Medical Microbiology

1. Marbug Viral Disease
OLIVER-COMMEY J
GIDC/GHS
ID PHYSICIAN

2. OUTLINE
CARE FOR THE
SURVIVOR
CLINICAL
MANAGEMENT
CLINICAL
FEATURES
OVERVIEW

3. MVD
• Virus belongs to the filoviridae group
• Considered extremely dangerous , considered BSL 4 pathogen. Listed as a
category A bioterrorism agent.
• Causes a haemorrhagic fever in humans
• Average case fatality is around 50%. CFRs have varied between 24%-84% in
past outbreaks . Dependent on virus strain and case management .
• Fruit bat Rosusettus aegyptiacus considered to be the natural hosts .
• Transmission to humans from fruit bats and spread via contact amongst
humans.
• Community engagement is key to successfully controlling out breaks

4. CURRENT OUTBREAK
• The current outbreak in Ghana is the second in the W. African region over
the last 2 years .
• 2 regions , 3 cases CFR -66.7%
• The first was in Guinea in 2020.
• Uganda seems to be the country with more outbreaks in the AFRO region.

5. TRANSMISSION
• Human – human
• Contact ( broken skin or mucous membranes) with blood, secretions, organs
or other bodily fluids from infected people .
• Contact with formites ( bedding, clothing) contaminated with these fluids .
• HCW usually infected whilst treating patients with suspected or
confirmed MVD without appropriate PPE.
• Documented transmission via needle stick injuries, usually associated
with more severe, rapid deterioration .
• Burial ceremonies may also contribute when there is direct contact
with the body
• People remain infectious as long as their blood contain the virus .

6. Clinical Features
Varied incubation period ( 2-21 days). 5-10 days
• High fever
• Severe headache
• Severe malaise
• Myalgia
Abrupt onset
• Watery diarrhoea
• Abdominal cramping with pain
• Nausea and vomiting
• Appearance of patients described as ‘ghost-like’
• Possible non itchy rash maculopapular rash prominent on the
trunk
Days 3-7
• Days 5-7
• Devpt of haemorrhagic
manifestations
• Sustained fevers
• Irritability
• Aggression
• Confusion
• Days 8-9
• Shock
• Death
• Day 15
• Orchitis

7. DIAGNOSIS
• Very difficult to clinically distinguish MVD from other ID such as malaria,
typhoid , shigellosis, Covid 19 and other VHFs.
• Other differentials when presenting with haemorrhagic manifestations
include UGI bleeds, Envenomination etc.
Clinical diagnosis
• ELISA
• RT-PCR
• Virus isolation by cell culture
Lab diagnosis

8. WET SYMPTOMS
• Diarrhea, vomiting
• Bleeding (in vomit, stool, urine, gums,
nose, etc.)
• Pregnancy loss (e.g., miscarriage).
• The bleeding is unusual and non-
traumatic.
DRY SYMPTOMS
• High fever (≥38°C) or history of fever in
the last 48 hours
• headache
• extreme tiredness, loss of appetite
• nausea, abdominal pain
• sore throat, muscle and joint pain red
eyes, skin rash
• hiccups
• difficulty in breathing and drowsiness

9. Triaging
• Please remember not to cohort patients with wet and dry symptoms
together .
• Not all patients with symptoms have MVD.
• This will help reduce cross infection in the isolation area.

10. Management
• Treatment
• No vaccines
• No antivirals
• Main stay of treatment is supportive care
• Adequate hydration
• Correction of electrolyte imbalances
• Restoration of blood volume
• Management of co-morbidities
• Diabetes , hypertension , mental illness , SCDx, HIV etc

11. Keys to ensuring good prognosis
• At the isolation units patients should be managed symptomatically
• Most poor outcomes are as a result of neglect once the case is
labelled as suspect and isolated .
• Dehydration must be corrected
• Shock corrected ( R/L preferred fluid for correction, N/S can be used
in its absence.
• Blood volume must be replaced ( appropriate blood products)
• Labs should be notified when samples for routine tests are sent so
they are appropriately handled .

19. Discharge from a treatment unit

20. Viral persistence post recovery
• Virus may persist in some immune privileged sites , namely testes and
eye.
• Documented transmission via infected semen 7 weeks after clinical
recovery.
• Documented evidence of persistence of virus in placenta, amniotic
fluid and foetus of women who were infected whilst pregnant .
• May persist in breast milk too.
• Documentation of relapse – symptomatic illness in the absence of
reinfection .

21. WHO Recommendation for male survivors
• Enrol into semen testing programmes after discharge . ( 2 consecutive
negative results )
• Offer semen testing within 3 months of disease onset . ( patient must
be mentally and physically ready ).
• Safe sex practices until semen has twice tested negative for Marbug
virus , this can continue for up to close to 12 months .

23. Summary
• MVD may carry a high CFR , however with early intervention ,
outcomes may be better .
• Clinical care of MVD begins with close monitoring to recognise
warning signs of critical illness.
• For critically ill patients , careful provision of supportive care ,
including use of antimicrobials if needed can be life saving
• Survivors also need long term care .

24. THANK YOU