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J. ter Meulen



Virus—Lloviu virus, new filovirus from bat Miniopterus schreibersii in Spain.

Pathogenesis—role of host genetics and cytokines.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 29 April 2017

Filoviruses are large RNA viruses, of which Ebola virus and Marburg virus cause the most severe forms of viral haemorrhagic fever and have been best-studied because of fear of their misuse as bioterrorism agents. These are zoonotic viruses with reservoirs, most likely fruit-eating bats, in the rainforests of tropical Africa, where they cause sporadic infections and outbreaks among great apes and humans.

Epidemiology—the primary mode of transmission of Ebola virus to humans often involves contact of hunters with dead animals, especially chimpanzees, whose meat is consumed as ‘bush meat’; contact with bats has been implicated for Marburg virus. However, the viruses are highly infectious and are transmitted from the index case and subsequently from person to person by all body fluids, including sweat and respiratory droplets.

Clinical features—Ebola haemorrhagic fever is clinically indistinguishable from Marburg haemorrhagic fever. Presentation is with an influenza-like illness, often with gastrointestinal symptoms, followed by development of a maculopapular rash and haemorrhagic manifestations including epistaxis, gum bleeding, haematemesis, melaena, petechiae, and ecchymoses. There is no specific treatment, although recombinant activated protein C (Drotrecogin α‎) and the investigational anticoagulant rNAPc2 have reduced mortality by 20 to 30% in animal models. Mortality is 50 to 90%.

Diagnosis and prevention—viral haemorrhagic fever is a clinical diagnosis which requires the immediate instalment of the strictest barrier nursing procedures and notification of public health authorities. Care must be taken in both drawing and handling blood specimens, which must be inactivated before performing routine laboratory tests, and samples must be shipped immediately to a reference laboratory for diagnosis by detection of virus by cell culture, viral antigen by ELISA, and viral RNA by PCR. A prophylactic vaccine based on a replication-deficient adenoviral vector is in clinical development.

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