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Marburg virus — Questions

Study questions about Marburg virus — exam-style, clinical-scenario and FAQ.

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18 questions: 18 MCQ, 0 written.

Marburg virus and Ravn virus are two distinct viruses within a single species, Orthomarburgvirus marburgense, in the genus Orthomarburgvirus, and they cause the same disease.

They are not separate genera or families, are not ebolaviruses, and are genetically distinct rather than identical strains.

Marburg virus is taken up by macropinocytosis, after which endosomal cathepsins prime the glycoprotein to bind the intracellular receptor NPC1, the same receptor used by the ebolaviruses, triggering fusion.

It does not fuse at the plasma membrane, rely on a single specific surface receptor, use sialic acid, or enter through the transferrin receptor.

Marburg virus expresses its glycoprotein from a single reading frame and makes no secreted glycoprotein, unlike the ebolaviruses, which use cotranscriptional editing to produce both the surface spike and a secreted decoy (sGP).

It does not edit its glycoprotein gene, has a single such gene, and does carry a surface glycoprotein.

Acute disease is confirmed by RT-PCR for viral RNA in blood, with a reactive screen confirmed by a virus-specific assay, and all work performed under biosafety level 4 precautions.

Routine blood culture, serology alone, an antigen skin test and electron microscopy of urine are not the diagnostic approach.

The 1967 outbreaks struck laboratory and animal-facility staff exposed to tissue from African green monkeys imported from Uganda for vaccine and research work, infecting 31 people and killing 7.

The reservoir bat was identified only decades later; the source was not a bat colony, blood products, returning travellers or rodents.

Shock reflects a functional increase in vascular permeability driven by inflammation and coagulopathy; the endothelium is infected but not extensively destroyed, so survivors recover without lasting vascular damage.

It is not caused by direct destruction of the vessel wall, external exsanguination, cardiac infection or autoimmune vasculitis.

Marburg virus was the first filovirus ever recognised, in 1967, nine years before Ebola virus, and it established the filamentous morphology that defines the family.

It was not discovered after or alongside Ebola, does not date from the West African epidemic, and is not an arbovirus.

In 1975 Johannesburg saw the first recognised Marburg cases outside the original 1967 European cluster, when a traveller died and two contacts, including an attending nurse, were infected and survived.

It was not the site of the first vaccine trial, the reservoir discovery, the first Ravn case, or the largest outbreak.

Marburg virus has the filovirus form: an enveloped filament of uniform ~80 nm diameter and variable length, often looped or hooked, with a helical nucleocapsid inside.

It is not icosahedral, brick-shaped, bullet-shaped or a compact sphere.

No Marburg vaccine is licensed; several candidates are in clinical trials, and licensure is hampered because outbreaks are sporadic and small, which makes conventional efficacy trials difficult.

No vaccine is licensed or scheduled, and the Ebola (Zaire) vaccine does not protect against Marburg.

No vaccine or specific treatment is licensed for Marburg disease, so aggressive supportive care is the mainstay, above all fluid and electrolyte replacement.

Unlike Zaire ebolavirus disease, no monoclonal antibody or antiviral is licensed, and ribavirin and interferon have no established role.

The incubation period is about 2 to 21 days, most often 5 to 10 days, after which illness begins abruptly.

It is not a matter of hours, one to two days, several months or over a year.

A non-itchy maculopapular rash appearing around the fifth day of illness is characteristic of Marburg disease and was noted in the original 1967 cases.

It is not a vesicular dermatomal rash, rose spots, a migratory erythema or palmar desquamation.

Marburg outbreaks classically follow entry into caves or mines harbouring Egyptian rousette fruit bats, the exposure shared by affected miners and by cave-visiting tourists.

It is not acquired from mosquito or tick bites, undercooked pork, or freshwater exposure.

Late complications reflect viral persistence in immune-privileged sites and include orchitis, uveitis, and rare relapse as meningoencephalitis, alongside a broader convalescent syndrome.

