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Unusual presentation of Middle East respiratory syndrome coronavirus leading to a large outbreak in Riyadh during 2017.
Am J Infect Control. 2018 09; 46(9):1022-1025.AJ

Abstract

BACKGROUND

The hallmark of Middle East respiratory syndrome coronavirus (MERS-CoV) disease is the ability to cause major health care-associated nosocomial outbreaks with superspreading events leading to massive numbers of cases and excessive morbidity and mortality. In this report, we describe a patient who presented with acute renal failure requiring hemodialysis and became a MERS-CoV superspreader, igniting a recent multihospital outbreak in Riyadh.

MATERIAL AND RESULTS

Between May 31 and June 15, 2017, 44 cases of MERS-CoV infection were reported from 3 simultaneous clusters from 3 health care facilities in Riyadh, Saudi Arabia, including 11 fatal cases. Out of the total reported cases, 29 cases were reported from King Saud Medical City. The cluster at King Saud Medical City was ignited by a single superspreader patient who presented with acute renal failure. After 14 hours in the open area of the emergency department and 2 hemodialysis sessions he was diagnosed with MERS-CoV. One hundred twenty contacts who had direct unprotected exposure were screened. Among those contacts, 9 out of 107 health care workers (5 nurses, 3 physicians, and 1 paramedic) and 7 out of 13 patients tested positive for MERS-CoV.

CONCLUSIONS

This hospital outbreak demonstrated the difficulties in diagnosing pneumonia in patients with renal and cardiac failure, which leads to delayed suspicion of MERS-CoV and hence delay in applying the proper infection control procedures. In MERS-CoV endemic countries there is an urgent need for developing rapid point-of-care testing that would assist emergency department staff in triaging suspected cases of MERS-CoV to ensure timely isolation and management of their primary illness and prevent major MERS-CoV outbreaks.

Authors+Show Affiliations

Infection Control Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia; Department of Community Medicine, National Research Center, Egypt.Medical Affairs, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.Infection Control Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.Department of Emergency Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.Department of Emergency Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: zmemish@yahoo.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29661625

Citation

Amer, Hala, et al. "Unusual Presentation of Middle East Respiratory Syndrome Coronavirus Leading to a Large Outbreak in Riyadh During 2017." American Journal of Infection Control, vol. 46, no. 9, 2018, pp. 1022-1025.
Amer H, Alqahtani AS, Alzoman H, et al. Unusual presentation of Middle East respiratory syndrome coronavirus leading to a large outbreak in Riyadh during 2017. Am J Infect Control. 2018;46(9):1022-1025.
Amer, H., Alqahtani, A. S., Alzoman, H., Aljerian, N., & Memish, Z. A. (2018). Unusual presentation of Middle East respiratory syndrome coronavirus leading to a large outbreak in Riyadh during 2017. American Journal of Infection Control, 46(9), 1022-1025. https://doi.org/10.1016/j.ajic.2018.02.023
Amer H, et al. Unusual Presentation of Middle East Respiratory Syndrome Coronavirus Leading to a Large Outbreak in Riyadh During 2017. Am J Infect Control. 2018;46(9):1022-1025. PubMed PMID: 29661625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unusual presentation of Middle East respiratory syndrome coronavirus leading to a large outbreak in Riyadh during 2017. AU - Amer,Hala, AU - Alqahtani,Abdulrahman S, AU - Alzoman,Hind, AU - Aljerian,Nawfal, AU - Memish,Ziad A, Y1 - 2018/04/13/ PY - 2018/02/07/received PY - 2018/02/26/revised PY - 2018/02/26/accepted PY - 2018/4/18/pubmed PY - 2019/9/26/medline PY - 2018/4/18/entrez KW - Kingdom of Saudi Arabia KW - hemodialysis KW - renal failure KW - superspreading KW - viral load SP - 1022 EP - 1025 JF - American journal of infection control JO - Am J Infect Control VL - 46 IS - 9 N2 - BACKGROUND: The hallmark of Middle East respiratory syndrome coronavirus (MERS-CoV) disease is the ability to cause major health care-associated nosocomial outbreaks with superspreading events leading to massive numbers of cases and excessive morbidity and mortality. In this report, we describe a patient who presented with acute renal failure requiring hemodialysis and became a MERS-CoV superspreader, igniting a recent multihospital outbreak in Riyadh. MATERIAL AND RESULTS: Between May 31 and June 15, 2017, 44 cases of MERS-CoV infection were reported from 3 simultaneous clusters from 3 health care facilities in Riyadh, Saudi Arabia, including 11 fatal cases. Out of the total reported cases, 29 cases were reported from King Saud Medical City. The cluster at King Saud Medical City was ignited by a single superspreader patient who presented with acute renal failure. After 14 hours in the open area of the emergency department and 2 hemodialysis sessions he was diagnosed with MERS-CoV. One hundred twenty contacts who had direct unprotected exposure were screened. Among those contacts, 9 out of 107 health care workers (5 nurses, 3 physicians, and 1 paramedic) and 7 out of 13 patients tested positive for MERS-CoV. CONCLUSIONS: This hospital outbreak demonstrated the difficulties in diagnosing pneumonia in patients with renal and cardiac failure, which leads to delayed suspicion of MERS-CoV and hence delay in applying the proper infection control procedures. In MERS-CoV endemic countries there is an urgent need for developing rapid point-of-care testing that would assist emergency department staff in triaging suspected cases of MERS-CoV to ensure timely isolation and management of their primary illness and prevent major MERS-CoV outbreaks. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/29661625/Unusual_presentation_of_Middle_East_respiratory_syndrome_coronavirus_leading_to_a_large_outbreak_in_Riyadh_during_2017_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(18)30146-9 DB - PRIME DP - Unbound Medicine ER -