- Mike Bray, MD, MPH
Mike Bray, MD, MPH
- Antiviral Research
- Adjunct Professor
- Georgetown Medical School
The virus family Filoviridae contains three genera: Ebolavirus, Cuevavirus, and Marburgvirus. Ebola virus is best known as the causative agent of the widespread epidemic in West Africa that began in late 2013. The Cuevavirus is at present only known through RNA sequences recovered from bats in Spain; no human infections have been reported. This topic reviews the epidemiology, clinical manifestations, treatment, and other aspects of the disease caused by members of the third filovirus genus, Marburgvirus. Detailed discussions of Ebola virus disease are found elsewhere. (See "Epidemiology and pathogenesis of Ebola virus disease" and "Clinical manifestations and diagnosis of Ebola virus disease" and "Treatment and prevention of Ebola virus disease".)
The filoviruses are nonsegmented, negative-sense, single-stranded RNA viruses that resemble rhabdoviruses and paramyxoviruses in their genome organization and intracellular replication mechanism (see "Clinical manifestations and diagnosis of rabies" and "Measles: Clinical manifestations, diagnosis, treatment, and prevention"). The family name is derived from the Latin "filum," meaning "thread-like," based upon the filamentous structure of the virion.
The genus Marburgvirus contains a single species that consists of two recognized variants, Lake Victoria marburgvirus and Ravn marburgvirus, which show approximately 20 percent overall sequence divergence [1,2]. Despite this variation, the two strains cause an apparently identical disease in humans and laboratory animals, and animals that have received an experimental vaccine based on one variant are cross-protected against the other [3,4]. In contrast, Ebola vaccines do not provide protection against Marburg virus. (See 'Vaccine development' below.)
Endemic areas — The first recognized outbreak of Marburg virus disease occurred in Germany and Yugoslavia in 1967; the overall fatality rate was 23 percent. This outbreak was a result of the inadvertent importation of infected vervet monkeys (Chlorocebus pygerythrus) from Uganda for use in vaccine production. However, extensive screening of a wide variety of animal species in the region where the macaques had been captured failed to identify a source of the infection [5,6].
Since then, all human infections have occurred in Africa [7-9]. Three cases were seen in South Africa in 1975 . The next recognized outbreak did not take place until 1998, when cases of severe febrile illness were recognized among men working in an abandoned mine in the eastern part of the Democratic Republic of the Congo (DRC) . The largest epidemic, with almost 400 cases, occurred in Angola in 2004. Since then, several individual cases of Marburg virus disease and one further outbreak have been reported in Uganda [2,9,11-13]. Fatality rates among African patients have been as high as 80 to 90 percent .
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