Chronic hepatitis, progressive dementia, nephrotic syndrome and pulmonary fibrosis are not characteristic.

The most direct primary-prevention measure is avoiding entry to caves and mines that harbour rousette fruit-bat colonies, or using protection when entry is unavoidable, because these are the sites of spillover.

Bed nets, water chlorination, household rodent control and vaccination do not address the bat-cave route.

Marburg virus uses VP40 to block the JAK-STAT pathway, disabling the cell’s response to interferon, whereas the ebolaviruses use VP24 to block STAT1 nuclear import; both genera use VP35 to prevent interferon being made.

VP35, VP24, VP30 and NP do not carry out Marburg’s JAK-STAT block.

The Angolan outbreak of 2004 to 2005 was the largest and most lethal recorded, with about 252 cases and a case fatality near 90%.

The 1967 European, 2008 Ugandan tourist, Durba mining and 2024 Rwandan outbreaks were all smaller.

MCQ
How are Marburg virus and Ravn virus classified?
- A. As two separate genera within the family Filoviridae, order Mononegavirales
- B. As two species placed in different families
- C. As two viruses within one species, Orthomarburgvirus marburgense
- D. As two species of the genus Orthoebolavirus
- E. As identical strains of a single virus
Show answer
Correct answer: C
Marburg virus and Ravn virus are two distinct viruses within a single species, Orthomarburgvirus marburgense, in the genus Orthomarburgvirus, and they cause the same disease.

They are not separate genera or families, are not ebolaviruses, and are genetically distinct rather than identical strains.
MCQ
How does Marburg virus enter and gain access to the cytoplasm?
- A. Macropinocytosis, then cathepsin priming and binding to NPC1
- B. Direct fusion at the plasma membrane on contact
- C. Binding to one specific surface receptor, followed by caveolar uptake
- D. Sialic-acid binding with neuraminidase-mediated release
- E. Endocytosis through the transferrin receptor
Show answer
Correct answer: A
Marburg virus is taken up by macropinocytosis, after which endosomal cathepsins prime the glycoprotein to bind the intracellular receptor NPC1, the same receptor used by the ebolaviruses, triggering fusion.

It does not fuse at the plasma membrane, rely on a single specific surface receptor, use sialic acid, or enter through the transferrin receptor.
MCQ
How does Marburg virus glycoprotein expression differ from that of the ebolaviruses?
- A. It uses RNA editing to make several glycoprotein forms
- B. It produces a large secreted decoy glycoprotein that absorbs antibody
- C. It carries two separate glycoprotein genes
- D. It lacks a surface glycoprotein entirely
- E. It uses a single reading frame and makes no secreted glycoprotein
Show answer
Correct answer: E
Marburg virus expresses its glycoprotein from a single reading frame and makes no secreted glycoprotein, unlike the ebolaviruses, which use cotranscriptional editing to produce both the surface spike and a secreted decoy (sGP).

It does not edit its glycoprotein gene, has a single such gene, and does carry a surface glycoprotein.
MCQ
How is acute Marburg virus disease confirmed in the laboratory?
- A. Standard blood culture incubated on routine bacteriological media
- B. Serology alone at first presentation
- C. An antigen-based skin test
- D. RT-PCR for viral RNA, confirmed and handled at high containment
- E. Electron microscopy of a urine sample
Show answer
Correct answer: D
Acute disease is confirmed by RT-PCR for viral RNA in blood, with a reactive screen confirmed by a virus-specific assay, and all work performed under biosafety level 4 precautions.

Routine blood culture, serology alone, an antigen skin test and electron microscopy of urine are not the diagnostic approach.
MCQ
The 1967 outbreaks that led to the discovery of Marburg virus arose from exposure to what?
- A. Tissue from African green monkeys imported from Uganda
- B. A captive research colony of African fruit bats
- C. Contaminated blood-product transfusion batches
- D. Travellers returning from a large West African outbreak
- E. Rodents handled during vaccine production work
Show answer
Correct answer: A
The 1967 outbreaks struck laboratory and animal-facility staff exposed to tissue from African green monkeys imported from Uganda for vaccine and research work, infecting 31 people and killing 7.

