Middle East respiratory syndrome coronavirus infection differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

MERS-CoV must be differentiated from other respiratory tract infections that cause flu-like symptoms, such as influenza virus, respiratory syncytial virus (RSV), and other coronaravirus infections.

Differential Diagnosis

The differential diagnosis of MERS-CoV include the following:^[1]^[2]

Influenza virus infection
Parainfluenza virus infection
Respiratory syncytial virus (RSV) infection
Adenovirus infection
Rhinovirus infection
Infection with other coronaviruses
Metapneumovirus infection
Acute respiratory distress syndrome
Community-acquired pneumonia
Brucellosis

Life threatening infection with 2019-nCoV, MERS-CoV and SARS-CoV should be differentiated from each other. The following table differentiates infection from these coronaviruses:^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]


Type of Coronavirus	Origins	Family (Lineage)	Receptor	Incubation Period	Genome size	Clinical Features							Transmission	Epidemiology	Cytokine Profile	Imaging Findings	Serological Testing
Type of Coronavirus	Origins	Family (Lineage)	Receptor	Incubation Period	Genome size	Fever	Dry cough	Dyspnea	Rhinorrhea	Sneezing	Sore throat	Diarrhea	Transmission	Epidemiology	Cytokine Profile	Imaging Findings	Serological Testing
2019-nCoV	Huanan seafood market, Wuhan, Hubei China (December 2019)	Betacoronaviridea, subgenus: Sarbecovirus (Lineage B)	ACE1/2	1-14 days	29.8 kB (> 80% nucleotide identity with SARS-CoV)	++	++	++	+	+	+	-	Human to human transmission through close contact	14380 confirmed cases 17 deaths Males > females Mortality rate 2.7%	IL1B, IFNγ, IP10, and MCP1 GCSF, IP10, MCP1, MIP1A, and TNFα (ICU-admitted) IL4 and IL10	On CT scan: Bilateral ground-glass opacities Peripheral localization and subpleural sparing
MERS-CoV	Saudi Arabia (September 2012)	Betacoronaviridea (Lineage C)	DPP4 (CD26)	2-14 days	29.9 kB	++	++	++	++	++	++	+	Limited human to human trasnmission Reservoirs: Bats Civets Camels	2494 confirmed cases 858 deaths Mortality rate of 34%	IFNγ, TNFα, IL15, and IL17	On CT scan: Bilateral, subpleural and basilar infiltrates Ground glass opacities Organizing pneumonia-like pattern (subpleural and peribroncho-vascular)
SARS-CoV	Guangdong, Southern China (November 2002)	Betacoronaviridea (Lineage B)	ACE2	2-7 days	29.3 kB	++	++	++	++	++	++	+	Human to human transmission through close contact Reservoirs: Bats Civets Camels	8098 cases 774 deaths Mortality rate of about 10%	IL1B, IL6, IL12, IFNγ, IP10, and MCP1	On CT scan: Airspace consolidation Focal or multi-focal opacities

