Middle East respiratory syndrome coronavirus infection overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. MERS is caused by a coronavirus called “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV). MERS-CoV is a beta coronavirus. It was first reported in 2012 in Saudi Arabia. MERS-CoV used to be called “novel coronavirus,” or “nCoV”. It is different from other coronaviruses that have been found in people before.
Historical Perspective
The Middle East respiratory syndrome coronavirus (MERS-CoV) was first reported to cause human infection in September 2012. In July 2013, the World Health Organization (WHO) International Health Regulations Emergency Committee determined that MERS-CoV did not meet criteria for a "public health emergency of international concern," but was nevertheless of "serious and great concern".
Pathophysiology
Potential animal reservoirs and mechanism(s) of transmission of MERS-CoV to humans remain unclear. A zoonotic origin for MERS-CoV was initially suggested by high genetic similarity to bat coronaviruses , and some recent reports have described serologic data from camels and the identification of related viruses in bats. However, more epidemiologic data linking cases to infected animals are needed to determine if a particular species is a host, a source of human infection, or both.
Causes
Ten years after the outbreak of SARS-CoV, the MERS-CoV is identified as the agent of a lethal pneumonia in patients who have recently been related to the Arabian Peninsula. The Middle east respiratory syndrome coronavirus (MERS-CoV), also termed EMC/2012 (HCoV-EMC/2012), is positive-sense, single-stranded RNA novel species of the genus Betacoronavirus.[1][2] First called novel coronavirus 2012 or simply novel coronavirus, it was first reported in 2012 after genome sequencing of the virus, isolated from sputum samples of patients, affected by a 2012 outbreak of a "new flu". Until May 2013, MERS-CoV was being described as a SARS-like virus or colloquially as "Saudi SARS. Since then it is known to be distinct, not only from SARS-CoV, but also from other known endemic coronaviruses, such as betacoronavirus HCoV-OC43 and HCoV-HKU1, as well as from the common cold coronavirus.[3] As of May 2014, several MERS-CoV cases have been reported in different countries, including Saudi Arabia, Malaysia, Jordan, Qatar, Egypt, the United Arab Emirates, Tunisia, Kuwait, Oman, Algeria, Bangladesh, the United Kingdom and the United States.[4]
The differential diagnosis of the middle east respiratory syndrome coronavirus infection include other respiratory tract infection, such as influenza.
Epidemiology and Demographics
As of September 20, 2013, a total of 130 cases from eight countries have been reported to WHO; 58 (45%) of these cases have been fatal. All cases have been directly or indirectly linked through travel to or residence in four countries: Saudi Arabia, Qatar, Jordan, and the United Arab Emirates (UAE). Most reported cases involved severe respiratory illness requiring hospitalization.
As of May 28, 2014, globally, 636 laboratory-confirmed cases of infection with MERS-CoV have officially been reported to WHO, including 193 deaths. This global total includes all of the cases reported in this update, plus 17 laboratory confirmed cases officially reported to WHO by Saudi Arabia between 16 and 18 May, 2014.
Risk Factors
Some individuals have higher risk of being infected with MERS-CoV. Those who have either close contact with an infected traveler from endemic areas or who travel to endemic areas such as Arabian Peninsula, are at increased risk of contracting Middle East respiratory syndrome (MERS). Healthcare personnel who have close contact with probable or confirmed cases without using recommended infection control precautions, are also more likely to be infected with MERS-CoV. However, according to the available data, individuals with underlying clinical conditions are more likely to contract the infection. The preexisting medical conditions that may increase the risk of infection by MERS-CoV, include: diabetes, cancer, immunodeficiencies and chronic kidney, lung and heart disease.[5]
Natural History, Complications and Prognosis
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. It is caused by an emerging coronavirus, specifically a betacoronavirus called MERS-CoV (Middle East Respiratory Syndrome Coronavirus), first discovered in 2012. Being a relatively novel virus, there is no virus-specific prevention or treatment options for MERS patients. Attending to the fact that a vaccine hasn't been developed yet, enhancing infection prevention and control measures is critical to prevent the possible spread of MERS-CoV in hospitals and communities. To date, the mortality rate of MERS-CoV is approximately 30%. Cases have been reported where critically ill patients have developed complications such as: acute renal failure, pericarditis and disseminated intravascular coagulation.[6][7][8][9]
History and Symptoms
The symptoms of the middle east respiratory syndrome coronavirus infection include fever, cough, shortness of breath and gatsrointestinal symptoms.
