importància clínica dels nous virus emergents: grip i ... · pdf...
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Importància clínica dels nous
virus emergents: grip i
coronavirus
Carolina Garcia-Vidal
Servei de Malaties Infeccioses
Hospital Universitari de Bellvitge
Barcelona, Spain
Neumonía viral: ¡no sólo afecta a niños!
• MERS-CoV
• Avian influenza A H7N9
• Avian influenza A H10N8
Desde SARS hasta MERS: 10 años de investigación sobre los coronavirus
Hace 10 años: • Síndrome respiratorio agudo grave (SARS) -Primeros casos en China, manipuladores de alimentos y chefs. -Murciélagos y otros mamíferos pequeños son reservorios de coronavirus -Trasmisión de infección a parientes, staff médico, y contactos cercanos. -Diseminación global “global village” -Mortalidad cercana al 10%
Hilgenfeld R, et al. Antiv Res 2013
Coronavirus Study Group of the International Committee on Taxonomy of Viruses (Mayo de 2013)
http://abscbnnews.tumblr.com
Zaki AM. N Engl J Med 2012
A 60-yr-old Saudi man was admitted on June 13, 2012, with fever X 7 days, cough,
expectoration, and shortness of breath; rx oseltamivir, levo, P/T, and micafungin.
ICU admission and IMV. On June 24, he died of ARDS and ARF.
A new betacoronavirus in
lineage C; HCoV-EMC, along
with other bat coronavirus
WHO, 5 Febr 2015
971 cases 356 deaths (26%)
Affected countries (8 May 2014)
Middle East
Jordan
Kuwait
Oman
Qatar
Saudi Arabia
United Arab Emirates
Yemen
Africa
Egypt
Tunissia
Europe
France
Germany
Greece
Italy
United Kingdom
Asia
Malaysia
Philippines
North America
USA
Assiri A. Lancet Infect Dis 2013
47 individuals from Saudi Arabia with lab-confirmed MERS-CoV were identified
between Sep 1, 2012, and June 15, 2013; 60% case-fatality rate
Imaging findings at presentations in Saudi patients
with Middle East respiratory syndrome
Assiri A. Lancet Infect Dis 2013
Zhou J. J Infect Dis 2013
Active replication of Middle East Respiratory Syndrome Coronavirus replication and aberrant induction of
inflammatory cytokines and chemokines
Study of viral replication, cytokine/chemokines response, and antigen presentation in MERS-CoV-
infected human monocyte-derived macrophages (MDMs) vs SARS-CoV infected MDMs
Arabi YM. Ann Intern Med 2014
Arabi YM. Ann Intern Med 2014
Guery B. Lancet 2013
Assiri A. N Engl J Med 2013
Memish ZA. N Engl J Med 2013
WHO, 8 May 2014
Assiri A. N Engl J Med 2013
23 cases of MERS-CoV in the eastern province of Saudi Arabia
The median incubation period was 5.2 days
21 of 23 cases were acquired by person-to-person transmission
- hemodialysis units
- ICUs
- in-patient units
15 patients died (65%)
Among 217 household contacts and > than 200 HCW, MERS-CoV
infection developed in 5 family members and in 2 HCW.
Assiri A. N Engl J Med 2013
Avian influenza A(H7N9) virus
WHO, October 2014
>450 cases since April 2013
with more than 130 deaths
Li Q. N Engl J Med 2014
Li Q. N Engl J Med 2014
Gao HN. N Engl J Med 2013
• Of the 111 pts studied, 77% were admitted to an ICU, and 27% died.
• The median age was 61 yrs, and 69.5% of pts were male.
• A total of 61% of the pts had at least one underlying medical condition.
• 56% of pts had exposure to live poultry in the previous 14 days.
• On admission, 108 pts (97%) had findings consistent with pneumonia.
• Lymphocytopenia was observed in 88% of pts; thrombocytopenia in 73%.
• Antiviral therapy was initiated in 97% of pts at a median of 7 days.
after the onset of illness.
• The median time from therapy to negative PCR was 6 days (4 – 7 d).
Gao HN. N Engl J Med 2013
Gao HN. N Engl J Med 2013
Chi Y. J nfect Dis 2013
Cytokine and Chemokine Levels in Patients Infected With the Novel Avian Influenza A (H7N9) Virus in China
Host cytokine and chemokine profiles in serum samples of 16 pts admitted to hospitals in Jianghu, China. 8 pts H3N2, and 9 healthy controls. IP-10, IL-6, IL-17, and IL-2 were increased in H7N9 pts. Proinflammatory cytokine responses, characterized by combined Th1/Th17 cytokine induction, are partially responsible for the disease progression
Hu Y. Lancet 2013
Emergence in China of human disease due to avian influenza A(H10N8) – Cause for concern?
To KKW. J Infect 2014
Chen H. Lancet 2014
A 73-yrs-old woman presented with fever and was admitted to hospital on Nov 30, 2013. She developed multiple organ failure and died 9 days after illness onset. A new reassortant avian influenza A H10N8 virus was isolated from tracheal aspirate.
Chen H. Lancet 2014
Comments
• The MERS-CoV is an emerging virus originally identified in
Saudi Arabia in 2012.
• It has been involved in 971 cases of severe acute respiratory
disease, including 356 deaths (26%), mainly in the Middle East.
• Person-to-person transmission occurs and may be associated
with considerable morbidity and mortality.
• Major gaps in our knowledge of the epidemiology, community
prevalence, treatment and prevention warrant urgent research.
Comments
• A novel avian influenza A H7N9 first detected in Shanghai in March
2013, has been involved in >450 cases with more than 130 deaths
mainly in eastern China.
• The majority of the pts have presented with rapidly progressive
pneumonia and developed ARDS.
• The neuraminidase inhibitors have been the main drugs used for
treatment of pts with H7N9.
• In December 2013, China reported the first human case of avian
influenza A H10N8; with fatal outcome.
