Editing Marburg virus disease (section)

== Diagnosis ==
[[File:Marburg virus liver injury.jpg|thumb|Marburg virus liver injury]]
MVD is clinically indistinguishable from [[Ebola virus disease|Ebola virus disease (EVD)]], and it can also easily be confused with many other diseases prevalent in [[Equatorial Africa]], such as other [[viral hemorrhagic fever]]s, [[malaria|falciparum malaria]], [[typhoid fever]], [[shigellosis]], [[rickettsia|rickettsial diseases]] such as [[typhus]], [[cholera]], [[Gram-negative bacteria|gram-negative]] [[sepsis]], [[borreliosis]] such as [[relapsing fever]] or [[Verotoxin-producing Escherichia coli|EHEC enteritis]]. Other infectious diseases that ought to be included in the [[differential diagnosis]] include [[leptospirosis]], [[scrub typhus]], [[plague (disease)|plague]], [[Q fever]], [[candidiasis]], [[histoplasmosis]], [[trypanosomiasis]], [[visceral]] [[leishmaniasis]], hemorrhagic [[smallpox]], [[measles]], and fulminant [[viral hepatitis]]. Non-infectious diseases that can be confused with MVD are [[acute promyelocytic leukemia]], [[hemolytic uremic syndrome]], [[snake]] [[envenomation]], [[coagulation|clotting factor]] deficiencies/platelet disorders, [[thrombotic thrombocytopenic purpura]], [[hereditary hemorrhagic telangiectasia]], [[Kawasaki disease]], and even [[warfarin]] intoxication.<ref name="Gear1989">{{Cite journal |last=Gear |first=J. H. |year=1989 |title=Clinical aspects of African viral hemorrhagic fevers |journal=Reviews of Infectious Diseases |volume=11 |issue=Suppl 4 |pages=S777–S782 |doi=10.1093/clinids/11.supplement_4.s777 |pmid=2665013}}</ref><ref name="Gear1978">{{Cite journal |last=Gear |first=J. H. |last2=Ryan |first2=J. |last3=Rossouw |first3=E. |year=1978 |title=A consideration of the diagnosis of dangerous infectious fevers in South Africa |journal=South African Medical Journal |volume=53 |issue=7 |pages=235–237 |pmid=565951}}</ref><ref name="Grolla2005">{{Cite journal |last=Grolla |first=A. |last2=Lucht |first2=A. |last3=Dick |first3=D. |last4=Strong |first4=J. E. |last5=Feldmann |first5=H. |year=2005 |title=Laboratory diagnosis of Ebola and Marburg hemorrhagic fever |journal=Bulletin de la Société de Pathologie Exotique |volume=98 |issue=3 |pages=205–209 |pmid=16267962}}</ref><ref name="Bogomolov1998">{{Cite journal |last=Bogomolov |first=B. P. |year=1998 |title=Differential diagnosis of infectious diseases with hemorrhagic syndrome |journal=Terapevticheskii Arkhiv |volume=70 |issue=4 |pages=63–68 |pmid=9612907}}</ref>

The most important indicator that may lead to the suspicion of MVD at clinical examination is the [[medical history]] of the patient, in particular the travel and occupational history (which countries and caves were visited?) and the patient's exposure to wildlife (exposure to bats or bat excrements?). MVD can be confirmed by isolation of marburgviruses from or by detection of marburgvirus antigen or genomic or subgenomic RNAs in patient [[blood]] or [[Blood serum|serum]] samples during the acute phase of MVD. Marburgvirus isolation is usually performed by [[inoculation]] of [[grivet]] kidney epithelial [[Vero cell|Vero E6]] or MA-104 [[cell culture]]s or by inoculation of human adrenal carcinoma SW-13 cells, all of which react to infection with characteristic [[cytopathic effect]]s.