Importance of Specimen Type and Quality in Diagnosing Middle East Respiratory Syndrome

Huh, Hee Jae; Ko, Jae-Hoon; Kim, Young Eun; Park, Chang-Hun; Hong, Gwan Ui; Choi, Rihwa; Yu, Shinae; Cho, Sun Young; Kang, Jeung-Mo; Lee, Myoung Keun; Ki, Chang Seok; Kang, Eun Suk; Lee, Nam Yong; Kim, Jong Won; Kim, Yae Jean; Ha, Young Eun; Kang, Cheol In; Chung, Doo Ryeon; Peck, Kyong Ran; Song, Jae Hoon

doi:10.3343/alm.2017.37.1.81

Cited by 9 publications

(10 citation statements)

References 5 publications

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“…She visited the ED again with the same symptoms on June 1, and was admitted to an isolation room because she had stayed with the MERS patient at a 223.9 m 2 -sized room of ED for 23 h on May 29 [3]. Although she did not have any MERS-related symptoms, she was screened for MERS-CoV infection by sputum rRT-PCR on June 4 [5]; the result was positive with a cycle threshold (Ct) value of 17.8. She remained in an asymptomatic status for four more days and received only supportive care and close monitoring.…”

Section: Case 1: Delayed Symptom Development After a Four-day Asymptomentioning

confidence: 99%

“…On June 18, she was diagnosed with miliary tuberculosis by chest computed tomography (CT) and sputum PCR for Mycobacterium tuberculosis complex, and anti-tuberculosis medication was started. Meanwhile, her follow-up sputum rRT-PCR for MERS-CoV was equivocal (Ct value of 37.1, with Ct values below 35 considered positive [5]) on the same day, converting to positive with a Ct value of 21.6 on June 22. She was intubated for mechanical ventilation the next day ( Fig.…”

Section: Case 2: Delayed Development Of Mers After a 20 Day Incubatiomentioning

confidence: 99%

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Atypical presentations of MERS-CoV infection in immunocompromised hosts

Kim

Park

et al. 2017

Journal of Infection and Chemotherapy

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During the 2015 Korean MERS outbreak, we experienced atypical presentations of MERS-CoV infections in three immunocompromised hosts that warranted exceptional management. Case 1 showed delayed symptom development after a four-day asymptomatic period, Case 2 experienced a 20-day incubation period, and Case 3 exhibited persistent viral shedding without clinical deterioration. Recognizing these exceptions is extremely important in the management of MERS-CoV-exposed or -infected patients and for control of potential MERS outbreaks.

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Section: Case 1: Delayed Symptom Development After a Four-day Asymptomentioning

confidence: 99%

Section: Case 2: Delayed Development Of Mers After a 20 Day Incubatiomentioning

confidence: 99%

Atypical presentations of MERS-CoV infection in immunocompromised hosts

Kim

Park

et al. 2017

Journal of Infection and Chemotherapy

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“…During the MERS outbreak in our hospital, six MERS-related patients underwent surgery including three possibly exposed patients, one directly exposed patient, and two MERS-confirmed patients who recovered from the disease. All patients were negative during two preoperative MERS screenings using real-time reverse transcription polymerase chain reaction (rRT-PCR) 14 . Figure 1 shows the total number of surgeries performed during the outbreak period at our hospital and the distribution of MERS-related patients undergoing surgery.…”

Section: Resultsmentioning

confidence: 99%

“…For MERS-CoV PCR tests, either sputum or nasopharyngeal swab samples were collected and sputum samples were preferred if available 14 . Sputum was collected directly into a sterile, leak-proof, screw-capped sputum collection sterile container and nasopharyngeal swab was collected with an eSwab (482 C, Copan Diagnostics Inc., Murrieta, CA, USA).…”

Section: Methodsmentioning

confidence: 99%

Infection Prevention Measures for Surgical Procedures during a Middle East Respiratory Syndrome Outbreak in a Tertiary Care Hospital in South Korea

