Middle East Respiratory Syndrome (MERS-CoV): What have we learned?

Your next 3 patients…

#1: Physician who did an international health stint in United Arab Emirates 1 week ago
#2 & #3: Husband and wife with fever/sob/n/v who arrived from Jordan 10 days ago

Basics

– Coronavirus is responsible for severe viral PNA in humans. It was first called novel human coronavirus.
– 1^st reported case in Sept 2012 (Saudi Arabia), 1^st actual case in April 2012 (Jordan)
– Most common in Arabian Peninsula (Jordan, Iraq, Kuwait, Bahrain, Qatar, United Arab Emirates, Oman, Yemen, Saudi Arabia)
– Close contact transmission; does not spread like influenza; like SARS but more deadly
– Incubation 2-14 days; source unclear (?camels)
– 1^st US cases: May 2014 (Indiana, Florida)

Clinical Presentation + Imaging Findings

– Many present asymptomatically or as a simple URI
– Typically 50 years old, M > F; those with multiple co-morbidities are more significantly affected
– Severe acute respiratory illness: fever/chills, HA, non-productive cough, SOB, muscle aches, n/v/loose stools  =>  PNA / ARDS / respiratory failure, AKI, multiple organ dysfunction syndrome

Three Criteria

1) fever
2) PNA or ARDS or symptoms of respiratory illness
3) a) history of travel from countries in or near Arabian Peninsula within 14 days or b) close contact with a symptomatic traveler or c) part of cluster of patients with severe acute respiratory illness of unclear etiology

Imaging

– bilateral sub-pleural and basilar ground-glass opacities

Management

– Supportive care; no antiviral or vaccine available
– Standard/contact/airborne precautions for healthcare providers; patients need isolation similar to TB

Why do we care

–25-50% mortality; higher in those with multiple co-morbidities
-Hajj pilgrimage Oct 2-6, 2014
-Travel to US from Middle East peaks between April and September