Of all the hemorrhagic fevers, Marburg, Ebola-Z, and Ebola-S have the highest case-fatality rates, the most severe hemorrhagic manifestations, and the most pronounced liver necrosis. The pathophysiologic changes are still obscure. There is an early and profound leukopenia, followed by a dramatic neutrophilia with a shift to the left, and very little monocyte infiltration in sites of parenchymal necrosis in the liver, but no unequivocal evidence of disseminated intravascular clotting. Antigen is localized in the liver, spleen, kidney, and adrenal glands, where virus particles can also be seen by electron microscopy.

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