MERSMiddle East Respiratory Syndrome

Fay Ali AlBuainainRespiratory Care Department

University of Dammam

OUTLINE:

o Definition

o Structure of MERS CoV

o Transmission

o Risk Factors

o Symptoms and presentation.

o Diagnostic Test

o Prevention

o Treatment

o Recommendations

:Taxonomy

Family

Genus

Species

Virus

:Classification of MERS

:CoV

• Coronaviruses are a large family of viruses that can

cause diseases ranging from the common cold to

Severe Acute Respiratory Syndrome (SARS).

MERS:

• Middle East respiratory syndrome (MERS) is a viral

respiratory disease caused by a novel coronavirus

(MERS‐CoV) that was first identified in Saudi Arabia

in 2012.

Structure of MERS:

Is it an outbreak ?

Today,

1638 cases infected by

MERS since 2012,

587 of these cases died.

How it is transmitted to

humans?

Several strains of MERS-CoV obtained from camels have been

shown to be similar or identical to a human-derived MERS-CoV

strain in their capacity to infect ex-vivo cultures of human

tracheal and lung cells

MERS-CoV is closely related to coronaviruses found in bats,

suggesting that bats might be a reservoir of MERS-CoV. Camels

likely serve as hosts for MERS-CoV.

Human-to-human transmission:

• Possible modes of transmission include droplet

and contact transmission.

Risk Factors and Clinical

Presentation: o The majority of the cases are aged 40 years and

above.

o Primary or Secondary contact with infected patient.

o “Is it a job related?”

⁻ YES

o The clinical presentation of MERS-CoV infection

ranges from asymptomatic to very severe

pneumonia with acute respiratory distress

syndrome (ARDS), septic shock and multi-organ

failure resulting in death.

Symptoms:

o Most people had severe and acute respiratory

symptoms:

– Fever.

– Cough.

– Shortness of breath.

o Some people also had gastrointestinal symptoms:

– Diarrhea.

– Nausea/vomiting.

o Some infected people had mild symptoms or no

symptoms at all; they recovered.

o But most of the people who died had an underlying

medical condition; such as:

– DM.

– Cancer.

– Chronic lung, heart, and kidney disease.

– Immunocompromised.

Diagnostic Test:

o Oropharyngeal and nasopharyngeal swabs.

o Bronchoalveolar lavage.

o Sputum and tracheal aspirates.

o Faeces and urine samples.

o CxR, what will you see?

o CT.

Groundglassopacity and

condensation

o Laboratory findings:

– Leucopoenia, particularly lymphopaenia.

– Thrombocytopenia.

– Elevated lactate dehydrogenase levels.

Prevention:

• Currently, there is no vaccine to prevent MERS-

CoV infection.

Treatment:

o No specific treatment for MERS-CoV infection is

currently available. Clinical management includes

supportive management.

Recommendations:

o Avoid close contact with camels specially if you are

diabetic, immunocompromised or with chronic

disease.

o Avoid drinking raw camel milk or camel urine, or

eating meat that has not been properly cooked.

o General hygiene “regular hand washing before and

after touching animals”.

As a HCP what should you do to

avoid being infected with

MERS?

Standard precautions

Droplet precautions

Contact precautions

For all patients

Symptoms of acute respiratory infection

Suspected or confirmed MERS

Airborne precautions

Aerosol therapy

References:

Uptodate.

Centers for Disease Control and Prevention:

World Health Organization.

Guery B, Poissy J, el Mansouf L, et al. MERS-CoV

study group. Clinical features and viral diagnosis of

two cases of infection with Middle East respiratory

syndrome coronavirus.