The reservoir bat was identified only decades later; the source was not a bat colony, blood products, returning travellers or rodents.
MCQ
What best explains the shock of severe Marburg virus disease?
- A. Direct viral destruction of the endothelial vessel-wall lining
- B. Massive external blood loss
- C. Functional vascular leak from inflammation and coagulopathy
- D. Direct infection of cardiac muscle
- E. An autoimmune vasculitis
Show answer
Correct answer: C
Shock reflects a functional increase in vascular permeability driven by inflammation and coagulopathy; the endothelium is infected but not extensively destroyed, so survivors recover without lasting vascular damage.

It is not caused by direct destruction of the vessel wall, external exsanguination, cardiac infection or autoimmune vasculitis.
MCQ
What is Marburg virus's place in the history of the filoviruses?
- A. It was discovered shortly after Ebola virus
- B. It was the first filovirus recognised, nine years before Ebola virus
- C. It was discovered in the same year as Ebola virus
- D. It was first identified during the large 2013 West African Ebola epidemic
- E. It was originally classified as an arbovirus
Show answer
Correct answer: B
Marburg virus was the first filovirus ever recognised, in 1967, nine years before Ebola virus, and it established the filamentous morphology that defines the family.

It was not discovered after or alongside Ebola, does not date from the West African epidemic, and is not an arbovirus.
MCQ
What is South Africa's notable place in the history of Marburg virus disease?
- A. It hosted the first Marburg vaccine efficacy trial during a recent outbreak
- B. The reservoir bat was first discovered there
- C. Johannesburg had the first Marburg cases outside the 1967 cluster, in 1975
- D. The first Ravn virus case occurred there
- E. It recorded the largest Marburg outbreak
Show answer
Correct answer: C
In 1975 Johannesburg saw the first recognised Marburg cases outside the original 1967 European cluster, when a traveller died and two contacts, including an attending nurse, were infected and survived.

It was not the site of the first vaccine trial, the reservoir discovery, the first Ravn case, or the largest outbreak.
MCQ
What is the characteristic morphology of the Marburg virion?
- A. Bullet-shaped enveloped virion
- B. Brick-shaped virion with a dumbbell-shaped core
- C. Non-enveloped icosahedral capsid
- D. Enveloped filament of uniform 80 nm width and variable length
- E. Spherical enveloped virion with a helical nucleocapsid, ~100 nm across
Show answer
Correct answer: D
Marburg virus has the filovirus form: an enveloped filament of uniform ~80 nm diameter and variable length, often looped or hooked, with a helical nucleocapsid inside.

It is not icosahedral, brick-shaped, bullet-shaped or a compact sphere.
MCQ
What is the current status of vaccines against Marburg virus?
- A. A single-dose vaccine is licensed and in routine use
- B. None is licensed; several candidates remain in clinical trials
- C. Two vaccines are licensed for children
- D. The Ebola (Zaire) vaccine also cross-protects against Marburg virus
- E. An inactivated vaccine is on the routine schedule
Show answer
Correct answer: B
No Marburg vaccine is licensed; several candidates are in clinical trials, and licensure is hampered because outbreaks are sporadic and small, which makes conventional efficacy trials difficult.

No vaccine is licensed or scheduled, and the Ebola (Zaire) vaccine does not protect against Marburg.
MCQ
What is the mainstay of treatment for Marburg virus disease?
- A. A licensed monoclonal antibody given by intravenous infusion
- B. A licensed oral antiviral
- C. Ribavirin
- D. Interferon therapy
- E. Supportive care, since no specific treatment is licensed
Show answer
Correct answer: E
No vaccine or specific treatment is licensed for Marburg disease, so aggressive supportive care is the mainstay, above all fluid and electrolyte replacement.