References

↑ Paulino, Renato de Souza; Benega, Margarete Aparecida; Santos, Katia Correa de Oliveira; Silva, Daniela Bernardes Borges da; Pereira, Juliana Cristina; Sasaki, Norio Augusto; Silva, Patricia Evelin; Curti, Suely Pires; Oliveira, Maria Isabel; R.M.P. Carvalhanas, Telma; Peret, Teresa; Erdman, Dean; Paiva, Terezinha Maria de (2013). "DIFFERENTIAL DIAGNOSIS OF RESPIRATORY VIRUSES BY USING REAL TIME RT-PCR METHODOLOGY". Revista do Instituto de Medicina Tropical de São Paulo. 55 (6): 432–432. doi:10.1590/S0036-46652013000600012. ISSN 0036-4665.
↑ "Eurosurveillance: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) July 2013" (PDF).
↑ Chan, Jasper Fuk-Woo; Kok, Kin-Hang; Zhu, Zheng; Chu, Hin; To, Kelvin Kai-Wang; Yuan, Shuofeng; Yuen, Kwok-Yung (2020). "Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan". Emerging Microbes & Infections. 9 (1): 221–236. doi:10.1080/22221751.2020.1719902. ISSN 2222-1751.
↑ Lu, Roujian; Zhao, Xiang; Li, Juan; Niu, Peihua; Yang, Bo; Wu, Honglong; Wang, Wenling; Song, Hao; Huang, Baoying; Zhu, Na; Bi, Yuhai; Ma, Xuejun; Zhan, Faxian; Wang, Liang; Hu, Tao; Zhou, Hong; Hu, Zhenhong; Zhou, Weimin; Zhao, Li; Chen, Jing; Meng, Yao; Wang, Ji; Lin, Yang; Yuan, Jianying; Xie, Zhihao; Ma, Jinmin; Liu, William J; Wang, Dayan; Xu, Wenbo; Holmes, Edward C; Gao, George F; Wu, Guizhen; Chen, Weijun; Shi, Weifeng; Tan, Wenjie (2020). "Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding". The Lancet. doi:10.1016/S0140-6736(20)30251-8. ISSN 0140-6736.
↑ Ajlan, Amr M.; Ahyad, Rayan A.; Jamjoom, Lamia Ghazi; Alharthy, Ahmed; Madani, Tariq A. (2014). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings". American Journal of Roentgenology. 203 (4): 782–787. doi:10.2214/AJR.14.13021. ISSN 0361-803X.
↑ Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.
↑ "Coronavirus | Home | CDC".
↑ Nassar MS, Bakhrebah MA, Meo SA, Alsuabeyl MS, Zaher WA (August 2018). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics". Eur Rev Med Pharmacol Sci. 22 (15): 4956–4961. doi:10.26355/eurrev_201808_15635. PMID 30070331.
↑ Xia S, Liu Q, Wang Q, Sun Z, Su S, Du L, Ying T, Lu L, Jiang S (December 2014). "Middle East respiratory syndrome coronavirus (MERS-CoV) entry inhibitors targeting spike protein". Virus Res. 194: 200–10. doi:10.1016/j.virusres.2014.10.007. PMID 25451066.
↑ Hajjar SA, Memish ZA, McIntosh K (2013). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV): a perpetual challenge". Ann Saudi Med. 33 (5): 427–36. doi:10.5144/0256-4947.2013.427. PMC 6074883. PMID 24188935.
↑ Memish ZA, Assiri AM, Al-Tawfiq JA (December 2014). "Middle East respiratory syndrome coronavirus (MERS-CoV) viral shedding in the respiratory tract: an observational analysis with infection control implications". Int. J. Infect. Dis. 29: 307–8. doi:10.1016/j.ijid.2014.10.002. PMID 25448335.
↑ Satija N, Lal SK (April 2007). "The molecular biology of SARS coronavirus". Ann. N. Y. Acad. Sci. 1102: 26–38. doi:10.1196/annals.1408.002. PMID 17470909.
↑ Bolles M, Donaldson E, Baric R (December 2011). "SARS-CoV and emergent coronaviruses: viral determinants of interspecies transmission". Curr Opin Virol. 1 (6): 624–34. doi:10.1016/j.coviro.2011.10.012. PMC 3237677. PMID 22180768.
↑ Fehr AR, Perlman S (2015). "Coronaviruses: an overview of their replication and pathogenesis". Methods Mol. Biol. 1282: 1–23. doi:10.1007/978-1-4939-2438-7_1. PMC 4369385. PMID 25720466.

Template:WH Template:WS

[PaulinoBenega2013-1] Paulino, Renato de Souza; Benega, Margarete Aparecida; Santos, Katia Correa de Oliveira; Silva, Daniela Bernardes Borges da; Pereira, Juliana Cristina; Sasaki, Norio Augusto; Silva, Patricia Evelin; Curti, Suely Pires; Oliveira, Maria Isabel; R.M.P. Carvalhanas, Telma; Peret, Teresa; Erdman, Dean; Paiva, Terezinha Maria de (2013). "DIFFERENTIAL DIAGNOSIS OF RESPIRATORY VIRUSES BY USING REAL TIME RT-PCR METHODOLOGY". Revista do Instituto de Medicina Tropical de São Paulo. 55 (6): 432–432. doi:10.1590/S0036-46652013000600012. ISSN 0036-4665.

