MERSMiddle East Respiratory Syndrome
Fay Ali AlBuainainRespiratory Care Department
University of Dammam
OUTLINE:
o Definition
o Structure of MERS CoV
o Transmission
o Risk Factors
o Symptoms and presentation.
o Diagnostic Test
o Prevention
o Treatment
o Recommendations
:Taxonomy
Family
Genus
Species
Virus
:Classification of MERS
:CoV
• Coronaviruses are a large family of viruses that can
cause diseases ranging from the common cold to
Severe Acute Respiratory Syndrome (SARS).
MERS:
• Middle East respiratory syndrome (MERS) is a viral
respiratory disease caused by a novel coronavirus
(MERS‐CoV) that was first identified in Saudi Arabia
in 2012.
Structure of MERS:
Is it an outbreak ?
Today,
1638 cases infected by
MERS since 2012,
587 of these cases died.
How it is transmitted to
humans?
Several strains of MERS-CoV obtained from camels have been
shown to be similar or identical to a human-derived MERS-CoV
strain in their capacity to infect ex-vivo cultures of human
tracheal and lung cells
MERS-CoV is closely related to coronaviruses found in bats,
suggesting that bats might be a reservoir of MERS-CoV. Camels
likely serve as hosts for MERS-CoV.
Human-to-human transmission:
• Possible modes of transmission include droplet
and contact transmission.
Risk Factors and Clinical
Presentation: o The majority of the cases are aged 40 years and
above.
o Primary or Secondary contact with infected patient.
o “Is it a job related?”
⁻ YES
o The clinical presentation of MERS-CoV infection
ranges from asymptomatic to very severe
pneumonia with acute respiratory distress
syndrome (ARDS), septic shock and multi-organ
failure resulting in death.
Symptoms:
o Most people had severe and acute respiratory
symptoms:
– Fever.
– Cough.
– Shortness of breath.
o Some people also had gastrointestinal symptoms:
– Diarrhea.
– Nausea/vomiting.
o Some infected people had mild symptoms or no
symptoms at all; they recovered.
o But most of the people who died had an underlying
medical condition; such as:
– DM.
– Cancer.
– Chronic lung, heart, and kidney disease.
– Immunocompromised.
Diagnostic Test:
o Oropharyngeal and nasopharyngeal swabs.
o Bronchoalveolar lavage.
o Sputum and tracheal aspirates.
o Faeces and urine samples.
o CxR, what will you see?
o CT.
Groundglassopacity and
condensation
o Laboratory findings:
– Leucopoenia, particularly lymphopaenia.
– Thrombocytopenia.
– Elevated lactate dehydrogenase levels.
Prevention:
• Currently, there is no vaccine to prevent MERS-
CoV infection.
Treatment:
o No specific treatment for MERS-CoV infection is
currently available. Clinical management includes
supportive management.
Recommendations:
o Avoid close contact with camels specially if you are
diabetic, immunocompromised or with chronic
disease.
o Avoid drinking raw camel milk or camel urine, or
eating meat that has not been properly cooked.
o General hygiene “regular hand washing before and
after touching animals”.
As a HCP what should you do to
avoid being infected with
MERS?
Standard precautions
Droplet precautions
Contact precautions
For all patients
Symptoms of acute respiratory infection
Suspected or confirmed MERS
Airborne precautions
Aerosol therapy
References:
Uptodate.
Centers for Disease Control and Prevention:
World Health Organization.
Guery B, Poissy J, el Mansouf L, et al. MERS-CoV
study group. Clinical features and viral diagnosis of
two cases of infection with Middle East respiratory
syndrome coronavirus.
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