Physical Examination
A patient infected with MERS-CoV, during physical examination, might present with fever or hypothermia, tachypnea, hypotension, tachycardia, and/or low oxygen saturation. Additionally, patients may present with dyspnea, confusion and cyanosis, in which case will require immediate attention.[7][8][9]
Laboratory Findings
Laboratory findings for MERS on admission may include leukopenia, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase (LDH) levels. MERS-CoV can be detected with higher viral load and longer duration in the lower respiratory tract, compared to the upper respiratory tract, and has been detected in feces, serum, and urine.[9]
According to the CDC: a certified case of MERS-CoV infection is considered an individual who shows laboratory confirmation of infection by MERS-CoV. This last one is given by a positive PCR test on ≥2 specific genomic targets or, a single positive target followed by successful sequencing of a second; while a probable case of MERS-CoV infection is an individual who has missing or inconclusive laboratory test results for the infection and that has been in close contact with another individual who is a "laboratory-confirmed case" of MERS-CoV infection. Laboratory tests, such as the PCR for MERS-CoV are available at state health departments, CDC and some international laboratories. Otherwise, MERS-CoV tests are not routinely available, despite the existence of a limited number of non-FDA-approved commercial tests.[7][8][9]
CT
Despite the increasing number of publications on MERS infection, the description of chest CT image findings is scarce. According to a study in which patients with laboratory-confirmed MERS infection underwent chest CT scanning, the most prevalent findings were bilateral airspace abnormalities, predominantly located at the bases of the lungs essentially subpleural and characteristically consistent with ground-glass opacities, suggesting a pattern of organizing pneumonia. Attending to the broad range of symptoms and the different stages evolution of infection, understanding early patterns of CT images, particularly in patients related to endemic areas, might help in the early diagnosis of the condition.[10]
Medical Therapy
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. It is caused by an emerging coronavirus, specifically a betacoronavirus called MERS-CoV (Middle East Respiratory Syndrome Coronavirus), first discovered in 2012. Being a relatively novel virus, there is no virus-specific prevention or treatment options for MERS patients. Attending to the fact that a vaccine hasn't been developed yet, enhancing infection prevention and control measures is critical to prevent the possible spread of MERS-CoV in hospitals and communities. Health‐care facilities that provide care for patients suspected or confirmed to be infected with MERS-CoV, should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to others. It is not always possible to identify patients with MERS-CoV early in time due to the fact that some have mild or unusual symptoms. For this reason, it is mandatory that health‐care providers apply precaution measures consistently with all patients, regardless of their diagnosis, in all work practices.[7][8][9]
Contact and Airborne Precautions
Standard, contact, and airborne precautions are recommended for management of hospitalized patients with known or suspected MERS-CoV infection. In addition, ill people who are being evaluated for MERS-CoV infection and do not require hospitalization for medical reasons may be cared for and isolated in their home. Isolation at home is defined as the separation or restriction of activities of an ill person with a contagious disease from those who are well.
Primary Prevention
Enhancing infection prevention and control awareness and measures is critical to prevent the possible spread of MERS‐CoV in health care facilities. Health‐care facilities that provide care for patients suspected or confirmed to be infected with MERS‐CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health‐care workers and visitors. It is not always possible to identify patients with MERS‐CoV early because some have mild or unusual symptoms. For this reason, it is important that health‐care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.
References
- ↑ De Groot RJ; et al. (15 May 2013). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Announcement of the Coronavirus Study Group". Journal of Virology. 87 (14): 7790–2. doi:10.1128/JVI.01244-13. PMC 3700179. PMID 23678167.
- ↑ Perlman, S. (2013). "The Middle East Respiratory Syndrome--How Worried Should We Be?". mBio. 4 (4): e00531–13–e00531–13. doi:10.1128/mBio.00531-13. ISSN 2150-7511.
- ↑ Saey, Tina Hesman (27 February 2013). "Scientists race to understand deadly new virus: SARS-like infection causes severe illness, but may not spread quickly". Science News. 183 (6). p. 5.
- ↑ "Patient with deadly MERS virus waited hours in Florida ER". 2014-05-14. Retrieved 2014-05-14.
- ↑ "Symptoms & Complications".
- ↑ Drosten C, Seilmaier M, Corman VM, Hartmann W, Scheible G, Sack S; et al. (2013). "Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection". Lancet Infect Dis. 13 (9): 745–51. doi:10.1016/S1473-3099(13)70154-3. PMID 23782859.
- ↑ 7.0 7.1 7.2 7.3 Dyall J, Coleman CM, Hart BJ, Venkataraman T, Holbrook MR, Kindrachuk J; et al. (2014). "Repurposing of clinically developed drugs for treatment of Middle East Respiratory Coronavirus Infection". Antimicrob Agents Chemother. doi:10.1128/AAC.03036-14. PMID 24841273.
- ↑ 8.0 8.1 8.2 8.3 "Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do" (PDF).
- ↑ 9.0 9.1 9.2 9.3 9.4 "MERS Prevention and Treatment".
- ↑ 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: 1–6. doi:10.2214/AJR.14.13021. ISSN 0361-803X.