داء فيروس ماربورغ: الفرق بين النسختين

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نسخة 20:46، 2 يناير 2018

داء فيروس ماربورغ
مايكروغراف إلكترون ناقل لفيروس ماربورغ
مايكروغراف إلكترون ناقل لفيروس ماربورغ
مايكروغراف إلكترون ناقل لفيروس ماربورغ
تسميات أخرى حمى ماربورغ النزفية
معلومات عامة
الاختصاص أمراض معدية  تعديل قيمة خاصية (P1995) في ويكي بيانات
من أنواع مرض فيروسي،  وحمى نزفية فيروسية،  وعدوى المستشفيات  تعديل قيمة خاصية (P279) في ويكي بيانات
الأسباب
الأسباب فيروس ماربورغ،  وفيروس رافن  تعديل قيمة خاصية (P828) في ويكي بيانات
طريقة انتقال العامل المسبب للمرض انتقال بالاتصال  [لغات أخرى]‏  تعديل قيمة خاصية (P1060) في ويكي بيانات
المظهر السريري
الأعراض تسمم  [لغات أخرى]‏  تعديل قيمة خاصية (P780) في ويكي بيانات
التاريخ
سُمي باسم ماربورغ  تعديل قيمة خاصية (P138) في ويكي بيانات
تعديل مصدري - تعديل  طالع توثيق القالب

مرض فيروس ماربورغ (MVD) أو حمى ماربورغ النزفية، هي مرض شديد يصيب البشر والرئيسيات غير البشرية، وينجم عن الإصابة بفيروس ماربورغ (MARV) وفيروس رافن (RAVV).[1] MVD is a حمى نزفية فيروسية (VHF), and the clinical symptoms are indistinguishable from مرض فيروس إيبولا (EVD).

التصنيف

Marburg virus disease (MVD) is the official name listed in the منظمة الصحة العالمية's التصنيف الدولي للأمراض 10 (ICD-10) for the human disease caused by any of the two marburgviruses فيروس ماربورغ (MARV) and Ravn virus (RAVV). In the scientific literature, Marburg hemorrhagic fever (MHF) is often used as an unofficial alternative name for the same disease. Both disease names are derived from the ألمانيا city ماربورغ, where MARV was first discovered.[2]

العلامات والأعراض

The most detailed study on the frequency, onset, and duration of MVD علامة طبية and عرض (طب)s was performed during the 1998–2000 mixed MARV/RAVV disease outbreak.[3] A مرض جلدي طفح, حبرةe, فرفرية, كدمة, and ورم دمويs (especially around needle injection sites) are typical hemorrhagic manifestations. However, contrary to popular belief, hemorrhage does not lead to نقص حجم الدم and is not the cause of موت (total blood loss is minimal except during ولادة). Instead, death occurs due to متلازمة الاختلال العضوي المتعدد due to fluid redistribution, انخفاض ضغط الدم, تخثر منتشر داخل الأوعية, and focal نسيج حيوي نخر.[3][4][5][6][7][8][9][10][11][12][13][14]

Clinical phases of Marburg Hemorrhagic Fever's presentation are described below. Note that phases overlap due to variability between cases.

  1. Incubation: 2–21 days, averaging 5–9 days.
  2. Generalization Phase: Day 1 up to Day 5 from onset of clinical symptoms. MHF presents with a high fever (~40˚C) and a sudden, severe headache, with accompanying chills, fatigue, nausea, vomiting, diarrhea, pharyngitis, maculopapular rash, abdominal pain, conjunctivitis, & malaise.
  3. Early Organ Phase: Day 5 up to Day 13. Symptoms include prostration, ضيق النفس, استسقاء (طب), التهاب الملتحمة, viral طفح ظاهر, and CNS symptoms, including encephalitis, confusion, delirium, apathy, and aggression. Hemorrhagic symptoms typically occur late and herald the end of the early organ phase, leading either to eventual recovery or worsening & death. Symptoms include bloody stools, كدمة, blood leakage from بزل الوريد sites, mucosal & visceral hemorrhaging, and possibly تقيؤ دموي.
  4. Late Organ Phase: Day 13 up to Day 21+. Symptoms bifurcate into two constellations for survivors & fatal cases. Survivors will enter a convalescence phase, experiencing ألم عضلي, ألم عضلي ليفي, التهاب كبدي, ضعف, ocular symptoms, & ذهان. Fatal cases continue to deteriorate, experiencing continued fever, تبليد الإحساس, غيبوبة, اختلاج, diffuse اعتلال خثري, metabolic disturbances, صدمة (جهاز الدوران) and death, with death typically occurring between Days 8 and 16.[15]

