Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients

Abstract

BackgroundMiddle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection.MethodsRetrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples.ResultsDuring the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11–302.1, P = 0.04).ConclusionsMERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1303-8) contains supplementary material, which is available to authorized users.

Middle East Respiratory Syndrome Coronavirus: Are Makkah Medical Students Sufficiently Aware of It?

“…They mainly include cough and shortness of breath, as shown by evidence. (10) Up to date, there is no specific treatment or antiviral drugs for MERS-CoV, only supportive treatment is considered for management. (11) During Hajj season, millions of Muslims pilgrim to Makkah city as a part of their religious rituals.…”

MERS coronavirus outbreak: Implications for emerging viral infections

“…Since then, most outbreaks have occurred in KSA. These include a cluster of 25 cases in Al-Hasa between April 1st and May 23rd 2013 (Assiri et al, 2013a), 255 laboratory-confirmed cases in Jeddah between January 1st and May 16th, 2014 (Drosten et al, 2015;Oboho et al, 2015), 45 cases in King Fahad Medical City in Riyadh between March 29th and May 21st, 2014, with contemporaneous outbreaks in other Riyadh hospitals between March and April 2014 (Almekhlafi et al, 2016;Fagbo et al, 2015), and 130 cases at King Abulaziz Medical City in Riyadh during late June-late August 2015 (Balkhy et al, 2016a). An exception was the major outbreak that occurred in in the Republic of Korea between 20 May and 27 July 2015 (Nishiura et al, 2016a,b;Park et al, 2015).…”

“…Clearly, MERS-CoV is a serious public health issue in KSA. Extended outbreaks of the disease have been focused on healthcare facilities, with transmission apparently dependent on close human-to-human contact (Almekhlafi et al, 2016;Assiri et al, 2013a;Balkhy et al, 2016a;Drosten et al, 2015;Fagbo et al, 2015;Oboho et al, 2015). The emergence of this disease has therefore had a profound impact on infection control and prevention procedures in KSA as outbreaks in healthcare facilities have been associated with defective or inadequate infection prevention and control measures (Balkhy et al, 2016b;Butt et al, 2016;Cotten et al, 2014;Hastings et al, 2016).…”

“…Human-to-human transmission was also responsible for most of the MERS-CoV cases reported during the outbreak that occurred in Jeddah in 2014 (Oboho et al, 2015). The majority of cases were attributable to contact with a health care facility, other patients, or both, highlighting the role of healthcare facilities in human-to-human transmission that also arose in subsequent outbreaks, including hospital outbreaks in Riyadh and the 2015 outbreak in Korea (Oboho et al, 2015;Drosten et al, 2015;Fagbo et al, 2015;Almekhlafi et al, 2016;Balkhy et al, 2016a; Middle East respiratory syndrome coronavirus (MERS-CoV) -Republic of Korea, 2015). As explained above, healthcare facility human-to-human transmission has been associated with defective or inadequate infection prevention and control measures (Scientific Advisory Board, Ministry of Health, Kingdom of Saudi Arabia, n.d.; Balkhy et al, 2016b;Butt et al, 2016;Coronavirus infections, 2017;Cotten et al, 2014;Hastings et al, 2016).…”

Influenza is more common than Middle East Respiratory Syndrome Coronavirus (MERS-CoV) among hospitalized adult Saudi patients

“…The virus was initially isolated from a patient with a fatal community acquired pneumonia (CAP) in Saudi Arabia [1]. Since then, multiple hospital outbreaks occurred within [2][3][4][5][6][7] and outside Saudi Arabia [8][9][10][11]. As of May 1st, 2017, the World Health Organization reported 1952 laboratory-confirmed cases worldwide and at least 693 related deaths [12].…”