From Big Medical Encyclopedia

TSERKOPITEKOVY HEMORRHAGIC FEVER. The name «tserkopitekovy hemorrhagic fever» did not gain distribution, most often a disease call fever or a disease Marburg. C. of l. — the infectious disease proceeding usually hard with high temperature, severe headaches, diarrhea and the expressed hemorrhagic syndrome.

Believe that C. of l. is endemic for a number of territories of Africa; at the same time allocate the East African and South African centers. In Europe diseases of C. of l. are for the first time noted in 1967 at the same time in the cities of Marburg, Frankfurt am Main (Germany) and Belgrade (SFRYu). The African monkeys of Cercopithecus aethiops who are taken out from Uganda for laboratory works were a source of an infection. 25 cases of diseases as a result of infection from monkeys and 6 cases of the subsequent infections from sick people are registered.

Etiology. The activator — the Marburg virus is for the first time allocated in

1967 from blood of patients and section material during the studying of the diseases which arose in Marburg (from where the virus and received the name). The lowest monkeys (Macacus rhesus, Cercopithecus aethiops, Saimiri sciureus) and Guinea pigs are susceptible to a virus. The virus breeds in many cellular cultures (primary and intertwined), without causing accurate cytopathic changes. Its presence at culture is revealed by means of a submicroscopy (see) or reactions of an immunofluorescence (see). Virions of a virus Marburg have the form of crimped yarns, sometimes with branches. Outer diameter of their 70 — 80 nanometers, average length — 665 nanometers, meet particles up to 1200 nanometers long. Genetic material of a virus is RNA, as a part of a cover of virions lipoproteids are found. On a number of signs the Marburg virus is similar to rhabdoviruses (see). In 1984. The international committee on taxonomy of viruses, based on an originality of internal structure of virion, allocated the Marburg virus and similar to it on morphology of particles and an antigenic structure Ebola virus (see Ebola hemorrhagic fever) in separate taxonomical group — the family Filo-virus of the Filoviridae family (Latin of filum thread). The Marburg virus is rather steady against heating, is sensitive to effect of solvents of fats, is inactivated by weak formalins.

Epidemiology. The registered source of a contagium are monkeys of Cercopithecus aethiops and sick people. It is experimentally established that infection of a monkey with a virus leads Marburg to development of a feverish disease with an inevitable lethal outcome, therefore, monkeys-tserkopiteki are not feral hosts of viruses. However despite intensive researches it was not succeeded to find natural tanks of a virus in Africa and sources of infection of the persons who got sick in the Republic of South Africa and Kenya. The main part of the diseased in Germany in 1967 (19 people) caught in direct contact with blood or internals of monkeys during their opening. Also cases of infection of medical personnel from sick people in the first days of a disease at contact with their blood are registered, nasopharyngeal separated and urine. Assume that the activator gets into a human body through mucous membranes and the injured skin. The medical staff is especially subject to risk of infection — at all known outbreaks of tserko-pitekovy hemorrhagic fever doctors and nurses got sick.

Pathogeny and pathological anatomy. At hit in a human body the virus is transferred in the hematogenous way to parenchymatous bodies where breeds and again passes into blood. Patol. changes in bodies are caused by its direct damaging action. It is not possible to find defeats of walls of blood vessels. Development of the hemorrhagic phenomena is promoted by thrombocytopenia and decrease in level of factors of coagulation (II, V, VII, VIII, IX) in a blood plasma (see. Coagulant system of blood).

Pathoanatomical changes at C. of l. are found in a liver, a spleen, limf. nodes, ovaries, testicles, pancreas; in them widespread focal necroses of type coagulative without the expressed signs of an inflammation are noted. In white and gray matter of a brain glial nodular encephalitis is observed.

Immunity is not studied.