الأسباب

المقالة الرئيسة: فيروس ماربورغ
Genus Marburgvirus: species and its MVD-causing viruses
اللجنة الدولية لتصنيف الفيروسات اللجنة الدولية لتصنيف الفيروسات
Marburg marburgvirus* فيروس ماربورغ (MARV; previously MBGV)
فيروس رافن (RAVV; previously MARV-Ravn)
"*" يدل على النوع.

MVD is caused by two viruses فيروس ماربورغ and Ravn virus (RAVV)family Filoviridae[16]

Marburgviruses are endemic in قحولة الأراضي الخشبيةs of أفريقيا الاستوائية.[17][18][19] Most marburgvirus infections were repeatedly associated with people visiting natural كهفs or working in تعدين. In 2009, the successful isolation of infectious MARV and RAVV was reported from healthy خفاش الفاكهة المصري caught in caves.[20] This isolation strongly suggests that عالم قديم خفافيش الفاكهةs are involved in the natural maintenance of marburgviruses and that visiting bat-infested caves is a risk factor for acquiring marburgvirus infections. Further studies are necessary to establish whether Egyptian rousettes are the actual hosts of MARV and RAVV or whether they get infected via contact with another animal and therefore serve only as intermediate hosts. Another risk factor is contact with nonhuman primates, although only one outbreak of MVD (in 1967) was due to contact with infected monkeys.[2] Finally, a major risk factor for acquiring marburgvirus infection is occupational exposure, i.e. treating patients with MVD without proper معدات الوقاية الشخصية.[بحاجة لمصدر]

Contrary to مرض فيروس إيبولا, which has been associated with heavy مطرs after long periods of dry weather,[18][21] triggering factors for spillover of marburgviruses into the human population have not yet been described.

علم الفيروسات

المقالة الرئيسة: فيروس ماربورغ

الجينوم

Like all monomegaviruses, marburgvirions contain non-infectious, linear nonsegmented, single-stranded حمض نووي ريبوزي مجموع مورثيs of negative polarity that possesses inverse-complementary 3' and 5' termini, do not possess a 5' cap, are not polyadenylated, and are not رابطة تساهمية linked to a بروتين.[22] Marburgvirus genomes are approximately 19 زوج قاعدي long and contain seven جينs in the order 3'-UTR-NP-VP35-VP40-GP-VP30-VP24-L-5'-UTR.[23]

التركيب

Like all فيروسات خيطية, marburgvirions are filamentous particles that may appear in the shape of a shepherd's crook or in the shape of a "U" or a "6", and they may be coiled, toroid, or branched.[23] Marburgvirions are generally 80 nm in طول, but vary somewhat in length. In general, the median particle length of marburgviruses ranges from 795–828 nm (in contrast to ebolavirions, whose median particle length was measured to be 974–1,086 nm ), but particles as long as 14,000 nm have been detected in tissue culture.[24] Marburgvirions consist of seven structural proteins. At the center is the لولب (رياضيات) ribonucleocapsid, which consists of the genomic RNA wrapped around a مبلمر of بروتين نوويs (NP). Associated with the ribonucleoprotein is the بوليميراز الآر إن إيه المعتمد على الآر إن إيه (L) with the polymerase cofactor (VP35) and a transcription activator (VP30). The ribonucleoprotein is embedded in a matrix, formed by the major (VP40) and minor (VP24) matrix proteins. These particles are surrounded by a ليبيد ثنائي الطبقة derived from the host cell membrane. The membrane anchors a glycoprotein (GP1,2) that projects 7 to 10 nm spikes away from its surface. While nearly identical to ebolavirions in structure, marburgvirions are مولد الضدically distinct.[بحاجة لمصدر]

