Middle EastRespiratory Syndrome

Corona virus

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Corona Virus

Coronaviruses primarily infect the upper respiratory and gastrointestinal tract of mammals and birds

Coronaviruses are believed to cause a significant percentage of all common colds in human adults

Coronaviruses can even cause pneumonia, either direct viral pneumonia or a secondary bacterial pneumonia

Coronaviruses also cause a range of diseases in farm animals and domesticated pets

List of human coronavirus

Human coronavirus 229E Human coronavirus OC43 SARS-CoV Human coronavirus NL63 Human coronavirus HKU1 Middle east respiratory

syndrome coronavirus

Corona Virus

MERS CoV

1st case June 2012 Kingdom of Saudi Arabia Acute pneumonia with renal failure

MERS CoV

MERS CoV All cases have had a direct or indirect link

with the Middle east Median age is 50 yrs, 64.5% were male Majority of patients experience severe

respiratory disease (63.4%) Patients who died had a higher median

age and propotion of male sex Most patients have underlying medical

conditions; chronic kidney disease (13.3%), diabetics (10%), heart disease (7.5%)

The WHO MERS-CoV research group, November 12, 2013

MERS CoV

Index cases Likely experience

severe and fatal disease

Requiring hospitalization

Secondary cases Most are health

care setting Other in household

setting Cluster occurance

European Centre for Disease Prevention and Control, May 1, 2014

Total cases : 424, Died 131

Clinical features

Incubation period 5-14 days The duration of hospitalization to discharge 7 days

and to died 9 days, median time 4 days Clinical range from asymptomatic to very severe

pneumonia 1/3 patients had gastrointestinal symptoms

Asymptomatic Pneumonia ARDS Septic shock Multi organ failure

13.5% 44.1% 12.4%

Gastrointestinal symptoms

26%

Clinical features

Pneumonia Fever Cough Dyspnea Tachypnea Desaturation

Systemic symptoms Myalgia Arthralgia

Gastrointestinal symptoms Nausea Vomiting Diarrhea

Nearly all symptomatic patients presented with respiratory symptoms

Chest radiograph

Finding vary but are consistent with viral pneumonitis and ARDS

Bilateral hilar infiltrationBilat or unilateral patchy infiltrationSegmented or lobar opacitiesGround glass appearanceSmall pleural effusion

Lower lobes tend to be affected early in the course of illness

Progressive rapidly

Common laboratory findings

Complete blood countLeukopenia, paticularly lymphopenia

Viral loadGreatest in lower respiratory tract, found in upper respiratory tract and some in blood, urine, stool

Co-infection with other respiratory virusesParainfluenza, rhinovirus, influenza, herpes simplex

Secondary nosocomially bacterial infectionKlebsiella pneumoniae, Staphylococcus aureus, Acinetobacter spp.

Transmission

Air borne transmission Droplet smaller < 10

micrometres Hang in air like invisible

smoke Droplets are loaded with

infectious particles Anthrax, Varicella zoster,

Mumps, Measles, Rubella, Tuberculosis

Air droplet transmission

Droplet larger > 10 micrometres Do not stay in the air Influenza

Transmission

MERS CoV

Zoonosis in sporadic case Camel and bat

Human to human transmission in secondary case Small air droplet Transmission did not extend beyond close contacts into the community Secondary attack rates among family members of patients appear to be low

ClusterDefined as two or more persons with onset of symptoms within 14 day period and are associated with specific setting

Transmission

MERS CoV

Epidemic potential Dose not yet have pandemic potential Sustained epidemic in an animal reservoir with sporadic spill-over into

humans Sustained human to human transmission causing a slowly growing human

epidemic

Treatment

Absent of pathogen-specific interventions

Management largely depends on provision of organ support and vigilance for and prevention of complications

Treatment

Treatment

Organ support and prevention of complication Lung-protective ventilatory strategies for ARDS Sepsis early directed goal therapy Antimicrobial treatment for co-infection Renal replacement therapy Cardiovascular support ECMO

Non useful drug

High dose corticosteroid Interferons, Cyclosporin A, Ribavirin, Nitazoxanide,Immunoglobulins,

Lopinavir SARS CoV convalescent plasma

Infection control

Standard precautions

Contactprecautions

Air borneprecautionsAir droplet

precautions

Infection control

Infection control

Infection control

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