, H. Feldmann, H. Ebihara: Clinical aspects of Marburg hemorrhagic fever. In: Future Virology. 2011, No. 6, pp. 1091-1106.
  13. ↑ Focus Online: First known case - dangerous Marburg virus introduced to Europe . On: faz.net
  14. ^ Spiegel Online: First known case: Deadly Marburg virus introduced to Europe . On: spiegel.de of July 10, 2008, last accessed on August 14, 2014.
  15. ↑ NZZ: Dutch woman dies of Marburg virus . On: nzz.ch from July 1, 2008, last accessed on August 14, 2014.
  16. ^ First Ebola, then Marburg . On: taz.de from October 6, 2014.
  17. ^ Outbreak of Ebola-like Marburg fever kills man in Uganda . On: reuters.com from October 5, 2014.
  18. ↑ Ebola-like virus emerged in Uganda . On: pharmische-zeitung.de from October 6, 2014.