Lab Stymied By First Case Of Marburg Fever

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One of the greatest challenges for laboratory technologists is identifying infectious organisms responsible for symptoms in new hospital admissions. This was certainly the case in Wheat Ridge, Colorado in January 2008 when a woman suffering from Marburg Hemorrhagic Fever arrived in the emergency room with symptoms of fever and malaise. Although her attending physicians suspected a hemorrhagic virus might be responsible, initial tests were negative.

In microbiology laboratories the identification of viruses can be particularly challenging. When the virus in question has not previously been encountered in a particular laboratory, solving the riddle can be even more difficult. For this reason, it's not surprising that a conclusive identification of the Marburg Virus and a definitive diagnosis of Marburg Hemorrhagic Fever was not made until January 2009 when the Centers for Disease Control (CDC) in Atlanta announced their findings. This is the first case of Marburg Fever ever reported in the United States. Without a careful patient history and the patient's own persistence, the diagnosis may have remained elusive.

The patient diagnosed with Marburg Hemorrhagic Fever reported that she traveled to Uganda in December 2007 where she toured a python cave in the Maramagambo Forest in Queen Elizabeth Park. There, the patient encountered fruit bats, which are known to carry the Marburg virus. The patient later learned that the cave was closed in August 2008 after another tourist to the cave from the Netherlands died from Marburg Hemorrhagic Fever in July 2008. Convinced she had also been infected with the Marburg Virus, the Wheat Ridge patient requested additional blood tests. Although she has made good progress toward recovery, the patient is still under doctor's care and hasn't fully recovered.

During the patient's first hospital admission, the hospital laboratory sent blood specimens from the patient to the CDC to help identify the infectious microorganism responsible for the patient's illness. Blood samples from the patient taken during the recovery phase were also sent to the CDC for comparison and to help identify the active and past stages of infection. With further testing of these specimens, CDC officials made a positive identification of the Marburg virus and a diagnosis for the patient of Marburg Hemorrhagic Fever in January 2009. In the laboratory, the Marburg virus is identified by an enzyme linked immunoassay (ELISA) method, which detects early IgM capture antibodies to the virus during the early active course of infection. Tests for IgG antibodies are used to identify past infection.

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The cause of Marburg Hemorrhagic Fever, the Marburg virus, is an RNA virus of the filovirus family, a species that includes the Ebola virus. Indigenous to Africa, the Marburg virus was first recognized in 1968 when it caused outbreaks of hemorrhagic fever in several European laboratory technicians who had been exposed to African green monkeys or their tissues and body fluids.

Marburg hemorrhagic fever has an incubation period ranging from 5 to 10 days followed by early symptoms of fever, chills, myalgia and headache. Symptoms typically worsen about five days after the onset of fever. A flattened rash typically occurs on the trunk and is accompanied by a cluster of symptoms including sore throat, vomiting, abdominal pain, jaundice, inflammation of the pancreas, diarrhea and weight loss. Depending on the severity of the infection and the treatment used to alleviate symptoms, the condition can progress to a fulminant fatal form of hepatitis; cause bleeding from multiple organs along with multi-organ dysfunction; cause high fever with delirium; and shock.

Recovery from Marburg hemorrhagic fever may be prolonged and is often accompanied by a recurrent form of hepatitis. Other possible complications include inflammation of the testes, spinal cord, eye and parotid gland or prolonged hepatitis. The case mortality rate for Marburg hemorrhagic fever is 23-25 percent.

Resources:
CDC: Patient in Wheat Ridge Came Down with Rare Fever; test confirmed first case in U.S. of Marburg Fever, The Associated Press, Gazette Telegraph, Colorado Springs, Colorado, February 8, 2009.

Elaine A. Moore - Hepatitis, Causes, Treatments and Resources, Jefferson, NC: McFarland and Company, Incorporated, 2006.

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