Middle Eastern Respiratory Syndrome Corona Virus (MERS CoV): case reports from a tertiary care hospital in Saudi Arabia

Abstract

BACKGROUND AND OBJECTIVESMiddle Eastern respiratory syndrome caused by novel coronavirus (MERS CoV) has been a major public health challenge since it was first described in 2012 in Saudi Arabia. So far, there is no effective treatment for this serious illness, which features a high mortality rate. We report an initial experience of the use of ribavirin and interferon (IFN)-α2b in the management of MERS CoV at a tertiary care hospital.DESIGN AND SETTINGSA case series of 6 patients admitted with a confirmed diagnosis of MERS CoV were treated with ribavirin and IFN-α2b in addition to supportive management. The patients’ demographics, clinical parameters, and outcomes were recorded. Fifty-four close contacts of these patients were screened for MERS CoV.METHODSSix patients with MERS CoV infection were included in this study. Four cases featured symptomatic disease, including pneumonia and respiratory failure, while 2 were asymptomatic close contacts of the MERS CoV patients. The MERS CoV infection was confirmed by reverse transcription–polymerase chain reaction detection of the consensus viral RNA targets upstream of the E gene (UPE) and open reading frame (ORF1b) on a sputum sample. The patients’ demographics, comorbid conditions, time to diagnosis and initiation of treatment, and clinical outcomes were recorded.RESULTSThree out of 6 patients who had comorbid conditions died during the study period, while 3 had successful outcomes. The diagnosis and treatment was delayed by an average of 15 days in those patients who died. Only 2 close contacts out of the 54 screened (3.7%) were positive for MERS CoV.CONCLUSIONTreatment with ribavirin and IFN-α2b may be effective in patients infected with MERS CoV. There appears to be a low infectivity rate among close contacts of MERS CoV patients.

Clinical outcomes of current medical approaches for Middle East respiratory syndrome: A systematic review and meta‐analysis

“…A total of 1095 references were retrieved. Upon screening them regarding inclusion and exclusion criteria from Section 2, eleven references were included for data extraction and analysis . Additionally, 5 references were identified through manual search .…”

“…Of the 16 studies including 116 patients, 10 were case reports, 2 were case series, and 4 were observational studies . Saudi Arabia was the country of origin for patients in 13 studies, and the rest were from France, Greece, and Qatar.…”

“…Eight studies used specific antiviral treatment while 7 studies used supportive treatment (including invasive ventilation, prone position, renal replacement therapy, vasopressors, corticosteroids, immunoglobulins, and oseltamivir) . Omrani et al used both specific antiviral treatment and supportive treatment.…”

“…The quality of 10 case reports and 2 case series was assessed using the CARE checklist (Table S1, Found in the Supporting Information). All of them contained an introduction and described the importance of the case in the abstract, main introduction section, demographics and symptoms of the patients, significant clinical findings, timeline for patients' history organization, diagnostic methods, type of treatment, clinical outcomes, discussion of the relevant medical literature, rationale for conclusion, and the primary take away lessons from these case reports.…”

Middle East respiratory syndrome coronavirus: current knowledge and future considerations

“…One-third of patients have gastrointestinal symptoms (1,6,7,36,39,(50)(51)(52). Chest radiography and computed tomography findings are generally consistent with viral pneumonitis and acute respiratory distress syndrome (7,8,47,(53)(54)(55), and laboratory findings include leukopenia, particularly lymphopenia (1,7,8,39,56).…”