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Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Epidemiology: - novel coronavirus identified in a man from Qatar who developed acute respiratory syndrome & renal failure [1] - nosocomial transmission documented [1] - as of June 7, 2012, 55 people infected, 31 have died [1] - 2 cases reported in U.S. 2014, the 1st in Indiana, the 2nd in Florida [7] - both patients had been in Saudi Arabia - close contact appears to be necessary for transmission - evidence for camel to human transmission [13] - no international public health emergency (WHO) May 2014 [10,11] - confirmed in 87 people in South Korea in 2014, with 5 related deaths [17] - South Korea declares end to MERS-CoV outbreak July 2015 [19] - Indiana patient transmitted MERS-CoV to Illinois man, but Illinois man not sick [12] - CDC concludes Indiana MERS patient did not spread MERS-CoV to Illinois business associate [12] - 2 workers at the Florida hospital treating the 2nd MERS-CoV case have developed flu-like symptoms % are being tested for MERS-CoV; 1 has been hospitalized [9] - neither of the two imported cases of MERS-CoV in the U.S. (2014) spread the virus to household members or health care workers who treated them [14] - 145 confirmed cases & 14 deaths in South Korea in May & June of 2015 [18] Pathology: 1) receptor for SARS coronavirus is ACE2 (angiotensin-converting enzyme-2) 2) CD13 serves as receptor for HCoV-229E spike glycoprotein in human coronavirus 229E (HCoV-229E) infection 3) risk factors for severe disease - older persons with comorbidities - diabetes mellitus - ESRD - obesity Clinical manifestations: - average incubation period of 5 days [23] - all patients have respiratory symptoms - nasal symptoms [1] - acute respiratory syndrome - diffuse bronchial breath sounds, rhonchi - progression to viral pneumonia & respiratory failure - renal failure - fever, diarrhea, nausea, headache, dry cough Laboratory: - RT-PCR for MERS-CoV RNA (NCV-2-12 rRT-PCR assay) - MERS-CoV N2 gene RNA - MERS-CoV N3 gene RNA - MERS-CoV upE gene RNA - conducted at the CDC [6] - nasopharyngeal swab & - a lower respiratory tract specimen - sputum - bronchoalveolar lavage - bronchial wash - tracheal aspirate - stool is also acceptable - complete blood count - case of 33 yo male with mild anemia & thrombocytopenia [23] - SaO2 low (91% case [23]) Radiology: - chest X-ray - case of 33 yo male shows diffuse cotton wool opaciities [23] Differential diagnosis: - SARS [21] - MERS progresses to respiratory failure much more rapidly than SARS Management: - supportive care [23] - ref [6] includes recommendations for management of MERS-CoV - low risk for transmission to household contacts [16] - contact percautions & airborne precautions in addition to standard precaution [23]

General

coronavirus; sarbecovirus

Properties

KINGDOM: virus GENOME-TYPE: RNA SINGLE-STRANDED POSITIVE-STRAND GENOME-SIZE: 16-21 kB ENVELOPE: PRESENT CAPSID-SYMMETRY: HELICAL