Clinical picture. Incubation interval of 3 — 9 days. The onset of the illness is acute, along with bystry rise in temperature to 39 ° severe head and muscular pains, morbidity of eyeglobes during the pressing develop, conjunctivitis. Within 1 — 2 days diarrhea, excrements watery develops, it is frequent with impurity of blood, nausea and vomiting are often observed. Characteristic of C. of l. a sign is rash on skin of a trunk, buttocks and an outer surface of hands. On 5 — the 7th day of a disease small dark red papules around hair follicles appear, then rash turns into makulopapulezny. Almost the mucous membrane of a soft palate gains dark red color from all patients, on it there are transparent vesicles, is more rare — yellowish sores. Between the 3 and 6 day of a disease lymphadenitis can develop (see) in occipital, cervical and axillary areas. On 5 — the 7th day most of patients has symptoms of hemorrhagic diathesis — spontaneous bleedings from a nose, gums, gastric and intestinal bleedings, a hamaturia. Bleedings from places of injections and formation of hematomas in surrounding fabrics are characteristic. At a blood analysis find critical falling of number of thrombocytes (to 10 Ltd companies in 1 mkl between the 6th and 12th day) and the expressed leukopenia (sometimes the number of leukocytes in 1 mkl blood falls lower than 1000) with sharp shift to the left. Duration of the acute period of a disease about two weeks, recovery drags on to 3 — 4 weeks. In cases of a lethal outcome death comes on 7 — the 14th day at the phenomena of cardiovascular insufficiency (see. Heart failure, Vascular insufficiency), an acute renal failure (see) or a brain coma (see).

Diagnosis. At diagnosis consider a wedge, a picture of a disease and communication of a disease with areas where infection with a virus Marburg is possible. The final diagnosis is made on the basis of results of virologic and serological researches. In an onset of the illness the virus can be found in blood by means of a submicroscopy. For allocation of a virus from blood the studied material is brought in culture of cells of Vero or entered intraperitoneally to Guinea pigs. Accumulation of a virus in culture is found by an indirect method to them-mu by noflyuorestsention (see) or by means of a submicroscopy (see). Identification of antibodies and increase of their caption in the pair tests of blood serum (taken in the first days of a disease and in 2 — 3 weeks after its beginning) carry out in culture of cells of Vero infected with a virus Marburg, an indirect method of an immunofluorescence.

Differential diagnosis is carried out with hemorrhagic fever Ebola (see Ebola hemorrhagic fever) and Jiassa-fever (see).

Treatment. Patients are isolated in special departments, in separate chambers. Apply the funds allocated for the prevention and stopping of hemorrhagic diathesis — transfusion is fresher than blood, administration of drugs of thrombocytes, fibrinogen and phthiocol; performing disintoxication therapy (see) — in particular plentiful drink, parenteral administration of various solutions is necessary (glucose, salt, Haemodesum, etc.). Maintenance of water and electrolytic balance is carried out administration of the salt solutions containing potassium. Specific remedy is immune plasm or blood serum had.

Forecast adverse. In the described flashes of C. of l. the lethality reached 30%.

Prevention. Recommendations about transportation and keeping of the lowest primacies, and also about work with them are developed for the prevention of delivery of sick monkeys of WHO. Specific prevention is not developed.

Bibliography: Drozdov. And Sergiyev V. P. Protection of ecdemic territories against tropical viral hemorrhagic fevers, M., 1984; M about -

nathT. R. Likhoradka JIacca and viral disease of Marburg, Chronicle of WHO, t. 28, No. 9, page 513, 1974; With and m p with about D. I. N X. Viral hemorrhagic fevers che

a loveka, Bulletin WHO, t. 56, page 633, 1978; Chumakov M. P. Viral hemorrhagic fevers, M., 1979; Marburg virus disease, ed. by G. A. Martini a. R. Si-egert, B., 1971; S i m p s o n D. I. H. Marburg and Ebola virus infections, guide for their diagnosis, management and control, Geneva, 1977. S.G. Drozdov.