TABLE 1.

Comparison of the clinical presentations of Marburg virus disease during the epidemiologically connected episodes in West Germany and Yugoslavia

Parameter	Outbreak (references)
	Belgrade, Yugoslavia	Marburg an der Lahn, West Germany	Frankfurt am Main, West Germany
References	47, 65, 66	27, 28, 47, 114	29, 47, 63
Incubation period (days)	6–7	5–7	7–9
Total no./no. with fatal outcome	2/0	24/5	6/2 (death in early organ phase); of 4 remaining, 2 with severe course and 2 with mild clinical course with resolution
No. of primary/secondary cases	1/1	21/3	4/2
Skin rash	From day 6–11 post-symptom onset, diffuse	Initially, head, trunk, hands; later expanding over body	From day 5–12 post-symptom onset; in severe cases, rash was hemorrhagic
Conjunctivitis	Initial sign, lasted 11 days (primary case)	Initial sign	Initial sign
Fever (°C)	High (37.7–39.6)	High	High (39–40)
Exanthema	Presented	Described	Hemorrhagic in a few cases
Liver	Palpable from day 10 of illness, altered enzyme values, jaundice, yellow sclerae; in secondary case, discretely enlarged	Palpable, altered enzyme values	Palpable (except in 1 patient), altered enzyme values
Respiratory signs	Persistent cough, tachypnea (for both patients)	Bronchopneumonia as secondary bacterial infection (1 patient)	Unremarkable
Kidneys	Urine with granular cylinders, albumin, blood; abnormal kidney function test; frequent urination (both patients)	Hematuria, oliguria	Proteinuria, hematuria, and oliguria in 4/6 patients
Lymph nodes	Slightly enlarged cervical lymph nodes	Enlarged cervical, axillary lymph nodes	Enlarged cervical lymph nodes
Fluid disturbances	Facial, skin edema; electrolyte imbalance; dehydration; hemoconcentration	Facial edema	Facial edema (some patients); ascites (1 patient); hypoalbuminemia (all patients)
Hematology	Early leukopenia (shift to the left) followed by leukocytosis, thrombocytopenia (90,000 mm3), abnormal lymphocytes (6%), basophils (6%), segmented leukocytes (52–68%)	Early leukopenia (shift to the left) followed by leukocytosis, severe thrombocytopenia	Early leukopenia (shift to the left) followed by leukocytosis, severe thrombocytopenia
Gastrointestinal signs	Pharyngeal cramps; from day 7 to peak on day 11 of illness (total of 26 days), profuse, frequent diarrhea with sloughed membranes and melena as noted by positive Adler-Weber test on day 14 of illness; anorexia, hematemesis, nausea	Very persistent diarrhea, initially without blood or mucus; in a few patients followed by constipation; 2 patients with constipation from beginning	Profuse diarrhea with blood (in all except 1 patient)
Hemorrhage	On admission, blood in nostrils; later, mucosal bleeding hematemesis, melena, disseminated intravascular coagulation, uncontrolled bleeding from injection sites, requiring blood transfusion; prolonged coagulation tests	Generalized mucosal bleeding, hematemesis, melena, disseminated intravascular coagulation	Preagonal hemorrhage from all systems (in lethal outcomes)
Genital tract	Male, none; female, erythema, amenorrhea with eventual resumption of menses	Male, reddening without pruritus; female, erythema	Male, sporadic scrotal edema and redness; acute orchitis (in 2 patients)
Cardiovascular signs	From day 10 of illness, sinus tachycardia (120–145 beats/min) with muffled tones; on day 12 of illness, damage to myocardium and increased blood pressure (150/70 mm Hg); signs of myocardiopathy present weeks after discharge	Bradycardia initially; tachycardia only in fatal cases	Bradycardia in all patients; 2 with ECG abnormalities; 1 with congestive heart failure (fatal outcome)
Neurological signs	On admission, fasciculation on hands, tongue, arm tremor, hyperacusis, Kernig’s syndrome, increased Babinski’s reflex, nystagmus, clouded consciousness	Mental disturbances, hyperesthesia, amnesia	Mild disturbances of consciousness, apathy, somnolence; encephalitis (lethal outcomes)
Differential diagnosis	All samples of urine and stool were free of infectious particles and parasites	Dysentery, severe digestive symptoms (suspicious of Shigella sp. infection or leptospirosis)	Yellow fever (due to liver damage)