A US traveler to Uganda was diagnosed with Marburg Virus after visiting the Maramagambo Forest’s “python cave”, a popular tourist destination. The marburg virus is closely related to the Ebola virus and is in the same Filoviridae family. Fatality rates for Ebola virus range from 50-90%. The fact that a traveler acquired this infection should underscore the need for awareness and preventative steps needed by all those who visit areas of the world where this dangerous illness is present.
Marburg Virus History
Marburg virus has only been diagnosed on several occasions, since being first recognized in 1967. Imported Ugandan Green Monkeys (Cercopithecus aethiops) were responsible for infecting 31 humans and causing 7 fatalities during the initial discovery of the virus, in Germany. From 1998-2000 the Democratic Republic of Congo confirmed 12 infections from over 140 suspect cases with a case fatality rate of 80%.
Risk to Travelers
Overall, the risk of a traveler acquiring Ebola or Marburg virus is low, but there are things that can be done to reduce risk of getting this very dangerous disease. Handling forest dwelling primates, such as monkeys, gorillas, etc. has been linked to acquiring Ebola virus. The American traveler who acquired Marburg was noted to have been visiting a cave inhabited by fruit bats and obviously had close contact with the animals. The carcasses of these forest dwelling mammals are known to be capable of carrying the virus, even though a confirmed reservoir is not yet known.
The nature of wildlife safaris is that animal contact is directly sought, by the participants. This desire to closely interact with animals can put the traveler at risk for zoonotic diseases, including these types of viral hemorrhagic fevers. Travelers who engage in such wildlife safaris should make attempts to limit direct contact with animals, especially carcasses. The interesting question arises when cave dwelling bats are added to the equation. Bats are known to carry these viruses and not die, unlike primates. The CDC has advised that travelers to these areas avoid entering caves or mines where bats live. These viruses have also been spread through handling infected body fluids like blood, urine and saliva. This is a common method of infection for hospital workers caring for these patients.
Symptoms and Treatment
- Sudden onset of fever
- Muscle ache
- Fatigue
- Vomiting
- Rash
Treatment for these terrible viral infections is supportive, meaning there is no real treatment, just helping alleviate the associated problems such as fever, muscle ache and bleeding disorders. Liver damage can result and contribute to massive blood loss through hemorrhage from the intestines, IV sites and gums. Diagnosis requires a blood test, typically for antibodies.
Overall, the risk of a traveler acquiring this type of infection is low, but care should be taken to limit the risk. Travelers to areas of Africa known to have a history of Ebola and Marburg virus should avoid caves with bats and handling forest dwelling/wild primates, including dead aminals. Treat all illnesses, acquired after travel to such locations, as serious and have a very low threashold for seeking prompt and adequate medical advice.
For additional reading:
CDC report on American traveler infected with Marburg Virus
WHO Report on imported case of Marburg virus to Netherlands
Known outbreaks and mortality statistics of Marburg Virus (CDC)