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Clinical management of respiratory syndrome in patients hospitalized for suspected Middle East respiratory syndrome coronavirus infection in the Paris area from 2013 to 2016.
BMC Infect Dis. 2018 07 16; 18(1):331.BI

Abstract

BACKGROUND

Patients with suspected Middle East respiratory syndrome coronavirus (MERS-CoV) infection should be hospitalized in isolation wards to avoid transmission. This suspicion can also lead to medical confusion and inappropriate management of acute respiratory syndrome due to causes other than MERS-CoV.

METHODS

We studied the characteristics and outcome of patients hospitalized for suspected MERS-CoV infection in the isolation wards of two referral infectious disease departments in the Paris area between January 2013 and December 2016.

RESULTS

Of 93 adult patients (49 male (52.6%), median age 63.4 years) hospitalized, 82 out of 93 adult patients had returned from Saudi Arabia, and 74 of them were pilgrims (Hajj). Chest X-ray findings were abnormal in 72 (77%) patients. The 93 patients were negative for MERS-CoV RT-PCR, and 70 (75.2%) patients had documented infection, 47 (50.5%) viral, 22 (23.6%) bacterial and one Plasmodium falciparum malaria. Microbiological analysis identified Rhinovirus (27.9%), Influenza virus (26.8%), Legionella pneumophila (7.5%), Streptococcus pneumoniae (7.5%), and non-MERS-coronavirus (6.4%). Antibiotics were initiated in 81 (87%) cases, with two antibiotics in 63 patients (67.7%). The median duration of hospitalization and isolation was 3 days (1-33) and 24 h (8-92), respectively. Time of isolation decreased over time (P < 0.01). Two patients (2%) died.

CONCLUSION

The management of patients with possible MERS-CoV infection requires medical facilities with trained personnel, and rapid access to virological results. Empirical treatment with neuraminidase inhibitors and an association of antibiotics effective against S. pneumoniae and L. pneumophila are the cornerstones of the management of patients hospitalized for suspected MERS-CoV infection.

Authors+Show Affiliations

APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France. alexandre.bleibtreu@aphp.fr. APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France. alexandre.bleibtreu@aphp.fr. INSERM, IAME, UMR 1137, Paris, France. alexandre.bleibtreu@aphp.fr. Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France. alexandre.bleibtreu@aphp.fr.APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France.Virology Department, APHP-Bichat-Claude Bernard Hospital, Paris, France.AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service de Virologie, et Sorbonne Universités, UPMC Univ Paris 06, CR7, CIMI, INSERM U1135, Paris, France.APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France.APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France.APHP, Infection control unit, Bichat Claude Bernard hospital, Paris Diderot University, Paris, France. INSERM, IAME, UMR 1137, Paris, France. Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Bactériologie-Hygiène Hospitalière, Paris, France. Faculté de Médecine P. & M. Curie Paris-6 - Site Pitié, Centre d'Immunologie et des Maladies Infectieuses (CIMI) - E13, Paris, France.INSERM, IAME, UMR 1137, Paris, France. Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France. APHP- Hôpital Bichat Claude Bernard, Service de Réanimation médicale et Infectieuse, Paris, France.Service de pneumologie et réanimation Département R3S, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, unité de Soin de Réadaptation Post Réanimation (SRPR), Paris, France.APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France.APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France. INSERM, IAME, UMR 1137, Paris, France. Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France.APHP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service des Maladies Infectieuses et Tropicales, Paris, France.APHP, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris Diderot University, Paris, France. INSERM, IAME, UMR 1137, Paris, France. Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30012113

