What Is the Difference Between Marburg and Ebola Virus Infections?

Symptoms of Marburg virus and Ebola virus infections include: 

• Sudden onset of flu-like illness
  • High fever
  • Headache
  • General malaise
  • Weakness
  • Fatigue
  • Muscle and joint pains
  • Sore throat
• By the third day
  • Nausea
  • Vomiting
  • Abdominal pain
  • Watery diarrhea (sometimes containing blood and mucus)
  • Loss of appetite
• About five to seven days after the onset of symptoms
  • Red, bumpy, non-itchy skin rash mostly on the trunk
  • Bleeding
    • Bloody diarrhea
    • Nosebleeds
    • Vomiting blood
    • Bleeding from gums
    • Bruising
    • Prolonged bleeding from needle puncture sites
    • Symptoms of impaired kidney and liver function
• In severe cases
  • Confusion
  • Irritability
  • Decreased level of consciousness
• The final stage of the disease, which is fatal
  • Multi-organ failure 
  • Hypovolemic shock due to severe fluid losses

Marburg virus causes Marburg virus disease and Ebola virus causes Ebola virus disease.

Initially, human Marburg virus infection results from prolonged exposure to mines or caves inhabited by Rousettus bat colonies while the Ebola virus is initially spread through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as fruit bats, chimpanzees, gorillas, monkeys, forest antelope or porcupines found ill or dead or in the rainforest.

After initial infection, both viruses are transmitted from person-to-person through direct contact through broken skin or mucus membranes via:

• Blood or body fluids of a person who is sick with or has died from Marburg virus or Ebola virus disease
• Surfaces and materials (e.g., bedding, clothing) contaminated with bodily fluids (such as blood, feces, vomit) from a person sick with Marburg virus or Ebola virus disease or the body of a person who died from the infection
• The viruses may persist in breast milk in pregnant women who get acute infections and recover or women who have been infected while breastfeeding and they may pass the virus on to their baby (breastfeeding women recovering from the virus may continue breastfeeding, but breast milk needs to be tested for the viruses before she can do so)
• Burial ceremonies that involve direct contact with the body of the deceased can also contribute to transmission 

People continue to be contagious as long as their blood contains the viruses.

It can be difficult to distinguish Marburg virus and Ebola virus infections from other infectious diseases such as malaria, typhoid fever, meningitis, shigellosis, and other viral hemorrhagic fevers.

Marburg virus and Ebola virus infections are diagnosed with a patient history and physical examination, along with tests such as:

• Antibody-capture enzyme-linked immunosorbent assay (ELISA)
• Antigen-capture detection tests
• Serum neutralization test
• Reverse transcriptase polymerase chain reaction (RT-PCR) assay
• Electron microscopy
• Virus isolation by cell culture

The main treatment for both Marburg virus and Ebola virus infections includes supportive care, including:  

• Rehydration with oral or intravenous fluids
• Maintenance of blood volume and electrolyte balance
• Replacement of depleted coagulation factors
• Minimization of invasive procedures
• Treatment of specific symptoms, including use of pain medications

There are also a number of treatments being developed. Most of them are for forms of Ebola virus infection though some may be used for Marburg virus infection under compassionate use/expanded access.

Monoclonal Antibodies 

• A combination of atoltivimab, maftivimab, and odesivimab-ebgn (Inmazeb) and ansuvimab-zykl (Ebanga) were approved for the treatment of Zaire ebolavirus (Ebolavirus) infection

Antivirals 

• Remdesivir (Veklury) and favipiravir (Avigan) have been used in clinical studies for Ebola virus disease and may also be tested for Marburg virus disease or used under compassionate use/expanded access

Vaccines

• Ebola Zaire vaccine, live (Ervebo) for Zaire ebolavirus
• A two-component vaccine: Ad26.ZEBOV (Zabdeno) and MVA-BN-Filo (Mvabea) for Ebola virus disease

• The average fatality rate for both Marburg virus and Ebola virus infections is around 50%. 
• Fatality rates have varied from 24% to 88% in past outbreaks of Marburg virus infection depending on virus strain and case management.
• Case fatality rates of Ebola virus infection have varied from 25% to 90% in past outbreaks.