Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 32-06: Common Viral Respiratory Infections + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Mild, moderate, or severe respiratory illness Travel to endemic area, including Saudi Arabia, United Arab Emirates, Qatar, and Jordan, within 14 days before symptom onset Contact with camels reported in many cases Fever, cough, and dyspnea CDC can assist with real-time PCR Supportive treatment; mortality 36–45% +++ General Considerations ++ History of residence or travel in the Middle East, in particular Saudi Arabia, or contact with such patients Virus is transmitted between humans through direct or indirect contact of mucous membranes with infectious respiratory droplets The virus is shed in stool, but the role of fecal-oral transmission is unknown Person-to-person transmission can occur within families; hospital-associated cases comprise 10–25% of cases Median incubation period is 5 days (range, 2–14) with the mean age of 50 (range 9 months to 99 years) and 65% occurring among men Over 90% of patients have an underlying medical condition, including diabetes mellitus (68%), hypertension (34%), or chronic heart or kidney disease Persons with diabetes, kidney disease, chronic lung disease, or other immunocompromising conditions likely are at highest risk for severe disease + Clinical Findings Download Section PDF Listen +++ ++ Most common symptoms being fever (98%), cough (83%), and dyspnea (72%) Chills and rigors are common (87%) Gastrointestinal symptoms may occur May precede respiratory symptoms Diarrhea is most common (26%), followed by nausea and abdominal pain Mild and asymptomatic cases are reported + Diagnosis Download Section PDF Listen +++ +++ Laboratory Findings ++ Hematologic findings include Thrombocytopenia (36%) Lymphopenia (34%) Lymphocytosis (11%) Moderate elevations in lactate dehydrogenase (49%), AST (15%), and ALT (11%) are recognized Serum serologies and RT-PCR are available through CDC (https://www.cdc.gov/coronavirus/mers/lab/index.html) Highest viral loads are found in lower respiratory tract specimens, including Bronchoalveolar lavage fluid Sputum Tracheal aspirates +++ Imaging ++ Chest radiograph abnormalities are nearly universal and include Increased bronchovascular markings Patchy infiltrates or consolidations Interstitial changes Opacities (reticular and nodular) and pleural effusions Total lung opacification + Treatment Download Section PDF Listen +++ ++ Respiratory support is essential No vaccine or known antiviral therapy exists to combat MERS Current therapies are adapted from SARS treatments and include Interferons Ribavirin Lopinavir-ritonavir Mycophenolate mofetil + Outcome Download Section PDF Listen +++ +++ Complications ++ Respiratory failure +++ Prevention ++ Isolation and quarantine of cases Strict infection control measures are essential as well as care and management of household contacts and hospital workers engaged in the care of patients Travelers to Saudi Arabia (including the many pilgrims to the holy sites) should practice frequent hand washing and avoid contact with those who have respiratory symptoms Control measures, including quarantining in the home for high-risk exposed persons and the use of facemasks for preventing hospital-acquired infections, are important Assisting public health authorities with case reporting and surveillance is essential Postexposure prophylaxis with ribavirin and lopinavir/ritonavir for health care workers is associated with a 40% decrease in the risk of acquiring infection +++ Prognosis ++ Overall mortality rate of identified cases is about 36% Factors associated with mortality include the use of corticosteroids and the use of continuous renal replacement therapy A set of radiographic criteria (diffuse involvement, fibrosing sequela) are associated with a worse prognosis and the need for intubation Advanced age is associated with a poor prognosis + References Download Section PDF Listen +++ + +Alfaraj SH et al. Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: a cohort study. Travel Med Infect Dis. 2019 May–Jun;39:48–50. [PubMed: 30872071] + +Al-Tawfiq JA et al. Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: extent and implications for infection control: a systematic review. Travel Med Infect Dis. 2019 Jan–Feb;27:27–32. [PubMed: 30550839] + +Arabi YM et al. Middle East Respiratory Syndrome. N Engl J Med. 2017 Feb 9;376(6):584–94. [PubMed: 28177862] + +Arabi YM et al; Saudi Critical Care Trials Group. Macrolides in critically ill patients with Middle East Respiratory Syndrome. Int J Infect Dis. 2019 Apr;81:184–90. [PubMed: 30690213] + +Momattin H et al. A systematic review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Travel Med Infect Dis. 2019 Jul–Aug;30:9–18. [PubMed: 31252170] + +Park SY et al. Post-exposure prophylaxis for Middle East Respiratory Syndrome in healthcare workers. J Hosp Infect. 2019 Jan;101:(1):42–6. [PubMed: 30240813]