Viral Haemorrhagic Fevers (Ebola/Lassa/Marburg) for MRCP Part 1
- Crack Medicine
- 7 hours ago
- 4 min read
TL;DR
Viral Hemorrhagic Fevers (Ebola/Lassa/Marburg)Â are high-yield infectious disease topics in MRCP Part 1Â because they combine microbiology, epidemiology, acute medicine and infection control. Candidates should focus on transmission routes, travel history, laboratory abnormalities, isolation precautions and the distinguishing features of Ebola, Lassa fever and Marburg virus disease. The exam commonly tests recognition of imported infection syndromes and early management priorities.
Why Viral Haemorrhagic Fevers Matter in MRCP Part 1
The MRCP examiners favour diseases that:
Require recognition from limited information
Involve public health implications
Have important infection-control consequences
Present initially with non-specific symptoms
VHFs fit all of these categories.
The clinical stem often begins with:
Fever after travel
Healthcare worker exposure
Severe diarrhoea or shock
Thrombocytopenia
Abnormal liver function tests
Candidates who identify the epidemiological clues early usually answer these questions correctly.
The 5 Most Tested Subtopics
1. Transmission and Reservoirs
This is one of the highest-yield exam areas.
Disease | Virus Family | Reservoir | Main Transmission |
Ebola | Filoviridae | Fruit bats | Body fluids |
Marburg | Filoviridae | Fruit bats | Body fluids |
Lassa fever | Arenaviridae | Multimammate rat | Rodent contamination and body fluids |
Key revision points
Ebola and Marburg spread through direct contact with infected blood or body fluids.
Nosocomial transmission is common in outbreaks with poor infection control.
Lassa fever frequently results from exposure to rodent urine or faeces.
Airborne spread is not the primary transmission route in typical outbreaks.
A common exam trap is assuming all VHFs spread primarily through the air.
2. Clinical Presentation
The early presentation is usually non-specific.
Common symptoms
Fever
Malaise
Myalgia
Headache
Sore throat
Vomiting
Diarrhoea
As the disease progresses, severe manifestations may develop:
Hypotension
Shock
Multi-organ failure
Coagulopathy
Encephalopathy
Important MRCP point
Haemorrhage is less common than many candidates assume. Severe capillary leak and shock are often more clinically important.
3. Distinguishing Features of Ebola, Lassa and Marburg
Ebola virus disease
Typical features include:
Severe gastrointestinal fluid loss
Shock
Conjunctival injection
High mortality in severe outbreaks
The West African outbreak significantly increased the exam relevance of Ebola.
Marburg virus disease
Marburg closely resembles Ebola clinically but may be linked to:
Cave exposure
Mining exposure
Bat-infested environments
Questions may mention African cave systems or laboratory workers.
Lassa fever
Distinctive features include:
More gradual onset
Sensorineural hearing loss
Less dramatic haemorrhage
High-yield association
Sensorineural hearing loss is classically associated with Lassa fever and is frequently tested.
4. Laboratory Findings
The following abnormalities are commonly seen:
Laboratory finding | Clinical implication |
Thrombocytopenia | Consumptive coagulopathy |
Raised AST and ALT | Hepatic injury |
Leucopenia | Viral marrow suppression |
Prolonged clotting times | Coagulopathy |
Elevated creatinine | Renal impairment |
High-yield fact
In Ebola infection, AST is often higher than ALT.
5. Management and Infection Control
Immediate priorities
Isolation
Infection-control precautions
Specialist notification
Supportive management
Fluid resuscitation
Supportive care remains central
Patients often require:
Intravenous fluids
Electrolyte replacement
Organ support
Haemodynamic monitoring
Specific therapy
Ribavirin may be used early in Lassa fever.
Monoclonal antibody therapies have emerged for Ebola virus disease.
However, MRCP questions usually focus on supportive care and infection control rather than detailed antiviral regimens.
For more infectious diseases revision, explore the Crack Medicine https://www.crackmedicine.com/lectures
High-Yield Revision Outline
10 Facts You Must Know
Ebola and Marburg are filoviruses.
Lassa fever is an arenavirus.
Fruit bats are the major reservoir for Ebola and Marburg.
Rodents transmit Lassa fever.
Travel history is essential in diagnosis.
Severe bleeding is not universal.
Thrombocytopenia is common.
Shock is a major cause of death.
Lassa fever may cause hearing loss.
Isolation is the first management priority.
Practical Mini-Case
A 34-year-old healthcare volunteer returns from Sierra Leone with fever, vomiting and profound weakness. Examination reveals hypotension and conjunctival injection. Blood tests show thrombocytopenia and elevated transaminases.
What is the most appropriate immediate action?
A. Prescribe oral ribavirinB. Start corticosteroidsC. Arrange urgent CT headD. Immediate isolation and specialist notificationE. Begin anticoagulation
Answer: D. Immediate isolation and specialist notification
Explanation
In suspected viral haemorrhagic fever, infection control is the immediate priority. Isolation and early specialist involvement reduce the risk of nosocomial transmission and facilitate appropriate testing and supportive management.
Practise similar clinical scenarios in the Crack Medicine https://www.crackmedicine.com/mock-tests
Practical Study Checklist
Before exam day, ensure you can:
Differentiate Ebola, Marburg and Lassa fever
Recall their reservoirs and transmission routes
Recognise key laboratory abnormalities
Interpret travel history clues
Identify the first management step
Understand isolation requirements
Recall the association between Lassa fever and hearing loss
Distinguish bacterial sepsis from VHFs
Recognise that haemorrhage may be absent
Apply infection-control principles correctly
Common MRCP Pitfalls
Assuming every patient has massive haemorrhage
Forgetting rodent exposure in Lassa fever
Ignoring travel history in febrile illness
Confusing airborne with direct-contact transmission
Delaying isolation while awaiting confirmation
Related MRCP Revision Topics
VHFs are best revised alongside:
Tropical medicine
Malaria
Sepsis and shock
Infection prevention
Acute liver injury
FAQs
Does Ebola always cause bleeding?
No. Although haemorrhage is classically associated with Ebola, many patients primarily present with fever, diarrhoea, shock and organ dysfunction.
Which viral haemorrhagic fever causes hearing loss?
Lassa fever is strongly associated with sensorineural hearing loss, making it a favourite MRCP association.
What is the first step in managing suspected viral haemorrhagic fever?
Immediate isolation and infection-control precautions are essential before confirmatory testing.
Are Ebola and Marburg transmitted by air?
Direct contact with infected body fluids is the primary route of transmission. Airborne spread is not the dominant mechanism in routine outbreaks.
Is ribavirin effective for all viral haemorrhagic fevers?
No. Ribavirin may be beneficial in Lassa fever but is not standard treatment for Ebola or Marburg virus disease.
Ready to start?
Strengthen your preparation with structured revision via the MRCP Part 1 overview. Practise actively using the Free MRCP MCQs and simulate exam conditions with a Start a mock test.
For deeper understanding, combine this guide with lecture-based revision at:https://www.crackmedicine.com/lectures/
Sources
MRCP(UK) syllabus
World Health Organization — Ebola virus disease
https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease
World Health Organization — Lassa fever
https://www.who.int/news-room/fact-sheets/detail/lassa-fever
Centers for Disease Control and Prevention — Marburg Virus Disease
UK Health Security Agency — Management of viral haemorrhagic fever incidents
Davidson’s Principles and Practice of Medicine, 24th Edition