Ebola and Marburg fever

Ebola and Marburg fever causes fever and bleeding. The diseases are triggered by viruses and are life-threatening

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What is the Ebola and Marburg fever?

Ebola and Marburg fevers are among the so-called hemorrhagic fever diseases and are triggered by viruses. Both the Ebola virus and the Marburg virus belong to the group of filoviruses.

The diseases occur comparatively rarely, but often have a dramatic course. The pathogens are among the most dangerous known pathogens. While only one type of the Marburg virus is known to date, which has been found in all outbreaks, over the years several subtypes of the Ebola virus have been detected as causative agents of infections in humans (Zaire, Sudan, Bundibugyo and Tai- Forest subtype). A subtype that is not dangerous for humans, the Reston subtype, was also found in monkeys and pigs. It is not yet known whether the Bombali subtype, recently discovered in bats, can cause infections in animals or humans.

Background info - history of the viruses

Ebola virus

Ebola was first detected in 1976 in Sudan and the Democratic Republic of the Congo, then Zaire. The name was given after the river Ebola, which runs through the Democratic Republic of the Congo near the center of the epidemic at that time.

Marburg virus

In 1967, several laboratory employees in Marburg (Hesse), Frankfurt and Belgrade (Serbia) contracted the virus from monkeys imported from Uganda. The disease site with the most infected people later gave its name to the virus.

Occurrence: In which regions do Ebola and Marburg viruses occur?

Since the virus became known, there have been isolated cases and small epidemics of Ebola and Marburg fever, almost exclusively in sub-Saharan Africa. The regions of Democratic Republic of the Congo (formerly Zaire), Republic of Konge, South Sudan, Gabon and Uganda are particularly affected.

The largest outbreak to date occurred in 2014/2015 in several West African countries.

Since the end of July 2018, another Ebola outbreak has raged in the northeast of the Democratic Republic of the Congo, which has already affected more than 3,100 people. According to the Congolese Ministry of Health, around two thirds of those affected have died so far (2100 cases). This makes the outbreak one of the most severe Ebola outbreaks in history (as of October 7, 2019).

Bats are considered to be carriers of the Marburg virus

© ddp Images / Pacific Press

Path of infection: how can you get infected with the virus?

According to experts, various bats (bats, fruit bats) are the natural reservoir of the pathogen. The virus can be transmitted through contact with the animals or their body fluids. If monkeys become infected, humans can become ill after contact with these animals, including their carcasses. Consumption of infected wild animals ("bush meat") can also lead to infection. In infected people, the virus is transmitted to other people through body fluids such as blood, urine, or saliva. Since an infection through droplets of saliva in the air is possible, but extremely rare, it is predominantly close contact persons and caregivers that get sick. Transmission via sperm is also possible.

The viruses do not last long outside the body. Ebola viruses can remain contagious on objects for up to a few days.

A sick person is contagious as long as symptoms and viraemia (viruses in the blood) persist. The risk of infection correlates with the number of viruses present (viral load) and thus the severity of the symptoms. Therefore it is greatest towards the end of the disease. The Ebola virus was often transmitted in outbreak regions, for example through funeral rituals.

Symptoms: what are the symptoms?

The viruses can infect and destroy many types of cells, including blood, liver, and skin cells. Cells of the immune system in particular are affected by the disease, which is why the virus can spread rapidly and vigorously in the body.

The main characteristic symptoms of Ebola and Marburg fever are fever and bleeding (hemorrhagic fever). The bleeding occurs because of a severe blood clotting disorder, causing bleeding in the skin and mucous membranes. The eyes, mouth, gastrointestinal tract and also internal organs are particularly affected. Blood stool, blood in the urine, nosebleeds, and bloody vomiting are observed. In severe cases, neurological symptoms with signs of paralysis are possible. The severe coagulation disorder causes a so-called hemorrhagic shock and ultimately leads to organ and circulatory failure and thus to death.

In current Ebola epidemics, however, the focus is more on diarrhea and vomiting, which leads to a strong loss of fluids and electrolytes (blood salts), which can lead to what is known as hypovolemic shock.

Ebola fever

The incubation period (time between infection and the appearance of the first symptoms) is two to 21 days.

