An Overview of Marburg Virus

Marburg virus disease is a deadly, but rare, hemorrhagic fever similar to Ebola. While the disease typically starts out like many other tropical illnesses with fever and body aches, it can quickly lead to severe bleeding, shock, and death. As many as nine in 10 people with the virus die as a result of the infection. 

Outbreaks of Marburg virus are extremely uncommon. Initial cases have been linked to exposure to African fruit bats and non-human primates, but the virus can also spread from person-to-person through body fluids like blood or vomit. No cure or effective treatment exists for Marburg virus disease, making preventing the disease critical through steps like personal protective equipment and safe handling of body fluids.

Marburg virus first popped up on health officials' radar in 1967 when more than two dozen cases of hemorrhagic fever first appeared in Germany and what is now Serbia. The outbreaks started in laboratory workers and then spread to healthcare workers and caregivers. Seven people died. The initial infections were traced back to a shipment of infected African green monkeys from Uganda. It took just three months for researchers to pinpoint the virus responsible. They named it after the site of the largest outbreak—Marburg, Germany. Outbreaks have since occurred in Uganda, Angola, and the Democratic Republic of Congo.

The largest epidemic occurred in 2004 in Angola and was thought to be caused by contaminated transfusion equipment, infecting almost 400 children.

Symptoms

Marburg virus causes symptoms that come on suddenly and become increasingly severe. Like Ebola, Marburg virus disease can cause severe hemorrhaging that leads to shock, organ failure, or death.

Symptoms of a Marburg virus infection can include: 

• Fever
• Malaise
• Body aches and headache
• Gastrointestinal distress, including watery diarrhea, nausea, and cramping, often around three days after symptoms appear
• Lethargy
• Non-itchy rash on the stomach, chest, and back that is flat and red with small bumps, similar to the rash caused by scarlet fever
• Neurological changes like confusion, seizures, and delirium
• Severe bleeding, typically five to seven days after symptoms start 
• Organ failure
• Blood abnormalities including low white blood count or low platelets
• Abnormalities in kidney, liver, and clotting function

In many cases, symptoms appear about a week (five to 10 days) after someone is infected with the virus, but they can come on anywhere from two days to three weeks. 

Marburg virus disease is often fatal. Anywhere from 23% to 90% of people infected with the virus die from it, generally about eight to nine days after symptoms first appear. 

Complications

The long-term effects of Marburg virus disease aren’t as well known as those of other viruses like Ebola. This could be due, at least in part, to the high fatality rate in some outbreaks and the rarity of the disease. It’s difficult to study health issues after someone has recovered from a Marburg virus infection when so few people do. 

That said, previous outbreaks have left some clues as to how the virus might affect someone’s health in the long run. These complications can include: 

• Myalgia (muscle pain)
• Arthralgia (joint pain)
• Hepatitis (swelling in the liver) 
• Asthenia (weakness)
• Ocular (eye) disease
• Psychosis

Causes

Marburg virus disease is caused by the Marburgvirus single-stranded RNA virus. Marburg virus can spread from animals to humans, as well as from person to person and through contaminated objects.

People are generally infected by Marburg virus after being exposed to one of three things: bat colonies, body fluids, or contaminated objects.

Rousettus Bat Colonies

Before the virus can pass from person to person, it first has to jump from animal to human, typically through African fruit bats (Rousettus aegyptiacus). Humans and other primates can become infected with the virus after spending a lot of time in a cave or mine inhabited by Rousettus bat colonies found throughout Africa, where they might have contact with the bats’ feces.

Body Fluids 

Like Ebola, Marburg virus moves from person to person through direct contact with body fluids like blood, urine, saliva, respiratory droplets (such as from coughing), vomit, feces, and possibly breast milk. The infected fluids get into the body through breaks in the skin (like cuts or scrapes) or through mucosal membranes like the mouth, nose, or eyes. 

The virus can also be passed on via sex, with some reports finding the virus in semen for up to seven weeks after the person has recovered. Studies are needed to determine if there could be a return of virus-induced signs and symptoms with pregnancy.

Washing the dead body of someone who had the virus can result in being contaminated via the mouth and eyes.

Because of this, healthcare providers and other caregivers who care for those with Marburg virus disease are especially at risk of becoming infected with the virus. 

