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Marburg hemorrhagic fever differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Marburg hemorrhagic fever must be differentiated from other viral hemorrhagic fevers that may cause fever, abdominal pain,and bleeding such as Ebola, Crimean-Congo hemorrhagic fever (CCHF), Hantavirus Infection, Rift Valley fever, Lujo hemorrhagic fever and Lassa fever. SInce many of the signs and symptoms of marburg hemorrhagic fever are similar to those of other infectious diseases such as malaria or typhoid fever, leptospirosis, marburg hemorrhagic fever must also be differentiated from those infections.

Differentiating Marburg Hemorrhagic Fever from other Diseases

Marburg hemorrhagic fever must be differentiated from other viral hemorrhagic fevers that may cause fever, abdominal pain,and bleeding such as Ebola, Crimean-Congo hemorrhagic fever (CCHF), Hantavirus Infection, Rift Valley fever, Lujo hemorrhagic fever and Lassa fever. SInce many of the signs and symptoms of marburg hemorrhagic fever are similar to those of other infectious diseases such as malaria or typhoid fever, leptospirosis, marburg hemorrhagic fever must also be differentiated from those infections.[1][2][3][4][5][6][7][8][9][10][11][12][13][14]

Virus Disease Incubation Period Symptoms Laboratory findings
Prodromal phase Illness phase
Fever Headache Myalgia Abdominal pain Hemorrhage
Filoviruses Marburg Hemorrhagic Fever 5-10 + + + + +
Ebola 2-21 + + + + +
Bunyaviruses Crimean-Congo hemorrhagic fever (CCHF) 13 + + + + +
  • Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate
  • Changes in mood and sensory perception.
Hantavirus Infection  9 -33 + + + – +
Rift Valley fever 2-6  + – + – –
  • Most commonly mild disease with recovery in 2 weeks
  • Encephalitis
  • Hemorrhagic fever, which occurs in less than 1% of overall RVF
Arenaviruses Lassa fever 7-21 + + + – –
Lujo hemorrhagic fever  7-13 + + + + +  
Lymphocytic choriomeningitis (LCM)  8-13 + + + – –
Flaviviruses Alkhurma hemorrhagic fever (AFD) 2-4  + – + – –
Kyasanur Forest Disease (KFD) 3-8  + + + + + Biphasic
Omsk hemorrhagic fever  3-8 + + + + + Biphasic
  • Complete recovery by 2 week
  • Wave of symptoms in 3 rd week with encephalitis


Shown below is a table summarizing the typical findings of the differential diagnoses of MHF.

Disease Incubation period Symptoms Physical signs Lab findings Other findings
Fever Cough Rash Joint pain Myalgia Diarrhea Common hemorrhagic symptoms Characterestic physical finding Icterus Plasma Creatine kinase Confirmatory test
Marburg hemorrhagic fever
  • 5-10 days
 + + Maculopapular rash on the trunk (chest, back, stomach) + + + Fever and upper respiratory symptoms – Normal Viral culture or PCR
  • History of Travel
  • Patients with co-morbid conditions
Leptospirosis
  • 2 to 30 days
 Fever last for 4-7 days, remission for 1-2 days and then relapse + Present over legs
hemorrhagic rash 		+ +
(Severe myalgia is
characteristic of
leptospirosis typically
localized to the calf
and lumbar areas) 		+ Conjunctival hemorrhage,

Hemoptysis

Conjunctival suffusion + Elevated Microscopic agglutination test of urine
  • History of exposure to soil or watercontaminated by infected rodents
  • Recent history travel to tropical, sub tropical areas, or humid areas
Dengue
  • 4 to 10 days
 Fever last for 1-2 days, remission for 1-2 days, and then relapse for 1-2 days

(Biphasic fever pattern)

– Pruritic rash over
legs and trunk
(may be hemorrhagic) 		+ + – Upper gastrointestinal bleeding Painful lymphadenopathy – Normal Serology showing positive IgM or IgG
  • Recent travel to South America, Africa, or Southeast Asia
Malaria Fever present daily or on alternate day or every 3 days depending on Plasmodium sps. – No rash – + – Bloody urine Hepatosplenomegaly + Normal Giemsa stained thick and thin blood smears
  • Recent travel to South America, Africa, or Southeast Asia
Ebola
  • 2 to 21 days.
 + + Maculopapular
non-pruritic rash
with erythema
Centripetal distribution 		+ + +

May be bloody in the early phase

Epistaxis
Mucosal bleeding 		Sudden onset of high fever with conjunctival injection and early gastrointestinal symptoms – Normal RT-PCR
  • Recent visit to endemic area especially African countries
Yellow fever
  • 3 to 6 days
 + + – – + – Conjunctival hemorrhage,
Hemoptysis 		Relative bradycardia
(Faget’s sign) 		+ Normal RT-PCR,
Nucleic acid amplification test,
Immuno-histochemical staining
  • Recent travel to  Africa, South and Central America, and the Caribbean
  • Tropical rain forests of south America
Typhoid fever
  • 6 to 30 days
 + – Blanching erythematous
maculopapularlesions
on the lower chest
and abdomen 		+ + + Intestinal bleeding Rose spots – Normal Blood or stool culture showing salmonella typhi sps.

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References

  1. ↑ Levett PN (2001). “Leptospirosis”. Clin. Microbiol. Rev. 14 (2): 296–326. doi:10.1128/CMR.14.2.296-326.2001. PMC 88975. PMID 11292640.
  2. ↑ “Marburg Hemorrhagic Fever (Marburg HF) | CDC”.
  3. ↑ “Chapare Hemorrhagic Fever (CHHF) | CDC”.
  4. ↑ “Lassa Fever | CDC”.
  5. ↑ “Lujo Hemorrhagic Fever (LUHF) | CDC”.
  6. ↑ “Lymphocytic Choriomeningitis (LCM) | CDC”.
  7. ↑ “Crimean-Congo Hemorrhagic Fever (CCHF) | CDC”.
  8. ↑ “CDC – Hantavirus Pulmonary Syndrome (HPS) – Hantavirus”.
  9. ↑ “Rift Valley Fever | CDC”.
  10. ↑ “Ebola Hemorrhagic Fever | CDC”.
  11. ↑ “Alkhurma Hemorrhagic Fever (AHF) | CDC”.
  12. ↑ “Kyasanur Forest Disease (KFD) | CDC”.
  13. ↑ “Omsk Hemorrhagic Fever | CDC”.
  14. ↑ Yap S, Nguyen-Khuong T, Rudd PM, Alonso S (2017). “Dengue Virus Glycosylation: What Do We Know?”. Front Microbiol. 8: 1415. doi:10.3389/fmicb.2017.01415. PMC 5524768. PMID 28791003. Vancouver style error: initials (help)

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