Patient-to-Patient Transmission of the MERS Coronavirus

Mary E. Wilson, MD

After sharing a room with a patient with Middle East respiratory syndrome coronavirus infection, a second patient developed respiratory failure caused by the same virus.

In France, a 64-year-old renal-transplant recipient who had recently visited Dubai was hospitalized with fever, chills, myalgia, and diarrhea. He subsequently developed pneumonia, respiratory failure (which was treated with extracorporeal membrane oxygenation [ECMO]), and renal failure and died of multiple organ failure. A 51-year-old man who had not traveled abroad but had shared a hospital room with patient 1 for 3 days during the acute illness developed fever, chills, and myalgia 9 to 12 days after this contact. He subsequently developed renal failure and respiratory failure, which — as of May 29 (day 21 after symptom onset) — was being managed with ECMO.

Detailed virologic studies identified the Middle East respiratory syndrome coronavirus (MERS Co-V), with high viral loads in lower respiratory tract samples from both patients. Partial sequencing showed the viruses to be identical. Nasopharyngeal samples were weakly positive or inconclusive for virus. Whole blood from patient 1 was positive by real-time reverse-transcription polymerase chain reaction for MERS Co-V.

Both patients were taking steroids before illness onset. During the period when the men shared a hospital room, no isolation procedures were used. At the time of publication, no evidence of infection had been identified in hospital staff who had cared for patient 1 before he was isolated or in contacts of patient 2.

Citation(s):

Guery B et al. Clinical features and viral diagnosis of two cases of infection with Middle East respiratory syndrome coronavirus: A report of nosocomial transmission. Lancet 2013 May 29.