Contaminated Objects 

The Marburg virus can also be passed indirectly from person to person through contaminated objects or materials containing infected body fluids. This can include medical equipment like needles or cell cultures, as well as more common objects like soiled bed linens.

Diagnosis

Marburg virus symptoms look a lot like the symptoms of other illnesses—including flu, malaria, or typhoid fever—making it difficult sometimes to diagnose, especially if there’s only one case. That’s why doctors rely on lab tests like ELISA or PCR to make an official diagnosis.   

If there’s a reason to suspect Marburg virus disease (such as if the person has been around a known case or outbreak and is displaying symptoms consistent with the disease), doctors first isolate the person to minimize the risk someone else might be exposed to the virus. Once they’ve taken proper precautions and alerted public health authorities, healthcare providers then take a blood sample to test for signs of the virus. These tests include:

• ELISA testing: Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing looks for antibodies or antigens in the blood, which are signs that someone has been exposed to the virus. 
• Reverse transcription polymerase chain reaction (PCR): This test looks for the virus’ genetic material, specifically RNA, in order to detect the virus in a blood sample. 

In both cases, the tests can confirm a Marburg virus infection during the early stages of the disease, within a few days of symptoms appearing.

For later stages of the disease or after a person has recovered, healthcare providers can retroactively diagnose the disease using the IgG-capture ELISA test, which looks for antibodies against the virus. Similarly, doctors can use several lab tests—like virus isolation, immunohistochemistry (a way of detecting specific antigens in cells), or PCR—to detect the Marburg virus in those who have already died from the disease. 

Treatment

No cure currently exists for Marburg virus. As a result, healthcare providers treat the disease by managing the symptoms and doing what they can to prevent further complications or death. These measures can include:

• Managing pain
• Replenishing fluids and electrolytes to prevent dehydration
• Stabilizing oxygen levels and blood pressure
• Replacing blood or clotting factors in the case of hemorrhaging
• Treating any secondary infections or complications 

Some experimental treatments have shown promise when given to animals infected with the virus, but they’ve yet to be tested in humans. 

Prevention 

With no real effective treatment options, the most effective way to protect yourself from Marburg virus disease is to prevent it altogether. No vaccine is currently available to prevent Marburg, though one is in the early stages of development. Instead, methods to prevent Marburg virus center on barrier nursing techniques (like personal protective equipment used to prevent Ebola), as well as avoiding animals that might be carrying the virus.

Use Barrier Nursing Techniques

Barrier nursing techniques are precautions healthcare providers and caregivers should take when someone might have a virus like Marburg or Ebola. These include: 

• Putting the person who might be infected or who has already been diagnosed in a protected environment by themselves, effectively limiting the number of people who could be exposed to the virus
• Wearing personal protective equipment (PPE) like gowns, gloves, and masks before coming into contact with someone who has or may have Marburg virus disease
• Using single-use medical equipment—like needles—whenever possible, and thoroughly disinfecting multi-use equipment after coming into contact with body fluids that might contain the virus
• Exercising caution when disposing of body fluids like blood, vomit, or diarrhea or anything that might have come into contact with them (such as bedsheets)

These precautions extend beyond healthcare settings. Just like nurses should take precautions when changing soiled sheets or clothing when caring for someone with Marburg virus disease in a hospital setting, so should family members or friends caring for the individual in the home. Likewise, loved ones of someone who died from Marburg virus disease should be careful when touching their loved one’s body, including during funerals or other cultural traditions used to honor the deceased.

Avoid Potential Animal Hosts  

Exactly how the Marburg virus jumps from animals to humans isn’t well understood among public health and medical officials. As a result, researchers are still figuring out the best ways for humans to avoid getting the virus from an animal. However, given what we know already, certain animal groups should be avoided. These include:

• African fruit bats, including being in spaces like caves or mines where the bats live
• Non-human primates that show signs of infection
• Domestic pigs, especially in the event of an outbreak or if the animals are exposed to other animal hosts like African fruit bats

A Word From Verywell

While Marburg virus disease can be deadly, it is extremely rare. Even so, if you’re planning to travel to areas where animal hosts are common or where outbreaks are ongoing, be extra careful around animal feces or body fluids. If you come into contact with animals or people who might be infected with the virus and you start to experience any of the symptoms listed above, talk to a doctor right away.