[Euro-2] "Eurosurveillance: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) July 2013" (PDF).

[ChanKok2020-3] Chan, Jasper Fuk-Woo; Kok, Kin-Hang; Zhu, Zheng; Chu, Hin; To, Kelvin Kai-Wang; Yuan, Shuofeng; Yuen, Kwok-Yung (2020). "Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan". Emerging Microbes & Infections. 9 (1): 221–236. doi:10.1080/22221751.2020.1719902. ISSN 2222-1751.

[LuZhao2020-4] Lu, Roujian; Zhao, Xiang; Li, Juan; Niu, Peihua; Yang, Bo; Wu, Honglong; Wang, Wenling; Song, Hao; Huang, Baoying; Zhu, Na; Bi, Yuhai; Ma, Xuejun; Zhan, Faxian; Wang, Liang; Hu, Tao; Zhou, Hong; Hu, Zhenhong; Zhou, Weimin; Zhao, Li; Chen, Jing; Meng, Yao; Wang, Ji; Lin, Yang; Yuan, Jianying; Xie, Zhihao; Ma, Jinmin; Liu, William J; Wang, Dayan; Xu, Wenbo; Holmes, Edward C; Gao, George F; Wu, Guizhen; Chen, Weijun; Shi, Weifeng; Tan, Wenjie (2020). "Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding". The Lancet. doi:10.1016/S0140-6736(20)30251-8. ISSN 0140-6736.

[AjlanAhyad2014-5] Ajlan, Amr M.; Ahyad, Rayan A.; Jamjoom, Lamia Ghazi; Alharthy, Ahmed; Madani, Tariq A. (2014). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings". American Journal of Roentgenology. 203 (4): 782–787. doi:10.2214/AJR.14.13021. ISSN 0361-803X.

[HuangWang2020-6] Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.

[urlCoronavirus_|_Home_|_CDC-7] "Coronavirus | Home | CDC".

[pmid30070331-8] Nassar MS, Bakhrebah MA, Meo SA, Alsuabeyl MS, Zaher WA (August 2018). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics". Eur Rev Med Pharmacol Sci. 22 (15): 4956–4961. doi:10.26355/eurrev_201808_15635. PMID 30070331.

[pmid25451066-9] Xia S, Liu Q, Wang Q, Sun Z, Su S, Du L, Ying T, Lu L, Jiang S (December 2014). "Middle East respiratory syndrome coronavirus (MERS-CoV) entry inhibitors targeting spike protein". Virus Res. 194: 200–10. doi:10.1016/j.virusres.2014.10.007. PMID 25451066.

[pmid24188935-10] Hajjar SA, Memish ZA, McIntosh K (2013). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV): a perpetual challenge". Ann Saudi Med. 33 (5): 427–36. doi:10.5144/0256-4947.2013.427. PMC 6074883. PMID 24188935.

[pmid25448335-11] Memish ZA, Assiri AM, Al-Tawfiq JA (December 2014). "Middle East respiratory syndrome coronavirus (MERS-CoV) viral shedding in the respiratory tract: an observational analysis with infection control implications". Int. J. Infect. Dis. 29: 307–8. doi:10.1016/j.ijid.2014.10.002. PMID 25448335.

[pmid17470909-12] Satija N, Lal SK (April 2007). "The molecular biology of SARS coronavirus". Ann. N. Y. Acad. Sci. 1102: 26–38. doi:10.1196/annals.1408.002. PMID 17470909.

[pmid22180768-13] Bolles M, Donaldson E, Baric R (December 2011). "SARS-CoV and emergent coronaviruses: viral determinants of interspecies transmission". Curr Opin Virol. 1 (6): 624–34. doi:10.1016/j.coviro.2011.10.012. PMC 3237677. PMID 22180768.

[pmid25720466-14] Fehr AR, Perlman S (2015). "Coronaviruses: an overview of their replication and pathogenesis". Methods Mol. Biol. 1282: 1–23. doi:10.1007/978-1-4939-2438-7_1. PMC 4369385. PMID 25720466.

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Middle East respiratory syndrome coronavirus infection differential diagnosis

Overview

Differential Diagnosis

References

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