Presentation
The disease presents as severe respiratory infection often with shock, acute kidney injury, and coagulopathy. Recently, we observed three cases who presented with neurologic symptoms. [ncbi.nlm.nih.gov]
Affected patients typically present with fever, chills, rigors, headache, a nonproductive cough, dyspnea, and myalgia. [ajronline.org]
Entire Body System
- Fever
OR Close contact 2 with a confirmed or probable case of MERS while the case was ill AND fever ( 100 F) or symptoms of respiratory illness within 14 days following the close contact. (This is a lower threshold than category A.) [web.archive.org]
The first patient developed respiratory symptoms and fever 14 days after admission to hospital for an unrelated reason. He died 11 days later with multi-organ failure. [ncbi.nlm.nih.gov]
[…] or symptoms of respiratory infection; - If developing symptoms such as fever or cough, put on a mask and consult a doctor immediately. [ift.edu.mo]
It can start with a fever and cough, which can develop into pneumonia and breathing difficulties. MERS was first identified in 2012 in the Middle East and is most common in that region. [nhs.uk]
To diagnose MERS, a doctor will perform a physical examination and check for fever and swollen glands. He or she will also listen to your lungs with a stethoscope. [medbroadcast.com]
- Hypoxemia
One patient required extracorporeal membrane oxygenation to treat refractory hypoxemia, and one patient died of shock with multiorgan failure. All the patients had fever, myalgia, leucopenia, normal procalcitonin level, and pneumonia. [ncbi.nlm.nih.gov]
Until more data are available, ECMO could be considered as a rescue therapy in selected MERS-CoV patients with refractory hypoxemia. [doi.org]
[…] and safeguards for healthcare personnel working with infectious diseases, as well as the Acute Respiratory Distress Syndrome: A Complex Clinical Condition slideshow for more information on ARDS, a condition characterized by acute respiratory failure, hypoxemia [emedicine.medscape.com]
- Congestive Heart Failure
A 60-year-old man presented with pneumonia and congestive heart failure. On the first day of admission, he was found to have an elevated troponin-l level and severe global left ventricular systolic dysfunction on echo-cardiography. [ncbi.nlm.nih.gov]
Respiratoric
- Dry Cough
The patient was 44 years old and had symptoms including high fever, dry cough with a little phlegm, and shortness of breath, which are roughly consistent with those associated with MERS, and had had close contact with individuals with confirmed cases [ncbi.nlm.nih.gov]
The main symptoms are a fever, a dry cough, shortness of breath, or trouble breathing. MERS may also cause a headache, muscle aches, a sore throat, fatigue, and diarrhea or there may be no symptoms at all. [healthlinkbc.ca]
cough, shortness of breath (dyspnea) or breathing difficulties, and atypical pneumonia, a virus in the genus cornonavirus is the suspected causative agent ICD-9-CM Volume 2 Index entries containing back-references to 079.82 : [icd9data.com]
- Dyspnea
[…] elsewhere Approximate Synonyms SARS (severe acute respiratory distress syndrome) SARS (severe acute respiratory syndrome) Severe acute respiratory syndrome Clinical Information Viral disorder characterized by high fever, dry cough, shortness of breath (dyspnea [icd9data.com]
Affected patients typically present with fever, chills, rigors, headache, a nonproductive cough, dyspnea, and myalgia. [ajronline.org]
Gastrointestinal
- Diarrhea
Upon arrival, he complained of diarrhea and weakness, but denied any respiratory symptoms, and he directly went to visit an emergency room. [ncbi.nlm.nih.gov]
Other symptoms may include nausea, vomiting and diarrhea. Pneumonia is common, and sometimes it may cause injury to organs, such as the kidneys. Some people only have mild symptoms. [health.utah.gov]
Middle East respiratory syndrome ( MERS ), also known as camel flu, is a viral respiratory infection caused by the MERS-coronavirus (MERS-CoV).Symptoms may range from mild to severe.They include fever, cough, diarrhea, and shortness of breath .Disease [dimsumdaily.hk]
- Nausea
Other symptoms may include nausea, vomiting and diarrhea. Pneumonia is common, and sometimes it may cause injury to organs, such as the kidneys. Some people only have mild symptoms. [health.utah.gov]
Most people with MERS-CoV infection have had severe acute respiratory illness with symptoms of: Fever Cough Shortness of breath Pneumonia Other symptoms may include chils, diarrhea, nausea, vomiting. [sfcdcp.org]
Other symptoms may include nausea, vomiting and diarrhea. Pneumonia is common, and sometimes it may cause injury to organs, such as the kidneys. [wisehealthsystem.com]
In some cases, gastrointestinal symptoms including diarrhea and nausea/vomiting have been reported. [health.govt.nz]
Others reported having gastrointestinal symptoms, like diarrhea and nausea/vomiting, and kidney failure. MERS can even be deadly. Many people have died. [cdc.gov]
Cardiovascular
- Heart Failure
failure 0 (0%) 1 (5.6%) 0.975 Bronchial asthma 2 (11.8%) 2 (11.1%) 0.638 COPD c 2 (11.8%) 0 (0%) 0.442 Acute kidney injury 2 (11.8%) 1 (5.6%) 0.975 Chronic kidney disease 1 (5.9%) 4 (22.2%) 0.371 Liver disease 0 (0%) 2 (11.1%) 0.493 Immunocompromised [doi.org]
- Vascular Disease
