Tags

Type your tag names separated by a space and hit enter

Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission.
Lancet. 2013 Jun 29; 381(9885):2265-72.Lct

Abstract

BACKGROUND

Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital.

METHODS

Patient 1 visited Dubai in April, 2013; patient 2 lives in France and did not travel abroad. Both patients had underlying immunosuppressive disorders. We tested specimens from the upper (nasopharyngeal swabs) or the lower (bronchoalveolar lavage, sputum) respiratory tract and whole blood, plasma, and serum specimens for MERS-CoV by real-time RT-PCR targeting the upE and Orf1A genes of MERS-CoV.

FINDINGS

Initial clinical presentation included fever, chills, and myalgia in both patients, and for patient 1, diarrhoea. Respiratory symptoms rapidly became predominant with acute respiratory failure leading to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Both patients developed acute renal failure. MERS-CoV was detected in lower respiratory tract specimens with high viral load (eg, cycle threshold [Ct] values of 22·9 for upE and 24 for Orf1a for a bronchoalveolar lavage sample from patient 1; Ct values of 22·5 for upE and 23·9 for Orf1a for an induced sputum sample from patient 2), whereas nasopharyngeal specimens were weakly positive or inconclusive. The two patients shared the same room for 3 days. The incubation period was estimated at 9-12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure.

INTERPRETATION

Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor.

FUNDING

French Institute for Public Health Surveillance, ANR grant Labex Integrative Biology of Emerging Infectious Diseases, and the European Community's Seventh Framework Programme projects EMPERIE and PREDEMICS.

Authors+Show Affiliations

Service de Gestion du Risque Infectieux, Vigilances et Infectiologie, Hopital Huriez, Pavillon Fourrier, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2, Lille Cedex, France. bguery@invivo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23727167

Citation

Guery, Benoit, et al. "Clinical Features and Viral Diagnosis of Two Cases of Infection With Middle East Respiratory Syndrome Coronavirus: a Report of Nosocomial Transmission." Lancet (London, England), vol. 381, no. 9885, 2013, pp. 2265-72.
Guery B, Poissy J, el Mansouf L, 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;381(9885):2265-72.
Guery, B., Poissy, J., el Mansouf, L., Séjourné, C., Ettahar, N., Lemaire, X., Vuotto, F., Goffard, A., Behillil, S., Enouf, V., Caro, V., Mailles, A., Che, D., Manuguerra, J. C., Mathieu, D., Fontanet, A., & van der Werf, S. (2013). Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission. Lancet (London, England), 381(9885), 2265-72. https://doi.org/10.1016/S0140-6736(13)60982-4
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 Jun 29;381(9885):2265-72. PubMed PMID: 23727167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission. AU - Guery,Benoit, AU - Poissy,Julien, AU - el Mansouf,Loubna, AU - Séjourné,Caroline, AU - Ettahar,Nicolas, AU - Lemaire,Xavier, AU - Vuotto,Fanny, AU - Goffard,Anne, AU - Behillil,Sylvie, AU - Enouf,Vincent, AU - Caro,Valérie, AU - Mailles,Alexandra, AU - Che,Didier, AU - Manuguerra,Jean-Claude, AU - Mathieu,Daniel, AU - Fontanet,Arnaud, AU - van der Werf,Sylvie, AU - ,, Y1 - 2013/05/30/ PY - 2013/6/4/entrez PY - 2013/6/4/pubmed PY - 2013/7/16/medline SP - 2265 EP - 72 JF - Lancet (London, England) JO - Lancet VL - 381 IS - 9885 N2 - BACKGROUND: Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital. METHODS: Patient 1 visited Dubai in April, 2013; patient 2 lives in France and did not travel abroad. Both patients had underlying immunosuppressive disorders. We tested specimens from the upper (nasopharyngeal swabs) or the lower (bronchoalveolar lavage, sputum) respiratory tract and whole blood, plasma, and serum specimens for MERS-CoV by real-time RT-PCR targeting the upE and Orf1A genes of MERS-CoV. FINDINGS: Initial clinical presentation included fever, chills, and myalgia in both patients, and for patient 1, diarrhoea. Respiratory symptoms rapidly became predominant with acute respiratory failure leading to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Both patients developed acute renal failure. MERS-CoV was detected in lower respiratory tract specimens with high viral load (eg, cycle threshold [Ct] values of 22·9 for upE and 24 for Orf1a for a bronchoalveolar lavage sample from patient 1; Ct values of 22·5 for upE and 23·9 for Orf1a for an induced sputum sample from patient 2), whereas nasopharyngeal specimens were weakly positive or inconclusive. The two patients shared the same room for 3 days. The incubation period was estimated at 9-12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure. INTERPRETATION: Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor. FUNDING: French Institute for Public Health Surveillance, ANR grant Labex Integrative Biology of Emerging Infectious Diseases, and the European Community's Seventh Framework Programme projects EMPERIE and PREDEMICS. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/23727167/Clinical_features_and_viral_diagnosis_of_two_cases_of_infection_with_Middle_East_Respiratory_Syndrome_coronavirus:_a_report_of_nosocomial_transmission_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(13)60982-4 DB - PRIME DP - Unbound Medicine ER -