Viral RNA in Blood as Indicator of Severe Outcome in Middle East Respiratory Syndrome Coronavirus Infection

Kim, So Yeon; Park, Sun Jae; Cho, Sook Young; Cha, Ran-hui; Jee, Hyeon-Gun; Kim, Gayeon; Shin, Hyoung-Shik; Kim, Yeonjae; Jung, Yousun; Yang, Jeong‐Sun; Kim, Sung Soon; Cho, Sung Im; Kim, Man Jin; Lee, Jee-Soo; Lee, Seung Jun; Seo, Soo Hyun; Park, Sung Sup; Seong, Moon Woo

doi:10.3201/eid2210.160218

Cited by 46 publications

(54 citation statements)

References 14 publications

(13 reference statements)

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“…Blood is only positive in one-half to one-third of cases, but detectable viremia at the time of diagnosis has been associated with an increased requirement for mechanical ventilation and patient death. 40 The limited viremia rate is in contrast to SARS-CoV, where RT-PCR on blood can be helpful for initial diagnosis and is often the first positive site identified. For MERS-CoV, testing of upper and lower respiratory samples along with patient blood may help maximize the sensitivity while also stratifying risk.…”

Section: Histopathologic Featuresmentioning

confidence: 99%

Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella

Bradley

Bryan

2019

Seminars in Diagnostic Pathology

110

126

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A B S T R A C TLower respiratory infections remain one of the top global causes of death and the emergence of new diseases continues to be a concern. In the first two decades of the 21st century, we have born witness to the emergence of newly recognized coronaviruses that have rapidly spread around the globe, including severe acute respiratory syndrome virus (SARS) and Middle Eastern respiratory syndrome virus (MERS). We have also experienced the emergence of a novel H1N1 pandemic influenza strain in 2009 that caused substantial morbidity and mortality around the world and has transitioned into a seasonal strain. Although we perhaps most frequently think of viruses when discussing emerging respiratory infections, bacteria have not been left out of the mix, as we have witnessed an increase in the number of infections from Legionella spp. since the organisms' initial discovery in 1976. Here, we explore the basic epidemiology, clinical presentation, histopathology, and clinical laboratory diagnosis of these four pathogens and emphasize themes in humans' evolving relationship with our natural environment that have contributed to the infectious burden. Histology alone is rarely diagnostic for these infections, but has been crucial to bettering our understanding of these diseases. Together, we rely on the diagnostic acumen of pathologists to identify the clinicopathologic features that raise the suspicion of these diseases and lead to the early control of the spread in our populations. (A. Bryan). Seminars in DiagnosticPathology 36 (2019) 152-159 0740-2570/

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Section: Histopathologic Featuresmentioning

confidence: 99%

Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella

Bradley

Bryan

2019

Seminars in Diagnostic Pathology

110

126

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“…In contrast, less severe cases had stronger antibody responses, less lymphopenia, and either no viremia or they cleared plasma until day 18 after symptom onset [9]. Also, it was reported ( n = 21) that patients without traceable blood MERS-CoV on admission had a survival rate of about 90% compared to 40% in blood viral RNA-positive patients [10]. …”

Section: Discussionmentioning

confidence: 99%

“…In the past, more than half of adult symptomatic MERS patients had to be admitted to intensive care units (ICU) because of respiratory failure as well as AKI (KDIGO 3): mechanical ventilation was necessary in 70–85% and renal replacement therapy (RRT) in 50–70% of ICU cases [6, 7]. Importantly, persisting bloodstream detection of MERS-CoV is seen in lethal cases, while the virus is cleared from blood in survivors [5, 8-10]. As of October 2017, the case fatality rate in Saudi Arabia is 41% [11].…”