التنسّخ

The marburgvirus دورة حياة (أحياء) begins with virion attachment to specific cell-surface مستقبل (كيمياء حيوية)s, followed by fusion of the virion envelope with cellular membranes and the concomitant release of the virus قفيصة into the عصارة خلوية. The virus RdRp partially uncoats the nucleocapsid and نسخ (وراثة) the جين into positive-stranded حمض نووي ريبوزي رسولs, which are then ترجمة (وراثة) into structural and nonstructural بروتين. Marburgvirus L binds to a single محفز located at the 3' end of the genome. Transcription either terminates after a gene or continues to the next gene downstream. This means that genes close to the 3' end of the genome are transcribed in the greatest abundance, whereas those toward the 5' end are least likely to be transcribed. The gene order is therefore a simple but effective form of transcriptional regulation. The most abundant protein produced is the بروتين نووي, whose تركيز in the cell determines when L switches from gene transcription to genome replication. Replication results in full-length, positive-stranded antigenomes that are in turn transcribed into negative-stranded virus progeny genome copies. Newly synthesized structural proteins and genomes self-assemble and accumulate near the inside of the غشاء خلوي. Virions تبرعم off from the cell, gaining their envelopes from the cellular membrane they bud from. The mature progeny particles then infect other cells to repeat the cycle.[25]

التشخيص

MVD is clinically indistinguishable from مرض فيروس إيبولا, and it can also easily be confused with many other diseases prevalent in أفريقيا الاستوائية, such as other حمى نزفية فيروسيةs, ملاريا, حمى التيفوئيد, داء الشيغيلات, ريكتسيا such as حمى نمشية, كوليرا, بكتيريا سلبية الغرام إنتان, داء لايم such as حمى راجعة or EHEC enteritis. Other infectious diseases that ought to be included in the تشخيص تفريقي include داء البريميات, تيفوس أكالي, طاعون, حمى كيو, داء المبيضات, داء النوسجات, trypanosomiasis, عضو (تشريح) داء الليشمانيات, hemorrhagic جدري, حصبة, and fulminant التهاب كبدي فيروسي. Non-infectious diseases that can be confused with MVD are لوكيميا حادة بخلايا النخاع الخديج, متلازمة انحلال الدم اليوريمية, ثعبان تأثر بزعاف الحشرات, تجلط الدم deficiencies/platelet disorders, thrombotic thrombocytopenic purpura, توسع الشعيرات النزفي الوراثي, داء كاواساكي, and even وارفارين intoxication.[26][27][28][29] The most important indicator that may lead to the suspicion of MVD at clinical examination is the سيرة مرضية of the patient, in particular the travel and occupational history (which countries and caves were visited?) and the patient's exposure to wildlife (exposure to bats or bat excrements?). MVD can be confirmed by isolation of marburgviruses from or by detection of marburgvirus antigen or genomic or subgenomic RNAs in patient دم or مصل الدم samples during the acute phase of MVD. Marburgvirus isolation is usually performed by inoculation of سعدان الهجرس kidney epithelial خلية فيرو or MA-104 زرع الخلاياs or by inoculation of human adrenal carcinoma SW-13 cells, all of which react to infection with characteristic تأثير الاعتلال الخلويs.[30][31] Filovirions can easily be visualized and identified in cell culture by مجهر إلكتروني due to their unique filamentous shapes, but electron microscopy cannot differentiate the various filoviruses alone despite some overall length differences.[24] Immunofluorescence assays are used to confirm marburgvirus presence in cell cultures. During an outbreak, virus isolation and electron microscopy are most often not feasible options. The most common diagnostic methods are therefore RT-PCR[32][33][34][35][36] in conjunction with مقايسة امتصاصية للإنزيم المرتبط,[37][38][39] which can be performed in field or mobile hospitals and laboratories. Indirect immunofluorescence assays (IFAs) are not used for diagnosis of MVD in the field anymore.

الوقاية

المقالة الرئيسة: الوقاية من الحمى النزفية الفيروسية

There are currently no إدارة الغذاء والدواء (الولايات المتحدة)-approved لقاحs for the prevention of MVD. Many candidate vaccines have been developed and tested in various animal models.[40][41][42][43][44][45][46] Of those, the most promising ones are تلقيح الحمض النووي[47] or based on فيروس التهاب دماغ الحصان الفنزويلي متضاعف (ربليكون),[43] فيروس التهاب الفم الحويصلي[45][48] or filovirus-like particles (VLPs)[46] as all of these candidates could protect nonhuman primates from marburgvirus-induced disease. DNA vaccines have entered clinical trials.[49] Marburgviruses are highly عدوى, but not very contagious. Importantly, and contrary to popular belief, marburgviruses do not get transmitted by هباء جوي during natural MVD outbreaks. Due to the absence of an approved vaccine, prevention of MVD therefore relies predominantly on behavior modification, proper معدات الوقاية الشخصية, and تعقيم/مطهر.[بحاجة لمصدر]