References

  1. Centers for Disease Control and Prevention Update: Severe Respiratory Illness Associated with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) - Worldwide, 2012-2013. MMWR Early Release June 7, 2013 / 62(Early Release);1-4 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0607a1.htm
  2. Centers for Disease Control and Prevention Update, Case Definitions, and Guidance MERS Update http://www.cdc.gov/coronavirus/mers/case-def.html
  3. Assiri A et al Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus. N Engl J Med. June 19, 2013 PMID: 23782161 http://www.nejm.org/doi/full/10.1056/NEJMoa1306742
  4. Centers for Disease Control and Prevention (CDC) Emergency Preparedness and Response. August 12, 2014 Notice to Healthcare Providers and Public Health Officials: Updated Guidance for the Evaluation of Severe Respiratory Illness Associated with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) http://emergency.cdc.gov/HAN/han00352.asp
  5. Centers for Disease Control and Prevention (CDC) Updated Information on the Epidemiology of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection and Guidance for the Public, Clinicians, and Public Health Authorities, 2012-2013 MMWR. September 27, 2013 / 62(38);793-796 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6238a4.htm
  6. Centers for Disease Control and Prevention (CDC) CDC Newsroom. May 2, 2014 CDC announces first case of Middle East Respiratory Syndrome Coronavirus infection (MERS) in the United States. http://www.cdc.gov/media/releases/2014/p0502-US-MERS.html - Centers for Disease Control and Prevention (CDC) CDC Newsroom. May 3, 2014 Confirmed Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Case in Indiana, 2014. http://emergency.cdc.gov/han/han00361.asp
  7. Centers for Disease Control and Prevention (CDC) Press Release. Tuesday, May 12, 2014 CDC announces second imported case of Middle East Respiratory Syndrome (MERS) in the United States http://www.cdc.gov/media/releases/2014/p0512-US-MERS.html
  8. Centers for Disease Control and Prevention (CDC) Middle East Respiratory Syndrome (MERS) Interim Home Care and Isolation Guidance for MERS-CoV http://www.cdc.gov/coronavirus/mers/hcp/home-care.html
  9. Young K MERS Update: 2 Florida Hospital Workers Have Flu-Like Illness, WHO Contemplates Calling a Public Health Emergency Physician's First Watch, May 14, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  10. WHO Statement. May 14, 2014 WHO statement on the Fifth Meeting of the IHR Emergency Committee concerning MERS-CoV. http://www.who.int/mediacentre/news/statements/2014/mers-20140514/en/
  11. Centers for Disease Control and Prevention (CDC) First Confirmed Cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection in the United States, Updated Information on the Epidemiology of MERS-CoV Infection, and Guidance for the Public, Clinicians, and Public Health Authorities. MMWR. May 14, 2014 / 63(Early Release);1-6 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0514a1.htm
  12. Centers for Disease Control and Prevention (CDC) Press Release. May 17, 2014 Illinois resident who had contact with Indiana MERS patient tests positive for MERS coronavirus. http://www.cdc.gov/media/releases/2014/p0517-mers.html - Centers for Disease Control and Prevention (CDC) Press Release. May 18, 2014 CDC concludes Indiana MERS patient did not spread virus to Illinois business associate. http://www.cdc.gov/media/releases/2014/p0528-mers.html
  13. Azhar EI et al Evidence for Camel-to-Human Transmission of MERS Coronavirus. N Engl J Med. June 4, 2014 PMID: 24896817 http://www.nejm.org/doi/full/10.1056/NEJMoa1401505
  14. Centers for Disease Control and Prevention (CDC) Press Release. June 17, 2014 MERS-CoV not spread to household members or health care contacts of the two U.S. cases. http://www.cdc.gov/media/releases/2014/p0617-Mers.html
  15. Prescriber's Letter 21(7): 2014 COMMENTARY: MERS Clinical Features GUIDELINES: Interim Guidance for Health Professionals (MERS-CoV) (2014) Detail-Document#: 300703 (subscription needed) http://www.prescribersletter.com
  16. Drosten C et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med 2014 Aug 28; 371:828 PMID: 25162889 http://www.nejm.org/doi/full/10.1056/NEJMoa1405858
  17. World Health Organization (WHO). Global Alert & Response (GAR) Disease outbreak news. June 6, 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) - Republic of Korea. http://www.who.int/csr/don/06-june-2015-mers-korea/en/
  18. Centers for Disease Control and Prevention (CDC) Emergency Preparedness and Response. June 11, 2015 Updated Information and Guidelines for Evaluation of Patients for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection. http://emergency.cdc.gov/han/han00380.asp - World Health Organization (WHO) News Release. June 13, 2015 WHO recommends continuation of strong disease control measures to bring MERS-CoV outbreak in Republic of Korea to an end. http://www.wpro.who.int/mediacentre/releases/2015/20150613/en/
  19. NEJM JWatch editors South Korea Declares End to MERS-CoV Outbreak Physician's First Watch, July 29, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  20. Arabi YM, Arifi AA, Balkhy HH et al Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection. Ann Intern Med. 2014 Mar 18;160(6):389-97. PMID: 24474051
  21. Hui DS, Memish ZA, Zumla A. Severe acute respiratory syndrome vs. the Middle East respiratory syndrome. Curr Opin Pulm Med. 2014 May;20(3):233-41. Review. PMID: 24626235
  22. Sampathkumar P. Middle East respiratory syndrome: what clinicians need to know. Mayo Clin Proc. 2014 Aug;89(8):1153-8. Review. PMID: 25034307
  23. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, American College of Physicians, Philadelphia 2015, 2018.