Arabian Peninsula

Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection.

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Background

The Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging virus involved in cases and case clusters of severe acute respiratory infection in the Arabian Peninsula, Tunisia, Morocco, France, Italy, Germany, and the UK. We provide a full description of a fatal case of MERS-CoV infection and associated phylogenetic analyses.

Methods

We report data for a patient who was admitted to the Klinikum Schwabing (Munich, Germany) for severe acute respiratory infection. We did diagnostic RT-PCR and indirect immunofluorescence. From time of diagnosis, respiratory, faecal, and urine samples were obtained for virus quantification. We constructed a maximum likelihood tree of the five available complete MERS-CoV genomes.

Findings

A 73-year-old man from Abu Dhabi, United Arab Emirates, was transferred to Klinikum Schwabing on March 19, 2013, on day 11 of illness. He had been diagnosed with multiple myeloma in 2008, and had received several lines of treatment. The patient died on day 18, due to septic shock. MERS-CoV was detected in two samples of bronchoalveolar fluid. Viral loads were highest in samples from the lower respiratory tract (up to 1·2 × 106 copies per mL). Maximum virus concentration in urine samples was 2691 RNA copies per mL on day 13; the virus was not present in the urine after renal failure on day 14. Stool samples obtained on days 12 and 16 contained the virus, with up to 1031 RNA copies per g (close to the lowest detection limit of the assay). One of two oronasal swabs obtained on day 16 were positive, but yielded little viral RNA (5370 copies per mL). No virus was detected in blood. The full virus genome was combined with four other available full genome sequences in a maximum likelihood phylogeny, correlating branch lengths with dates of isolation. The time of the common ancestor was halfway through 2011. Addition of novel genome data from an unlinked case treated 6 months previously in Essen, Germany, showed a clustering of viruses derived from Qatar and the United Arab Emirates.

Interpretation

We have provided the first complete viral load profile in a case of MERS-CoV infection. MERS-CoV might have shedding patterns that are different from those of severe acute respiratory syndrome and so might need alternative diagnostic approaches.

Source: lancet

 

MERS Coronavirus — An Update.

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A novel coronavirus originating in the Middle East and exported to Europe causes severe respiratory disease with a high case-fatality rate.

The first report of a novel coronavirus causing human infection on the Arabian Peninsula was received in September 2012. By June 7, 2013, the Middle East respiratory syndrome coronavirus (MERS-CoV) — as is it now known — had caused 55 confirmed cases, all of which were linked to four countries: Saudi Arabia (40 cases), Qatar, Jordan, and the United Arab Emirates. Four additional countries — the U.K., Italy, France, and Tunisia — have reported cases in returning travelers and their close contacts. To date, no cases have been reported in the U.S.

Person-to-person spread in nosocomial environments, both to other patients and to healthcare personnel, has been documented. The median age of patients is 56 years; 72% are female. The incubation period is now estimated to be 9 to 12 days (an increase from the 1–9 days initially described), and the case-fatality rate is 56%.

Because tests of upper respiratory samples have sometimes yielded negative results for patients later confirmed to be infected, testing of lower respiratory tract specimens (e.g., from cough or bronchial washing) with a newly approved polymerase chain reaction assay is recommended.

Comment: In new outbreaks, it is common for cases with the shortest incubation period to surface first, and for estimates of incubation periods to increase. Also, it would appear that respiratory symptoms may be mild or even absent at the outset of illness caused by the Middle East respiratory syndrome coronavirus. Clinicians should be alert to the possibility of infection with this pathogen and should contact the CDC if they encounter patients who develop severe acute lower respiratory illness within 14 days after returning from the endemic area — or are close contacts of such individuals. Current information and guidance are available on the CDC’s MERS website.

Source:  Journal Watch Infectious Diseases

 

 

 

CDC Issues Update on Novel SARS-like Coronavirus.

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Reports of new cases of the novel SARS-like coronavirus, now known as MERS-CoV, indicate continued risk for transmission in the Arabian Peninsula, according to an update from MMWR.

To date, MERS-CoV has been confirmed in 55 people, 31 of whom have died. All cases have been linked to Saudi Arabia, Qatar, Jordan, or the United Arab Emirates. Infections among close contacts of cases, including healthcare personnel and family members, “provide clear evidence of human-to-human transmission,” MMWR says.

The CDC recommends that MERS-CoV be considered in people who develop severe acute lower respiratory illness within 14 days of traveling from the Arabian Peninsula or nearby areas. The virus should also be considered for close contacts of symptomatic travelers. To improve detection, specimens should be taken from multiple locations (for example, the nasopharynx and lower respiratory tract); the CDC is performing testing.

 

Source: MMWR