Section: Introductionmentioning

confidence: 99%

Lectin Affinity Plasmapheresis for Middle East Respiratory Syndrome-Coronavirus and Marburg Virus Glycoprotein Elimination

et al. 2018

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Background/Aims: Middle East respiratory syndrome coronavirus (MERS-CoV) and Marburg virus (MARV) are among the World Health Organization’s top 8 emerging pathogens. Both zoonoses share nonspecific early symptoms, a high lethality rate, and a reduced number of specific treatment options. Therefore, we evaluated extracorporeal virus and glycoprotein (GP) elimination by lectin affinity plasmapheresis (LAP). Methods: For both MERS-CoV (pseudovirus) as well as MARV (GPs), 4 LAP devices (Mini Hemopurifiers, Aethlon Medical, San Diego, CA, USA) and 4 negative controls were tested. Samples were collected every 30 min and analyzed for reduction in virus infectivity by a flow cytometry-based infectivity assay (MERS-CoV) and in soluble GP content (MARV) by an immunoassay. Results: The experiments show a time-dependent clearance of MERS-CoV of up to 80% within 3 h (pseudovirus). Up to 70% of MARV-soluble GPs were eliminated at the same time. Substantial saturation of the binding resins was detected within the first treatment hour. Conclusion: MERS-CoV (pseudovirus) and MARV soluble GPs are eliminated by LAP in vitro. Considering the high lethality and missing established treatment options, LAP should be evaluated in vivo. Especially early initiation, continuous therapy, and timed cartridge exchanges could be of importance.

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“…The three most frequent symptoms are: fever (77% [IQR: 59-82]), cough (90% [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69]), and dyspnea (68% ).…”

Section: Clinical Symptomsmentioning

confidence: 99%

“…Positive PCR results for MERS-CoV in blood at diagnosis are associated with an increased risk of requiring mechanical ventilation, extracorporeal membrane oxygenation (ECMO) or to lead to death [58,59].…”

Section: Risk Factors For Severe Mersmentioning

confidence: 99%

Focus on Middle East respiratory syndrome coronavirus (MERS-CoV)

Bleibtreu

Bertine

Bertin

et al. 2020

Médecine et Maladies Infectieuses

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a b s t r a c tSince the first case of human infection by the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in June 2012, more than 2260 cases of confirmed MERS-CoV infection and 803 related deaths have been reported since the 16th of October 2018. The vast majority of these cases (71%) were reported in Saudi Arabia but the epidemic has now spread to 27 countries and has not ceased 6 years later, unlike SARS-CoV that disappeared a little less than 2 years after emerging. Due to the high fatality rate observed in MERS-CoV infected patients (36%), much effort has been put into understanding the origin and pathophysiology of this novel coronavirus to prevent it from becoming endemic in humans. This review focuses in particular on the origin, epidemiology and clinical manifestations of MERS-CoV, as well as the diagnosis and treatment of infected patients. The experience gained over recent years on how to manage the different risks related to this kind of epidemic will be key to being prepared for future outbreaks of communicable disease. Mots clés : Maladies émergentes MERS-CoV Coronavirus Pneumonie r é s u m é Depuis le premier cas d'infection liée au Middle East Respiratory Syndrome -Coronavirus (MERS-CoV), détecté en Arabie Saoudite en juin 2012, le MERS-CoV a donné lieu, au 16 octobre 2018, à plus de 2260 cas d'infections confirmées et à 803 décès. La grande majorité des cas (71 %) ont été déclarés en ArabieSaoudite mais l'épidémie a depuis touché 27 pays et n'est toujours pas enrayée 6 ans après son émergence, contrairement au SRAS-CoV qui a disparu un peu moins de deux ans après sa première détection. En raison du taux important de décès observé parmi les patients infectés par le MERS-CoV (36 %), beaucoup d'efforts ont été déployés pour comprendre l'origine et la physiopathologie de ce nouveau coronavirus ainsi que pour lutter contre une éventuelle installation endémique de ce virus au sein de la population humaine. Cette revue s'attache plus particulièrement à retracer l'origine et l'épidémiologie du MERS-CoV à décrire la clinique observée chez les patients ainsi que la prise en charge diagnostique et thérapeutique des patients infectés. L'expérience acquise au cours des dernières années dans la gestion des différents risques liés à ce type d'épidémie est importante pour pouvoir faire face à la prochaine émergence d'infection transmissible.

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Viral RNA in Blood as Indicator of Severe Outcome in Middle East Respiratory Syndrome Coronavirus Infection

Cited by 46 publications

References 14 publications

Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella

Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella

Lectin Affinity Plasmapheresis for Middle East Respiratory Syndrome-Coronavirus and Marburg Virus Glycoprotein Elimination

Focus on Middle East respiratory syndrome coronavirus (MERS-CoV)

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