Editing Marburg virus disease (section)

== Signs and symptoms ==
The most detailed study on the frequency, onset, and duration of MVD [[medical sign|clinical signs]] and [[symptom]]s was performed during the 1998–2000 mixed MARV/RAVV disease outbreak.<ref name="Bausch2006">{{Cite journal |last=Bausch |first=D. G. |last2=Nichol |first2=S. T. |last3=Muyembe-Tamfum |first3=J. J. |last4=Borchert |first4=M. |last5=Rollin |first5=P. E. |last6=Sleurs |first6=H. |last7=Campbell |first7=P. |last8=Tshioko |first8=F. K. |last9=Roth |first9=C. |last10=Colebunders |first10=R. |last11=Pirard |first11=P. |last12=Mardel |first12=S. |last13=Olinda |first13=L. A. |last14=Zeller |first14=H. |last15=Tshomba |first15=A. |year=2006 |title=Marburg Hemorrhagic Fever Associated with Multiple Genetic Lineages of Virus |url=https://researchonline.lshtm.ac.uk/11474/1/nejmoa051465.pdf |url-status=live |journal=New England Journal of Medicine |volume=355 |issue=9 |pages=909–919 |doi=10.1056/NEJMoa051465 |pmid=16943403 |archive-url=https://web.archive.org/web/20190921112222/https://researchonline.lshtm.ac.uk/11474/1/nejmoa051465.pdf |archive-date=2019-09-21 |access-date=2019-12-10 |last16=Kulidri |first16=A. |last17=Libande |first17=M. L. |last18=Mulangu |first18=S. |last19=Formenty |first19=P. |last20=Grein |first20=T. |last21=Leirs |first21=H. |last22=Braack |first22=L. |last23=Ksiazek |first23=T. |last24=Zaki |first24=S. |last25=Bowen |first25=M. D. |last26=Smit |first26=S. B. |last27=Leman |first27=P. A. |last28=Burt |first28=F. J. |last29=Kemp |first29=A. |last30=Swanepoel |first30=R.}}</ref> A skin [[rash]], red or purple spots (e.g. [[petechia]]e or [[purpura]]), [[bruises]], and [[hematoma]]s (especially around needle injection sites) are typical hemorrhagic manifestations. However, contrary to popular belief, hemorrhage does not lead to [[hypovolemia]] and is not the cause of [[death]] (total blood loss is minimal except during [[Childbirth|labor]]). Instead, death occurs due to [[multiple organ dysfunction syndrome|multiple organ dysfunction syndrome (MODS)]] due to fluid redistribution, [[hypotension]], [[disseminated intravascular coagulation]], and focal [[tissue (biology)|tissue]] [[necrosis|necroses]].<ref name=Bausch2006/><ref name="Martini1968">{{Cite journal |last=Martini |first=G. A. |last2=Knauff |first2=H. G. |last3=Schmidt |first3=H. A. |last4=Mayer |first4=G. |last5=Baltzer |first5=G. |year=2009 |title=Über eine bisher unbekannte, von Affen eingeschleppte Infektionskrankheit: Marburg-Virus-Krankheit |journal=Deutsche Medizinische Wochenschrift |volume=93 |issue=12 |pages=559–571 |doi=10.1055/s-0028-1105098 |pmid=4966280 |s2cid=260056835}}</ref><ref name="Stille1968">{{Cite journal |last=Stille |first=W. |last2=Böhle |first2=E. |last3=Helm |first3=E. |last4=Van Rey |first4=W. |last5=Siede |first5=W. |year=2009 |title=Über eine durch Cercopithecus aethiops übertragene Infektionskrankheit |journal=Deutsche Medizinische Wochenschrift |volume=93 |issue=12 |pages=572–582 |doi=10.1055/s-0028-1105099 |pmid=4966281 |s2cid=260058558}}</ref><ref name="Martini1971">{{Cite book |last=Martini |first=G. A. |title=Marburg Virus Disease |publisher=Springer-Verlag |year=1971 |isbn=978-0-387-05199-4 |editor-last=Martini |editor-first=G. A. |location=Berlin, Germany |pages=1–9 |chapter=Marburg Virus Disease. Clinical Syndrome |editor-last2=Siegert |editor-first2=R.}}</ref><ref>{{Cite news |date=4 October 2024 |title=Marburg virus kills 11 in Rwanda. What to know about the Ebola-like outbreak and symptoms |url=https://www.cbsnews.com/amp/news/marburg-virus-what-to-know-symptoms |url-status=live |archive-url=https://web.archive.org/web/20241004094820/https://www.cbsnews.com/amp/news/marburg-virus-what-to-know-symptoms/ |archive-date=4 October 2024 |access-date=4 October 2024 |work=[[CBS News]]}}</ref>

Clinical phases of Marburg hemorrhagic fever's presentation are described below. Note that phases overlap due to variability between cases.
# Incubation: 2–21 days, averaging 5–9 days.<ref name=clini/>
# Generalization Phase: Day 1 up to Day 5 from the onset of clinical symptoms. MHF presents with a high fever 104&nbsp;°F (~40˚C) and a sudden, severe headache, with accompanying chills, fatigue, nausea, vomiting, diarrhea, pharyngitis, maculopapular rash, abdominal pain, [[conjunctivitis]], and [[malaise]].<ref name=clini/>
# Early Organ Phase: Day 5 up to Day 13. Symptoms include prostration, [[dyspnea]], [[edema]], [[conjunctival injection]], viral [[exanthema]], and CNS symptoms, including encephalitis, confusion, delirium, apathy, and aggression. Hemorrhagic symptoms typically occur late and herald the end of the early organ phase, leading either to eventual recovery or worsening and death. Symptoms include bloody stools, [[ecchymoses]], blood leakage from [[venipuncture]] sites, mucosal and visceral hemorrhaging, and possibly [[hematemesis]].<ref name=clini/>
# Late Organ Phase: Day 13 up to Day 21+. Symptoms bifurcate into two constellations for survivors and fatal cases. Survivors will enter a convalescence phase, experiencing [[myalgia]], [[fibromyalgia]], [[hepatitis]], [[asthenia]], ocular symptoms, and [[psychosis]]. Fatal cases continue to deteriorate, experiencing continued fever, [[obtundation]], [[coma]], [[convulsions]], diffuse [[coagulopathy]], metabolic disturbances, [[Shock (circulatory)|shock]] and death, with death typically occurring between days 8 and 16.<ref name="clini">{{Cite journal |last=Mehedi |first=Masfique |last2=Allison Groseth |last3=Heinz Feldmann |last4=Hideki Ebihara |date=September 2011 |title=Clinical aspects of Marburg hemorrhagic fever |journal=Future Virol. |volume=6 |issue=9 |pages=1091–1106 |doi=10.2217/fvl.11.79 |pmc=3201746 |pmid=22046196}}</ref>

The WHO also writes that at the phase of gastrointestinal symptoms' predomination, "the appearance of patients...has been described as showing 'ghost-like' drawn features, deep-set eyes, expressionless faces, and extreme lethargy."<ref>{{Cite news |date=3 October 2024 |title=Marburg virus outbreak: What you need to know as Europe fears cases |url=https://www.independent.co.uk/news/health/marburg-virus-outbreak-germany-rwanda-symptoms-b2623181.html |url-status=live |archive-url=https://web.archive.org/web/20241004023607/https://www.independent.co.uk/news/health/marburg-virus-outbreak-germany-rwanda-symptoms-b2623181.html |archive-date=4 October 2024 |access-date=4 October 2024 |work=[[The Independent]]}}</ref>