Unlike Zaire ebolavirus disease, no monoclonal antibody or antiviral is licensed, and ribavirin and interferon have no established role.
MCQ
What is the usual incubation period of Marburg virus disease?
- A. About 2 to 21 days
- B. A few hours to a day
- C. About 3 to 6 months
- D. About 1 to 2 days
- E. More than a year
Show answer
Correct answer: A
The incubation period is about 2 to 21 days, most often 5 to 10 days, after which illness begins abruptly.

It is not a matter of hours, one to two days, several months or over a year.
MCQ
Which cutaneous feature is characteristic of Marburg virus disease and was described in the original 1967 cases?
- A. A vesicular rash confined to a single dermatomal band
- B. A non-itchy maculopapular rash around day 5
- C. Rose spots on the abdomen
- D. A migratory annular erythema
- E. Desquamation of the palms and soles
Show answer
Correct answer: B
A non-itchy maculopapular rash appearing around the fifth day of illness is characteristic of Marburg disease and was noted in the original 1967 cases.

It is not a vesicular dermatomal rash, rose spots, a migratory erythema or palmar desquamation.
MCQ
Which exposure classically precedes the index case of a Marburg outbreak?
- A. A mosquito bite acquired in a rural farming area at dusk
- B. Eating undercooked pork
- C. A tick bite during farming
- D. Entering caves or mines that harbour fruit bats
- E. Swimming in fresh water
Show answer
Correct answer: D
Marburg outbreaks classically follow entry into caves or mines harbouring Egyptian rousette fruit bats, the exposure shared by affected miners and by cave-visiting tourists.

It is not acquired from mosquito or tick bites, undercooked pork, or freshwater exposure.
MCQ
Which is a recognised late complication in survivors of Marburg virus disease?
- A. Chronic active hepatitis progressing to cirrhosis over years
- B. Progressive dementia
- C. Orchitis, uveitis and rare relapse as meningoencephalitis
- D. Nephrotic syndrome
- E. Progressive pulmonary fibrosis
Show answer
Correct answer: C
Late complications reflect viral persistence in immune-privileged sites and include orchitis, uveitis, and rare relapse as meningoencephalitis, alongside a broader convalescent syndrome.

Chronic hepatitis, progressive dementia, nephrotic syndrome and pulmonary fibrosis are not characteristic.
MCQ
Which measure most directly reduces the risk of Marburg virus spillover to humans?
- A. Avoiding entry to caves and mines that harbour fruit bats
- B. Sleeping under insecticide-treated nets in endemic regions
- C. Chlorinating drinking water supplies
- D. Rodent control within homes
- E. Annual booster vaccination
Show answer
Correct answer: A
The most direct primary-prevention measure is avoiding entry to caves and mines that harbour rousette fruit-bat colonies, or using protection when entry is unavoidable, because these are the sites of spillover.

Bed nets, water chlorination, household rodent control and vaccination do not address the bat-cave route.
MCQ
Which protein does Marburg virus use to block interferon signalling through the JAK-STAT pathway, differing from the mechanism used by the ebolaviruses?
- A. VP35
- B. VP40
- C. VP24
- D. VP30
- E. NP
Show answer
Correct answer: B
Marburg virus uses VP40 to block the JAK-STAT pathway, disabling the cell’s response to interferon, whereas the ebolaviruses use VP24 to block STAT1 nuclear import; both genera use VP35 to prevent interferon being made.

VP35, VP24, VP30 and NP do not carry out Marburg’s JAK-STAT block.
MCQ
Which was the largest and most lethal recorded outbreak of Marburg virus disease?
- A. Germany and Yugoslavia, 1967
- B. Rwanda, 2024
- C. Uganda, 2008, among tourists
- D. Durba, Democratic Republic of the Congo, 1998 to 2000
- E. Angola, 2004 to 2005, with a case fatality near 90%
Show answer
Correct answer: E
The Angolan outbreak of 2004 to 2005 was the largest and most lethal recorded, with about 252 cases and a case fatality near 90%.

The 1967 European, 2008 Ugandan tourist, Durba mining and 2024 Rwandan outbreaks were all smaller.