المناطق المستوطنة

The natural maintenance hosts of marburg viruses remain to be identified unequivocally. However, the isolation of both MARV and RAVV from خفاشياتs and the association of several MVD outbreaks with bat-infested mines or caves strongly suggests that bats are involved in marburg virus transmission to humans. Avoidance of contact with bats and abstaining from visits to caves is highly recommended, but may not be possible for those working in mines or people dependent on bats as a food source.[بحاجة لمصدر]

خلال حالات الانتشار

Since marburgviruses are not spreading via aerosol, the most straightforward prevention method during MVD outbreaks is to avoid direct (skin-to-skin) contact with patients, their إخراج (فسلجة)s and سوائل الجسم, or possibly contaminated materials and utensils. Patients ought to be isolated but still have the right to be visited by family members. Medical staff should be trained and apply strict barrier nursing techniques (disposable face mask, gloves, goggles, and a gown at all times). Traditional دفن rituals, especially those requiring تحنيط of bodies, ought to be discouraged or modified, ideally with the help of local طب تقليديs.[50]

في المختبر

Marburgviruses are منظمة الصحة العالمية Risk Group 4 Pathogens, requiring سلامة بيولوجية,[51] laboratory researchers have to be properly trained in BSL-4 practices and wear proper personal protective equipment.

العلاج

There is currently no effective marburgvirus-specific علاج (طب) for MVD. Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and كهرلs to counter تجفاف, administration of مضاد تخثر early in infection to prevent or control تخثر منتشر داخل الأوعية, administration of تجلط الدم late in infection to control نزف, maintaining أكسجين levels, إدارة الألم, and administration of مضاد حيوي or مضاد فطري to treat secondary infections.[52][53] Experimentally, recombinant فيروس التهاب الفم الحويصلي (VSIV) expressing the glycoprotein of MARV has been used successfully in nonhuman primate models as post-exposure prophylaxis.[54] Novel, very promising, experimental therapeutic regimens rely on علاج بمضادات تحسيس: phosphorodiamidate morpholino oligomers (PMOs) targeting the MARV genome could prevent disease in nonhuman primates.[55] Leading medications from Sarepta [56] and Tekmira [57] both have been successfully used in European humans as well as primates.

حالات التنبؤ

Prognosis is generally poor. If a patient survives, recovery may be prompt and complete, or protracted with sequelae, such as التهاب الخصية, التهاب كبدي, التهاب العنبية, التهاب النكفية, توسف or فقدان الشعر. Importantly, MARV is known to be able to persist in some survivors and to either reactivate and cause a secondary bout of MVD or to be transmitted via حيوان منوي, causing secondary cases of infection and disease.[13][58][59][60]

Of the 252 people who contracted Marburg during the 2004–2005 outbreak of a particularly virulent serotype in أنغولا, 227 died, for a case fatality rate of 90%.[61]

Although all age groups are susceptible to infection, children are rarely infected. In the 1998–2000 Congo epidemic, only 8% of the cases were children less than 5 years old.[62]

الأوبئة

حالات انتشار مرض فيروس ماربورغ
العام الدولة الفيروس حالات بشرية الموتى من البشر معدل إماتة الحالة
1967  ألمانيا الغربية
 يوغوسلافيا 		MARV 31 7 23%
1975  رودسيا
 جنوب إفريقيا 		MARV 3 1 33%
1980  كينيا MARV 2 1 50%
1987  كينيا RAVV 1 1 100%
1988  الاتحاد السوفيتي MARV 1 1 100%
1990  الاتحاد السوفيتي MARV 1 0 0%
1998–2000  جمهورية الكونغو الديمقراطية MARV & RAVV 154 128 83%
2004–2005  أنغولا MARV 252 227 90%
2007  أوغندا MARV & RAVV 4 1 25%
2008  أوغندا
 هولندا
 الولايات المتحدة 		MARV 2 1 50%
2012  أوغندا MARV 18 9 50%[63]
2014  أوغندا MARV 1 1 100%[64]
2017  أوغندا MARV 2 2 100%

