Marburg virus disease: a comprehensive review.

Abstract

SUMMARYMarburg virus disease (MVD) is a highly fatal illness closely resembling Ebola disease, caused by either Marburg virus (MARV) or Ravn virus (RAVV). It typically begins with a sudden onset of high fever, headache, and malaise, followed by severe gastrointestinal symptoms, bleeding disorders, and, in the most severe cases, multi-organ failure. Case fatality rates vary widely, from 24% up to 90%. MARV and RAVV are zoonotic pathogens, with fruit bats recognized as the main reservoir. Human-to-human transmission generally occurs through direct exposure to infected bodily fluids. Historically, MVD outbreaks were primarily restricted to Central and Eastern Africa. In recent years, however, the disease has appeared in new regions: Ghana recorded its first cases in 2022, followed by concurrent outbreaks in Equatorial Guinea and Tanzania in 2023. Rwanda and Ethiopia experienced their debut outbreaks in 2024 and 2025, respectively, and another outbreak occurred in early 2025 in Tanzania. These incidents point to a troubling rise in annual MVD outbreaks and emphasize the ongoing risk of spillover from wildlife reservoirs and continued human-to-human transmission. Currently, there are no approved vaccines or antiviral treatments for MVD. Patient care focuses on supportive therapies, including aggressive fluid resuscitation, management of blood pressure and circulation, and intensive critical care. Nonetheless, promising countermeasures, such as monoclonal antibodies and antiviral drugs, are advancing through research and clinical trials. Experimental vaccines, particularly those based on viral-vector technologies, have demonstrated robust immune responses and are undergoing human testing. This review provides clinicians with the most recent knowledge of MVD, with a focus on epidemiological patterns, diagnostic procedures, clinical management, and the latest progress in developing medical countermeasures.