Clinical Course and Outcomes of MERS-CoV Infection
Stephen G. Baum, MD
In a small case series from Saudi Arabia, confirmed Middle East respiratory syndrome coronavirus infection affected only people with comorbid conditions and had a high mortality rate.
As of January 20, 2014, 178 cases of confirmed Middle East respiratory coronavirus (MERS-CoV) infection had been reported to the WHO. The infection seems to have originated in Saudi Arabia and has now been seen in several Middle Eastern countries —as well as in travelers returning to Europe and North Africa from this region and in individuals exposed to them, including healthcare workers (HCWs) (NEJM JW Infect Dis Jun 12 2013). The case fatality rate, thus far, is 43%.
Between December 2012 and August 2013, 114 patients at two hospitals in Saudi Arabia were tested for suspected MERS-CoV infection. Investigators now describe the clinical course and outcomes for the 12 patients admitted to intensive care units with confirmed or probable MERS-CoV infection (11 had infection confirmed by real-time polymerase chain reaction applied to respiratory samples; 1 had probable infection, based on presentation and history of exposure to case-patients). Eight confirmed cases were community-acquired, and three — in HCWs — were nosocomial. The three infected HCWs had known exposure to confirmed case-patients and did not wear personal protective gear.
The patients presented with acute lower respiratory illness including dyspnea (92%), cough (83%), and fever (67%); all had chest radiographs consistent with pneumonia and acute respiratory distress syndrome. All had at least one comorbid condition (range, 1–6; median, 3). Hypoxic respiratory failure was the prominent feature of presentation, and all patients required ventilatory assistance. Eleven patients had one or more extrapulmonary manifestations; the systems involved varied widely. Mortality at 90 days was 58%.
Citation(s):
Arabi YM et al. Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection. Ann Intern Med 2014 Jan 28; [e-pub ahead of print].
