Middle East Respiratory Syndrome

Aka: Middle East Respiratory Syndrome, MERS, MERS-CoV, MERS Coronavirus

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II. Epidemiology

  1. Cases in the U.S. (and other non-arabian countries are uncommon)
    1. Was seen only in travelers to arabian peninsula as of 7/2014
  2. Countries on Arabian Peninsula in which primary outbreaks have occurred
    1. Saudi Arabia
    2. United Arab Emirates (UAE)
    3. Qatar
    4. Oman
    5. Jordan
    6. Kuwait
    7. Yemen
    8. Lebanon
    9. Iran

III. Pathophysiology

  1. Coronavirus (MERS-CoV) is a novel Coronavirus was first described in Saudi Arabia in 2012
  2. Coronaviruses are in the family Coronaviridae
    1. Coronaviridae are a family of enveloped RNA Viruses with a helical capsid
    2. Coronaviridae are Message Sense RNA Viruses (Positive Stranded, +ssRNA)
      1. Message sense RNA (+ssRNA) are identical to Messenger RNA (mRNA)
      2. Like mRNA, +ssRNA may be immediately translated by host ribosomes into Protein

IV. Findings

  1. Incubation Period: 14 days
  2. Prodromal non-specific symptoms
    1. Headache
    2. Chills
    3. Myalgias
    4. Nausea or Vomiting
    5. Diarrhea
  3. Severe acute respiratory illness
    1. Fever
    2. Cough
    3. Shortness of Breath

V. Labs

  1. rRT-PCR testing of lower respiratory tract specimen
  2. MERS-CoV Serology

VI. Diagnosis: Patient under investigation (PUI) for suspected MERS

  1. Fever AND
  2. Pneumonia or Acute Respiratory Distress Syndrome AND
  3. Exposure
    1. Travel to Arabian Peninsula within 14 days of symptom onset OR
    2. Close contact with symptomatic traveler to Arabian peninsula OR
    3. One of cluster of patients with severe acute respiratory illness OR
    4. Worked, visited or hospitalized in a healthcare facility on Arabian peninsula within 14 days of symptom onset

VII. Prognosis

  1. Mortality: 30%

VIII. Resources

  1. CDC MERS general page
    1. http://www.cdc.gov/coronavirus/mers/
  2. CDC Interim guidelines
    1. http://www.cdc.gov/coronavirus/mers/interim-guidance.html

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