Citation

Bleibtreu, A, et al. "Clinical Management of Respiratory Syndrome in Patients Hospitalized for Suspected Middle East Respiratory Syndrome Coronavirus Infection in the Paris Area From 2013 to 2016." BMC Infectious Diseases, vol. 18, no. 1, 2018, p. 331.
Bleibtreu A, Jaureguiberry S, Houhou N, et al. Clinical management of respiratory syndrome in patients hospitalized for suspected Middle East respiratory syndrome coronavirus infection in the Paris area from 2013 to 2016. BMC Infect Dis. 2018;18(1):331.
Bleibtreu, A., Jaureguiberry, S., Houhou, N., Boutolleau, D., Guillot, H., Vallois, D., Lucet, J. C., Robert, J., Mourvillier, B., Delemazure, J., Jaspard, M., Lescure, F. X., Rioux, C., Caumes, E., & Yazdanapanah, Y. (2018). Clinical management of respiratory syndrome in patients hospitalized for suspected Middle East respiratory syndrome coronavirus infection in the Paris area from 2013 to 2016. BMC Infectious Diseases, 18(1), 331. https://doi.org/10.1186/s12879-018-3223-5
Bleibtreu A, et al. Clinical Management of Respiratory Syndrome in Patients Hospitalized for Suspected Middle East Respiratory Syndrome Coronavirus Infection in the Paris Area From 2013 to 2016. BMC Infect Dis. 2018 07 16;18(1):331. PubMed PMID: 30012113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical management of respiratory syndrome in patients hospitalized for suspected Middle East respiratory syndrome coronavirus infection in the Paris area from 2013 to 2016. AU - Bleibtreu,A, AU - Jaureguiberry,S, AU - Houhou,N, AU - Boutolleau,D, AU - Guillot,H, AU - Vallois,D, AU - Lucet,J C, AU - Robert,J, AU - Mourvillier,B, AU - Delemazure,J, AU - Jaspard,M, AU - Lescure,F X, AU - Rioux,C, AU - Caumes,E, AU - Yazdanapanah,Y, Y1 - 2018/07/16/ PY - 2017/08/30/received PY - 2018/06/28/accepted PY - 2018/7/18/entrez PY - 2018/7/18/pubmed PY - 2019/6/27/medline KW - Isolation ward KW - Legionella KW - Middle East respiratory syndrome coronavirus (MERS-CoV) KW - Pilgrims KW - Respiratory tract infection KW - Saudi Arabia SP - 331 EP - 331 JF - BMC infectious diseases JO - BMC Infect Dis VL - 18 IS - 1 N2 - BACKGROUND: Patients with suspected Middle East respiratory syndrome coronavirus (MERS-CoV) infection should be hospitalized in isolation wards to avoid transmission. This suspicion can also lead to medical confusion and inappropriate management of acute respiratory syndrome due to causes other than MERS-CoV. METHODS: We studied the characteristics and outcome of patients hospitalized for suspected MERS-CoV infection in the isolation wards of two referral infectious disease departments in the Paris area between January 2013 and December 2016. RESULTS: Of 93 adult patients (49 male (52.6%), median age 63.4 years) hospitalized, 82 out of 93 adult patients had returned from Saudi Arabia, and 74 of them were pilgrims (Hajj). Chest X-ray findings were abnormal in 72 (77%) patients. The 93 patients were negative for MERS-CoV RT-PCR, and 70 (75.2%) patients had documented infection, 47 (50.5%) viral, 22 (23.6%) bacterial and one Plasmodium falciparum malaria. Microbiological analysis identified Rhinovirus (27.9%), Influenza virus (26.8%), Legionella pneumophila (7.5%), Streptococcus pneumoniae (7.5%), and non-MERS-coronavirus (6.4%). Antibiotics were initiated in 81 (87%) cases, with two antibiotics in 63 patients (67.7%). The median duration of hospitalization and isolation was 3 days (1-33) and 24 h (8-92), respectively. Time of isolation decreased over time (P < 0.01). Two patients (2%) died. CONCLUSION: The management of patients with possible MERS-CoV infection requires medical facilities with trained personnel, and rapid access to virological results. Empirical treatment with neuraminidase inhibitors and an association of antibiotics effective against S. pneumoniae and L. pneumophila are the cornerstones of the management of patients hospitalized for suspected MERS-CoV infection. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/30012113/Clinical_management_of_respiratory_syndrome_in_patients_hospitalized_for_suspected_Middle_East_respiratory_syndrome_coronavirus_infection_in_the_Paris_area_from_2013_to_2016_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-3223-5 DB - PRIME DP - Unbound Medicine ER -