انتشار المرض عام 1967

MVD was first documented in 1967, when 31 people became ill in the ألمانيا towns of ماربورغ and فرانكفورت, and in بلغراد, يوغوسلافيا. The outbreak involved 25 primary MARV infections and seven deaths, and six nonlethal secondary cases. The outbreak was traced to infected سعدان الهجرسs (species Chlorocebus aethiops) imported from an undisclosed location in أوغندا and used in developing شلل الأطفال لقاح. The monkeys were received by Behringwerke, a Marburg company founded by the first winner of the جائزة نوبل في الطب أو علم وظائف الأعضاء, إميل فون بهرنغ. The company, which at the time was owned by شركة هوكست, was originally set up to develop بلازما الدم against كزاز and خناق. Primary infections occurred in Behringwerke مختبر staff while working with grivet tissues or tissue cultures without adequate معدات الوقاية الشخصية. Secondary cases involved two طبيبs, a تمريض, a post-mortem attendant, and the wife of a طبيب بيطري. All secondary cases had direct contact, usually involving blood, with a primary case. Both physicians became infected through accidental skin pricks when drawing blood from patients.[65][66][67][68] A popular science account of this outbreak can be found in Laurie Garrett’s book The Coming Plague.[69]

حالات 1975

In 1975, an Australian tourist became infected with MARV in رودسيا (today زيمبابوي). He died in a hospital in جوهانسبرغ, جنوب أفريقيا. His girlfriend and an attending nurse were subsequently infected with MVD, but survived.[11][70][71]

حالات 1980

A case of MARV infection occurred in 1980 in كينيا. A French man, who worked as an electrical engineer in a sugar factory in Nzoia (close to Bungoma) at the base of Mount Elgon (which contains كهف كيتوم), became infected by unknown means and died shortly after admission to نيروبي Hospital. The attending physician contracted MVD, but survived.[72] A popular science account of these cases can be found in Richard Preston’s book The Hot Zone (the French man is referred to under the اسم مستعار “Charles Monet”, whereas the physician is identified under his real name, Shem Musoke).[73]

حالة 1987

In 1987, a single lethal case of RAVV infection occurred in a 15-year-old Danish boy, who spent his vacation in كيزيمو, كينيا. He had visited كهف كيتوم on Mount Elgon prior to travelling to مومباسا, where he developed clinical signs of infection. The boy died after transfer to نيروبي Hospital.[12] A popular science account of this case can be found in Richard Preston’s book The Hot Zone (the boy is referred to under the اسم مستعار “Peter Cardinal”).[73]

عدوى المختبر عام 1988

In 1988, researcher Nikolai Ustinov infected himself lethally with MARV after accidentally pricking himself with a syringe used for inoculation of كابياء خنزيريةs. The accident occurred at the Scientific-Production Association "Vektor" (today the مركز علم الفيروسات والتكنولوجيا الحيوية (فيكتور)) in Koltsovo, الاتحاد السوفيتي (today روسيا).[74] Very little information is publicly available about this MVD case because Ustinov’s experiments were classified. A popular science account of this case can be found in Ken Alibek’s book Biohazard.[75]

عدوى المختبر عام 1990

Another laboratory accident occurred at the Scientific-Production Association "Vektor" (today the مركز علم الفيروسات والتكنولوجيا الحيوية (فيكتور)) in Koltsovo, الاتحاد السوفيتي, when a scientist contracted MARV by unknown means.[13]

انتشار المرض في الفترة 1998–2000

A major MVD outbreak occurred among illegal تعدين الذهبrs around Goroumbwa mine in Durba and Watsa, جمهورية الكونغو الديمقراطية from 1998 to 2000, when co-circulating MARV and RAVV caused 154 cases of MVD and 128 deaths. The outbreak ended with the flooding of the mine.[3][76][77][77]