<ref name="Hofmann1968">{{Cite journal |last=Hofmann |first=H. |last2=Kunz |first2=C. |year=1968 |title="Marburg virus" (Vervet monkey disease agent) in tissue cultures |journal=Zentralblatt für Bakteriologie, Parasitenkunde, Infektionskrankheiten und Hygiene. 1. Abt. Medizinisch-hygienische Bakteriologie, Virusforschung und Parasitologie. Originale |volume=208 |issue=1 |pages=344–347 |pmid=4988544}}</ref><ref>{{Cite journal |last=Ksiazek |first=Thomas G. |year=1991 |title=Laboratory diagnosis of filovirus infections in nonhuman primates |journal=Lab Animal |volume=20 |issue=7 |pages=34–6}}</ref> Filovirions can easily be visualized and identified in cell culture by [[electron microscopy]] due to their unique filamentous shapes, but electron microscopy cannot differentiate the various filoviruses alone despite some overall length differences.<ref name="Geisbert1995">{{Cite journal |last=Geisbert |first=T. W. |last2=Jahrling |first2=P. B. |year=1995 |title=Differentiation of filoviruses by electron microscopy |url=https://zenodo.org/record/1258399 |url-status=live |journal=Virus Research |volume=39 |issue=2–3 |pages=129–150 |doi=10.1016/0168-1702(95)00080-1 |pmid=8837880 |archive-url=https://web.archive.org/web/20191217015555/https://zenodo.org/record/1258399 |archive-date=2019-12-17 |access-date=2019-06-29}}</ref> [[Immunofluorescence|Immunofluorescence assays]] are used to confirm marburgvirus presence in cell cultures. During an outbreak, virus isolation and electron microscopy are most often not feasible options. The most common diagnostic methods are therefore [[Reverse transcription polymerase chain reaction|RT-PCR]]<ref name="Gibb2001">{{Cite journal |last=Gibb |first=T. |last2=Norwood Jr |first2=D. A. |last3=Woollen |first3=N. |last4=Henchal |first4=E. A. |year=2001 |title=Development and evaluation of a fluorogenic 5′-nuclease assay to identify Marburg virus |url=https://zenodo.org/record/1229924 |url-status=live |journal=Molecular and Cellular Probes |volume=15 |issue=5 |pages=259–266 |doi=10.1006/mcpr.2001.0369 |pmid=11735297 |archive-url=https://web.archive.org/web/20210828155901/https://zenodo.org/record/1229924/preview/article.pdf |archive-date=2021-08-28 |access-date=2019-06-29}}</ref><ref name="Drosten2002">{{Cite journal |last=Drosten |first=C. |last2=Göttig |first2=S. |last3=Schilling |first3=S. |last4=Asper |first4=M. |last5=Panning |first5=M. |last6=Schmitz |first6=H. |last7=Günther |first7=S. |year=2002 |title=Rapid Detection and Quantification of RNA of Ebola and Marburg Viruses, Lassa Virus, Crimean-Congo Hemorrhagic Fever Virus, Rift Valley Fever Virus, Dengue Virus, and Yellow Fever Virus by Real-Time Reverse Transcription-PCR |journal=Journal of Clinical Microbiology |volume=40 |issue=7 |pages=2323–2330 |doi=10.1128/jcm.40.7.2323-2330.2002 |pmc=120575 |pmid=12089242}}</ref><ref name="Weidmann2004">{{Cite journal |last=Weidmann |first=M. |last2=Mühlberger |first2=E. |last3=Hufert |first3=F. T. |year=2004 |title=Rapid detection protocol for filoviruses |journal=Journal of Clinical Virology |volume=30 |issue=1 |pages=94–99 |doi=10.1016/j.jcv.2003.09.004 |pmid=15072761}}</ref><ref name="Zhai2007">{{Cite journal |last=Zhai |first=J. |last2=Palacios |first2=G. |last3=Towner |first3=J. S. |last4=Jabado |first4=O. |last5=Kapoor |first5=V. |last6=Venter |first6=M. |last7=Grolla |first7=A. |last8=Briese |first8=T. |last9=Paweska |first9=J. |last10=Swanepoel |first10=R. |last11=Feldmann |first11=H. |last12=Nichol |first12=S. T. |last13=Lipkin |first13=W. I. |year=2006 |title=Rapid Molecular Strategy for Filovirus Detection and Characterization |journal=Journal of Clinical Microbiology |volume=45 |issue=1 |pages=224–226 |doi=10.1128/JCM.01893-06 |pmc=1828965 |pmid=17079496}}</ref><ref name="Weidmann2007">{{Cite journal |last=Weidmann |first=M. |last2=Hufert |first2=F. T. |last3=Sall |first3=A. A. |year=2007 |title=Viral load among patients infected with Marburgvirus in Angola |journal=Journal of Clinical Virology |volume=39 |issue=1 |pages=65–66 |doi=10.1016/j.jcv.2006.12.023 |pmid=17360231}}</ref> in conjunction with [[ELISA|antigen-capture ELISA]],<ref name="Saijo2005">{{Cite journal |last=Saijo |first=M. |last2=Niikura |first2=M. |last3=Maeda |first3=A. |last4=Sata |first4=T. |last5=Kurata |first5=T. |last6=Kurane |first6=I. |last7=Morikawa |first7=S. |year=2005 |title=Characterization of monoclonal antibodies to Marburg virus nucleoprotein (NP) that can be used for NP-capture enzyme-linked immunosorbent assay |journal=Journal of Medical Virology |volume=76 |issue=1 |pages=111–118 |doi=10.1002/jmv.20332 |pmid=15778962 |s2cid=24207187}}</ref><ref name="Saijo2006-1">{{Cite journal |last=Saijo |first=M. |last2=Niikura |first2=M. |last3=Ikegami |first3=T. |last4=Kurane |first4=I. |last5=Kurata |first5=T. |last6=Morikawa |first6=S. |year=2006 |title=Laboratory Diagnostic Systems for Ebola and Marburg Hemorrhagic Fevers Developed with Recombinant Proteins |journal=Clinical and Vaccine Immunology |volume=13 |issue=4 |pages=444–451 |doi=10.1128/CVI.13.4.444-451.2006 |pmc=1459631 |pmid=16603611}}</ref><ref name="Saijo2006-2">{{Cite journal |last=Saijo |first=M. |last2=Georges-Courbot |first2=M. C. |last3=Fukushi |first3=S. |last4=Mizutani |first4=T. |last5=Philippe |first5=M. |last6=Georges |first6=A. J. |last7=Kurane |first7=I. |last8=Morikawa |first8=S. |year=2006 |title=Marburgvirus nucleoprotein-capture enzyme-linked immunosorbent assay using monoclonal antibodies to recombinant nucleoprotein: Detection of authentic Marburgvirus |journal=Japanese Journal of Infectious Diseases |volume=59 |issue=5 |pages=323–325 |doi=10.7883/yoken.JJID.2006.323 |pmid=17060700}}</ref> which can be performed in field or mobile hospitals and laboratories. [[Immunofluorescence|Indirect immunofluorescence assays (IFAs)]] are not used for diagnosis of MVD in the field anymore.{{citation needed|date=July 2019}}

=== Classification ===
Marburg virus disease (MVD) is the official name listed in the [[World Health Organization]]'s [[International Statistical Classification of Diseases and Related Health Problems]] 10 (ICD-10) for the human disease caused by any of the two marburgviruses; [[Marburg virus]] (MARV) and [[Ravn virus]] (RAVV). In the scientific literature, Marburg hemorrhagic fever (MHF) is often used as an unofficial alternative name for the same disease. Both disease names are derived from the [[Germany|German]] city [[Marburg]], where MARV was first discovered.<ref name="Siegert1967">{{Cite journal |last=Siegert |first=R. |last2=Shu |first2=H. L. |last3=Slenczka |first3=W. |last4=Peters |first4=D. |last5=Müller |first5=G. |year=2009 |title=Zur Ätiologie einer unbekannten, von Affen ausgegangenen menschlichen Infektionskrankheit |journal=Deutsche Medizinische Wochenschrift |volume=92 |issue=51 |pages=2341–2343 |doi=10.1055/s-0028-1106144 |pmid=4294540 |s2cid=116556454}}</ref>