Ebola fever has several phases:

  • Unspecific general symptoms such as tiredness, fever, headache and muscle pain (early febrile phase).
  • Three to ten days after the onset of the disease, there are also nausea, vomiting, diarrhea and upper abdominal pain (gastrointestinal phase). Some patients also develop conjunctivitis (conjunctivitis), inflammation of the throat (pharyngitis), a skin rash (maculo-papular rash) and delirium (clouding of consciousness with a state of confusion or even delusions).
    As the disease progresses, there may be profuse bleeding, especially of the intestines and lungs, as well as bleeding from the gums. Following the gastrointestinal phase, there is either an improvement in symptoms or an acute worsening.
  • Improvement or worsening of the condition. When it improves, the diarrhea, abdominal pain and vomiting go away. If it worsens, shock develops with impaired consciousness, coma, weak pulse, and decreased or no urine output (oliguria, anuria). This severe shock can lead to organ failure and death.
  • After the tenth day, so-called late complications in the form of gastrointestinal bleeding (gastrointestinal bleeding) or meningitis can occur.

Marburg fever

After an incubation period of five to ten days, fever, chills, headache and muscle pain occur quickly and suddenly. Usually five days after the onset of symptoms, a rash on the trunk (back, stomach, chest) occurs. You may experience nausea, vomiting, diarrhea, chest pain and stomach pain. A rapid deterioration is possible, accompanied by jaundice, pancreatitis, weight loss, shock, liver failure and massive bleeding. The result is multi-organ failure.

Diagnosis: How are Ebola and Marburg viruses diagnosed?

In order to detect Ebola and Marburg fever, the patient's blood is examined in special safety laboratories of the highest security level. Since the sample material is extremely contagious, the strictest safety rules apply when handling blood, urine or saliva samples from sick people. The diagnosis is successful as soon as the viruses or specific antibodies can be detected in the sample material. Special laboratory techniques such as cell culture or PCR are available for the direct detection of Ebola and Marburg viruses.

The highest security levels counteract the spread of the infection

© Laif / Svenn Torfin

Therapy: How is a disease treated?

A specific treatment for Ebola or Marburg fever is not yet available.

Those affected are treated under strict security precautions in special isolation wards to prevent the virus from spreading. With protective measures such as gloves, gowns, face and mouth protection, transmission can be avoided.

Doctors can only treat the symptoms, for example by giving fluids as an infusion, replacing blood salts (electrolytes) and regulating the sugar balance (glucose). Medicines are also used to stabilize blood pressure, reduce pain and fever, or to stop diarrhea and vomiting. Antibiotics are used when necessary to protect against additional bacterial infections. In the case of heavy bleeding, blood reserves and coagulation factors can be used. The patients often require intensive medical therapy.

In view of the large outbreak in West Africa, experts spoke out in favor of the use of drugs that had hardly been tested. However, their effectiveness has not yet been proven; possible advantages and disadvantages must be weighed up.

Prognosis: How are the diseases going?

Both diseases often lead to death. While death rates of up to 90 percent are assumed for infections with the Marburg virus, these fluctuate between 30 and 90 percent for Ebola, depending on the subtype. Due to the rather small number of cases, it is difficult to make precise statements.

Antibodies against the virus could be detected in survivors of Ebola fever, which are still present for up to ten years after infection. Whether this is a lifelong protection and also protects against all other subtypes of the Ebola virus cannot yet be said. Some studies have shown that the virus was still detectable in other body fluids such as semen, cerebral fluid, aqueous humor or amniotic fluid in cured people (no more viral load can be detected in the blood). It is currently unclear whether this poses a risk of infection.

Prevention: How can you protect yourself against Ebola and Marburg fever?

People who have had contact with sick people should be checked carefully for the first signs of an Ebola infection or Marburg fever. This includes taking your body temperature regularly. The doctor must report Ebola and Marburg virus illnesses to the health department, as well as suspected illnesses or deaths.

So far, regional cases of illness have always been contained relatively quickly. The major outbreak in West Africa, however, posed a major challenge for aid workers and the countries affected. Travelers to Africa should inform themselves comprehensively in advance about possible illnesses and, above all, take any travel warnings from the Federal Foreign Office seriously. An effective vaccination is not yet available. However, work is underway on a vaccine which has so far been used by international aid groups in crisis areas.

Dr. med. Markus N. Frühwein

© W & B / private

Consulting expert:

Our author Dr. med. Markus Frühwein, has his own practice in Munich and is director of the Bavarian Society for Immune, Tropical Medicine and Vaccination e.V.

Swell:

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Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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