انتشار المرض عامي 2004–2005

In early 2005, the منظمة الصحة العالمية (WHO) began investigating an outbreak of حمى نزفية فيروسية in أنغولا, which was centered in the northeastern مقاطعة أوجي but also affected many other provinces. The Angolan government had to ask for international assistance, pointing out that there were only approximately 1,200 doctors in the entire country, with some provinces having as few as two. Health care workers also complained about a shortage of معدات الوقاية الشخصية such as gloves, gowns, and masks. أطباء بلا حدود (MSF) reported that when their team arrived at the provincial hospital at the center of the outbreak, they found it operating without ماء and كهرباء. Contact tracing was complicated by the fact that the country's roads and other infrastructure have been devastated after nearly three decades of حرب الاستقلال الأنغولية and the countryside remained littered with لغمs. Americo Boa Vida Hospital in the Angolan عاصمة لواندا set up a special isolation ward to treat infected people from the countryside. Unfortunately, because MVD often results in death, some people came to view hospitals and medical workers with suspicion and treated helpers with hostility. For instance, a specially-equipped isolation ward at the provincial hospital in Uíge was reported to be empty during much of the epidemic, even though the facility was at the center of the outbreak. WHO was forced to implement what it described as a "harm reduction strategy", which entailed distributing disinfectants to affected families who refused hospital care. Of the 252 people who contracted MVD during outbreak, 227 died.[14][78][79][80][81][82][83]

حالات عام 2007

In 2007, four miners became infected with marburgviruses in Kamwenge District, أوغندا. The first case, a 29-year-old man, became symptomatic on July 4, 2007, was admitted to a hospital on July 7, and died on July 13. Contact tracing revealed that the man had had prolonged close contact with two colleagues (a 22-year-old man and a 23-year-old man), who experienced clinical signs of infection before his disease onset. Both men had been admitted to hospitals in June and survived their infections, which were proven to be due to MARV. A fourth, 25-year-old man, developed MVD clinical signs in September and was shown to be infected with RAVV. He also survived the infection.[20][84]

حالات عام 2008

On July 10, 2008, the Netherlands National Institute for Public Health and the Environment reported that a 41-year-old Dutch woman, who had visited Python Cave in Maramagambo Forest during her holiday in أوغندا suffered of MVD due to MARV infection, and had been admitted to a hospital in the هولندا. The woman died under treatment in the المركز الطبي لجامعة لايدن in لايدن on July 11. The Ugandan Ministry of Health closed the cave after this case.[85] On January 9 of that year an infectious diseases physician notified the Colorado Department of Public Health and the Environment that a 44-year-old American woman who had returned from أوغندا had been hospitalized with a حمى مجهولة المنشأ. At the time, serologic testing was negative for حمى نزفية فيروسية. She was discharged on January 19, 2008. After the death of the Dutch patient and the discovery that the American woman had visited Python Cave, further testing confirmed the patient demonstrated MARV جسم مضاد and حمض نووي ريبوزي.[86]

تفشي المرض في أوغندا عام 2017

In October 2017 an outbreak of Marburg virus disease was detected in Kween District, Eastern Uganda. All three initial cases (belonging to one family – two brothers and one sister) had died by 3 November. The fourth case – a health care worker – developed symptoms on 4 November and was admitted to a hospital. The first confirmed case traveled to كينيا before the death. A close contact of the second confirmed case traveled to كامبالا. It is reported that several hundred people may have been exposed to infection.[87][88]

المراجع

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مطالعة إضافية

  • Klenk، Hans-Dieter (1999). Marburg and Ebola Viruses. Current Topics in Microbiology and Immunology, vol. 235. Berlin, Germany: Springer-Verlag. ISBN:978-3-540-64729-4{{inconsistent citations}}{{استشهاد بكتاب}}: صيانة الاستشهاد: postscript (link)
  • Klenk، Hans-Dieter؛ Feldmann، Heinz (2004). Ebola and Marburg Viruses: Molecular and Cellular Biology. Wymondham, Norfolk, UK: Horizon Bioscience. ISBN:978-0-9545232-3-7{{inconsistent citations}}{{استشهاد بكتاب}}: صيانة الاستشهاد: postscript (link)
  • Kuhn، Jens H. (2008). Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies. Archives of Virology Supplement, vol. 20. Vienna, Austria: SpringerWienNewYork. ISBN:978-3-211-20670-6{{inconsistent citations}}{{استشهاد بكتاب}}: صيانة الاستشهاد: postscript (link)
  • Martini، G. A.؛ Siegert، R. (1971). Marburg Virus Disease. Berlin, Germany: Springer-Verlag. ISBN:978-0-387-05199-4.
  • Ryabchikova، Elena I.؛ Price، Barbara B. (2004). Ebola and Marburg Viruses: A View of Infection Using Electron Microscopy. Columbus, Ohio, USA: Battelle Press. ISBN:978-1-57477-131-2{{inconsistent citations}}{{استشهاد بكتاب}}: صيانة الاستشهاد: postscript (link)

وصلات خارجية

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