Park

Yoo

et al. 2020

Sci Rep

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In 2015, we experienced the largest in-hospital Middle East respiratory syndrome (MERS) outbreak outside the Arabian Peninsula. We share the infection prevention measures for surgical procedures during the unexpected outbreak at our hospital. We reviewed all forms of related documents and collected information through interviews with healthcare workers of our hospital. After the onset of outbreak, a multidisciplinary team devised institutional MERS-control guidelines. Two standard operating rooms were converted to temporary negative-pressure rooms by physically decreasing the inflow air volume (−4.7 Pa in the main room and −1.2 Pa in the anteroom). Healthcare workers were equipped with standard or enhanced personal protective equipment according to the MERS-related patient's profile and symptoms. Six MERS-related patients underwent emergency surgery, including four MERS-exposed and two MERS-confirmed patients. Negative conversion of MERS-CoV polymerase chain reaction tests was noticed for MERS-confirmed patients before surgery. MERS-exposed patients were also tested twice preoperatively, all of which were negative. All operative procedures in MERSrelated patients were performed without specific adverse events or perioperative MERS transmission. Our experience with setting up a temporary negative-pressure operation room and our conservative approach for managing MERS-related patients can be referred in cases of future unexpected MERS outbreaks in non-endemic countries.The Middle East respiratory syndrome (MERS) is a serious acute respiratory disease caused by the MERS coronavirus (MERS-CoV), and the mortality rates in infected patients are estimated at 20-40% 1 . Since the first case report in Saudi Arabia in 2012 2 , MERS outbreaks have occurred mainly in Middle Eastern countries and a small number of imported cases arose in Europe, Asia, United States, and Africa 3-7 . From May to July 2015, South Korea experienced the largest MERS outbreak outside the Arabian Peninsula 8,9 . The South Korean outbreak resulted in 186 laboratory-confirmed MERS cases, 92 of which were associated with our tertiary care hospital 10,11 . According to our institutional policy during the MERS outbreak, all elective surgeries for MERS-related patients were postponed when possible. However, several MERS-related patients inevitably required emergency operations under anesthesia. Two of the 92-MERS confirmed cases and four MERS-exposed patients underwent surgery. Although there is some literature regarding infection prevention during operative procedures for severe acute respiratory syndrome (SARS) coronavirus 12,13 , guidelines or references for MERS prevention during perioperative patient care were very limited. Therefore, we developed institutional guidelines for perioperative MERS infection prevention and we set up a temporary negative-pressure operating room.In this globalized era, along with small and large outbreaks that persist in the Arabian Peninsula, MERS outbreaks may recur in any other regions, especially if a super spreader i...

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“…Published data show that lower respiratory tract sampling gives the highest yield, followed by sputum and nasopharyngeal swabs. [6][7][8][9] In addition, lower respiratory samples have highest MERS-CoV viral loads. 6,[10][11][12][13][14] The number of samples required for confirmation of diagnosis or clearance from positivity has not been clearly defined, and the pattern of positivity of repeat sampling has not been looked at systematically.…”

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confidence: 99%

Middle East respiratory syndrome coronavirus intermittent positive cases: Implications for infection control

Alfaraj

Al‐Tawfiq

Memish

2019

American Journal of Infection Control

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Background: Middle East respiratory syndrome coronavirus (MERS-CoV) continues to be reported from the Kingdom of Saudi Arabia. Data on the phenomenon of intermittent positive results for MERS-CoV on reverse-transcription polymerase chain reaction (RT-PCR) with negative results in between are lacking. Here we describe cases with intermittent positive MERS-CoV test results and highlight the required number of tests to rule out or rule in MERS-CoV infection based on a large retrospective cohort of patients with confirmed MERS-CoV. Methods: This analysis included cases admitted between January 2014 and December 2017. The included patients had a minimum of 3 nasopharyngeal MERS-CoV RT-PCR tests for confirmation and needed 2 negative samples for MERS-CoV evaluated 48 hours apart with clinical improvement or stabilization apart to ensure clearance. Results: A total of 408 patients with positive MERS-CoV test results were treated at the referring hospital. We excluded 72 patients who had only 1 swab result available in the system and were treated in the initial years of the disease. Of the remaining 336 patients, 300 (89%) had a positive result after 1 swab, 324 (96.5%) had a positive result after 2 consecutive swabs, and 328 (97.6%) had a positive result after 3 consecutive swabs. Of the total cases, 46 (13.7%) had a positive MERS-CoV test then a negative test, followed by positive test results. Conclusions: Our data indicate that 2 to 3 nasopharyngeal samples are needed to produce the highest yield of positive results for MERS-CoV. In addition, 2 negative results 48 hours apart with clinical improvement or stabilization are needed to clear patients from MERS-CoV. Evaluation of the yield of sputum samples is needed to assess the effectiveness against nasopharyngeal swabs.

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Importance of Specimen Type and Quality in Diagnosing Middle East Respiratory Syndrome

Cited by 9 publications

References 5 publications

Atypical presentations of MERS-CoV infection in immunocompromised hosts

Atypical presentations of MERS-CoV infection in immunocompromised hosts

Infection Prevention Measures for Surgical Procedures during a Middle East Respiratory Syndrome Outbreak in a Tertiary Care Hospital in South Korea

Middle East respiratory syndrome coronavirus intermittent positive cases: Implications for infection control

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