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Key Diagnostic Tests.

• Measurement of coagulation times;
• Thrombocytopenia;
• Granulocytes show structural abnormalities in blood smears;
• Detection of antigens or antibody to the agent in the blood (serology) to detect anti-Ebola virus IgM or IgG;
• Proteinuria (high levels of protein in blood, or bloody urine in extreme cases);
• Elevated liver enzyme levels in blood;
• Detection of viral nucleic acid by PCR.

Symptoms and effects.

Onset of the disease is rapid with a blinding headache being the first symptom reported. The virus attacks the liver and exhausts the bloodstream of clotting factors. Clotting begins to occur in an uncontrolled manner and as a result of this, the small hemorrhages that occur as a consequence of wear and tear do not seal and bleeding occurs throught the body. There is bleeding from tissues where damage is common, such as the stomach, intestine, and gums. This gives rise to bloody diarrhea and vomiting of blood (hematemesis). The eyes often appear bloodshot. The loss of blood and fluids leads to lethargy, multiple organ failure, shock and death within 2 weeks of the appearance of symptoms in > 25% of cases.

Medical and Physical Countermeasures.

Vaccination (Immunoprophylaxis)

No vaccine is available, but convalescent serum may be effective.

 Specific Therapy

Supportive care

Minimize intrusive care to protect a weakened vascular bed. Fluid infusion to maintain normal kidney function and salt balance are recommended. Efforts to improve blood clotting, such as platelet transfusion may be useful. Actions to prevent and treat shock may be necessary

Decontamination

The virus is killed by common disinfectants, including hypochlorite bleach and glutaraldehyde, and by heat and ultra-violet light.

Agent Properties and Potential Uses

Marburg fever is as gruesome as all of the African hemorrhagic fevers, but as with Ebola hemorrhagic fever its rapid onset, poor transmissibility through air, and high lethality make it strongly self-limiting. Affected areas and individuals can be quarantined and contamination controlled by strict application of barrier nursing practices.

Although the virus can survive for several days in biological fluids, it cannot withstand drying. Dispersion of the virus in aerosols or droplets of body fluids is considered a risk and there may be potential for weaponization if a suitable stabilizing medium can be found.

The virus is known to be carried by the African Green monkey Cercopithecus aethiops but this is not thought to be the natural reservoir. Nothing is known about the natural reservoir or disease vectors.

The virus takes its name from Marburg in then-West Germany where it was first observed in people exposed to a colony of recently-imported Green monkeys. Accusations that samples were stolen from West Germany by the East German intelligence service who passed it on to Soviet biological weapons researchers have surfaced occasionally. However, it seems that samples were obtained through normal channels of international scientific cooperation.

Terrorist Acquisition and Attempted Use.

• None confirmed.