Evidence of chronic disease, including severe peripheral vascular disease, patchy cardiac fibrosis, and hepatic steatosis, was noted in the other organs. [ncbi.nlm.nih.gov]
Workup
Therefore, a diagnostic workup for MERS in a patient with an acute respiratory illness, with or without fever, should be guided by the presence of both clinical suspicion and an epidemiologic link 61 (Fig. [nejm.org]
Serum
- Lymphopenia
All 3 patients had fever, cough, shortness of breath, bilateral infiltrates on chest x-ray, thrombocytopenia, lymphopenia and rises in serum creatinine kinase and alanine transaminase. [ncbi.nlm.nih.gov]
Lymphopenia was the most common finding in a cohort of 157 patients with SARS. [doi.org]
Common admission imaging and laboratory features of SARS and MERS on admission to hospital include infiltrates on chest radiographs and lymphopenia, and thrombocytopenia and elevated liver enzymes have been noted in some cases [ 21, 23 ]. [erj.ersjournals.com]
[…] half of critically ill patients. 58 Stillbirth has been reported in a pregnant woman with probable MERS. 59 Neurologic manifestations suggestive of encephalitis have been reported in three cases. 60 Laboratory findings typically include leukopenia and lymphopenia [nejm.org]
Treatment
Combination therapy with interferon-α2b and ribavirin has been used successfully as primary treatment and prophylaxis in SARS. [ncbi.nlm.nih.gov]
Currently, there is no proven effective treatment. The new findings show that a combination of interferon-alpha 2b and ribavirin, drugs routinely used to treat hepatitis C, may be an effective treatment for MERS-CoV infection, said Dr. Angela L. [washington.edu]
Treatment No vaccine or specific treatment is currently available. Treatment is supportive in hospital and intensive care facilities may be needed. Prevention in Travellers The risk to travellers to the Middle East is very low. [fitfortravel.nhs.uk]
Treatment There is no specific antiviral treatment recommended for MERS-CoV infection. Individuals with MERS often receive medical care to help relieve symptoms. For severe cases, current treatment includes care to support vital organ functions. [cdc.gov]
Prognosis
A shorter incubation period was associated with more severe disease and greater risk of mortality, and the severity of fever predicted the prognosis of MERS-CoV infection-related pneumonia. [ncbi.nlm.nih.gov]
This understanding, in turn, should improve the assessment of lung abnormalities based on chest radiographic and CT scores and allow clinicians to accurately monitor disease progression and provide more accurate information regarding patient prognosis [ajronline.org]
Having been originally developed by Karnofsky to assess the functional ability and prognosis in patients with malignancies, the elements included in the score assessed for physical ability to determine whether the tested individual is able to carry out [journals.plos.org]
Etiology
[…] illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula 1 OR a member of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown etiology [web.archive.org]
or inconclusive (4) A febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome) that cannot be explained fully by any other etiology [who.int]
Overall, a clinical diagnosis of SARS is closely correlated with detection of viral RNA by RT-PCR and seroconversion supporting the etiologic association of SARS-CoV and SARS. [doi.org]
The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis 2015 ;211: 80 - 90 69. [nejm.org]
Epidemiology
We summarize what is known about the epidemiology, virology, phylogeny and emergence of MERS-CoV to inform public health policies. [ncbi.nlm.nih.gov]
MERS-CoV website (2) A direct epidemiological link with a confirmed MERS-CoV patient may include: Health care associated exposure, including providing direct care for MERS-CoV patients, working with health care workers infected with MERS-CoV, visiting [who.int]
[…] update: Middle East respiratory syndrome coronavirus (MERS-CoV), 1 September 2015 News Epidemiological update: Middle East respiratory syndrome coronavirus (MERS-CoV), 18 August 2015 Event Fourth Global Influenza Seroepidemiology Expert Meeting (CONSISE [ecdc.europa.eu]
Pathophysiology
CNS involvement should be considered in patients with MERS-CoV and progressive neurological disease, and further elucidation of the pathophysiology of this virus is needed. [ncbi.nlm.nih.gov]
The underlying pathophysiology of MERS-CoV is not fully understood. However, it is thought that MERS-CoV may be primarily zoonotic in nature, although human-to-human transmission is limited (but possible). [ajronline.org]
Prevention
Control and Prevention Middle East respiratory syndrome coronavirus (MERS-CoV) —The World Health Organization [professionals.site.apic.org]
Prevention Currently, there is no vaccine to prevent MERS-CoV infection. The U.S. National Institutes of Health is exploring the possibility of developing one. [cdc.gov]
Prevention : There is no vaccine for MERS so prevention is critical. [phc.amedd.army.mil]
Some of this information may be applicable to control and prevention of MERS-CoV infections. [osha.gov]
No specific drug treatment exists for MERS and infection prevention and control measures are crucial to prevent spread in health-care facilities. MERS-CoV continues to be an endemic, low-level public health threat. [ncbi.nlm.nih.gov]