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Essentials of Diagnosis
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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
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General Considerations
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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
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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
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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
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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
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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 ...