Marburg hemorrhagic fever is commonly associated with fever on physical examination at admission. At advanced stages of the disease, physical examination findings are more pertinent and often include unstable vital signs, such as tachycardia or relative bradycardia, orthostatic hypotension, and tachypnea. Physical examination may also be remarkable for abdominal tenderness and distension, evidence of mucosal or visceral bleeding, and neurological impairment.

The general appearance of the patient depends on the stage of the disease. Typically, patients demonstrate prostration, may be nauseated and vomiting, and less commonly present with signs of hemorrhage, such as epistaxis or gingival bleeding. In later stages of the disease, patients are often brought with convulsions or are in a state of shock, stupor, or coma.^[1]

• High-grade fever (most common presenting sign)

• Tachycardia
• Relative bradycardia

• Hypotension (SBP<90 mmHg and/or DBP<60 mmHg)
• Postural hypotension (common in dehydrated patients with inadequate volume repletion)

Hemorrhagic manifestations tend to occur during the more severe stages of the disease and may include:

• Maculopapular rash on the trunk
• Petechiae
• Ecchymoses
• Mucosal hemorrhages
• Uncontrolled bleeding from venipuncture sites

• Conjunctival hemorrhage (most common sign of abnormal clotting)
• Conjunctivitis

• Epistaxis
• Nasal discharge

• Mucosal hyperemia of the oral cavity
• Bleeding gums

• Signs of respiratory difficulty may be present, such as:

• Intercostal retractions
• Paradoxical breathing
• Nasal flare

• Tachypnea (often precedes death during final hours of infection)

• Abdominal tenderness (may suggest pancreatitis, intestinal swelling, or mesenteric lymphadenopathy)
• Abdominal distention (may suggest paralytic ileus)
• Tender hepatomegaly
• Splenomegaly

• Edema may be present

• Obtundation may be present
• Stupor
• Coma