On January 22, 2009, CDC’s Viral Special Pathogens Branch retrospectively diagnosed a case of Marburg hemorrhagic fever in a U.S. traveler, who was hospitalized, discharged, and fully recovered. Initial testing of samples collected during the patient’s acute illness in January, 2008 did not initially show evidence of Marburg virus infection. Testing of a convalescent sample indicated a possible previous infection, and more detailed testing of both samples at CDC confirmed that the patient’s illness was due to Marburg hemorrhagic fever.
The recovered patient had visited the “python cave” in Maramagambo Forest, Queen Elizabeth Park, western Uganda. This is a popular destination among tourists to see a cave inhabited by thousands of bats; a fatal case of Marburg hemorrhagic fever occurred in a Dutch tourist in July 2008 who had entered this cave. Both patients likely acquired their infections as a result of contact with cave-dwelling fruit bats, which are capable of harboring Marburg virus. Marburg virus is a zoonotic virus that occurs in tropical areas of Africa, and causes a severe, often fatal, hemorrhagic fever in humans and nonhuman primates. It can also be transmitted through direct contact with a symptomatic patient or materials contaminated with infectious body fluids. The Ugandan Ministry of Health officially closed the cave to visitors in August 2008, after the Dutch case.
The state and local health departments are working with CDC’s Viral Special Pathogens Branch and Traveler’s Health and Animal Importation Branch to further investigate the circumstances of this patient’s case. This includes an assessment of any persons who may have been at risk of exposure at the time the patient was ill, and an investigation of travelers potentially exposed when visiting this or other caves in Africa. There is no evidence of apparent transmission as a result of this case.
Travelers should be aware of the risk of acquiring Marburg hemorrhagic fever and other potentially fatal diseases such as rabies after contact with bats. Healthcare providers should be aware of the risk of viral hemorrhagic fever among travelers returning from endemic countries, and should report any suspected cases immediately to their health department and to CDC’s Viral Special Pathogens Branch (Tel. (404) 639-1115; (404) 639-2888 after hours) for diagnostic testing and further guidance.
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