Middle East respiratory syndrome coronavirus infection natural history, complications and prognosis: Difference between revisions
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{{MERS}} | {{MERS}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{JS}} | ||
==Overview== | ==Overview== | ||
Following exposure, patients with MERS-CoV remain asymptomatic during the incubation period for 5 to 14 days. If left untreated, patients typically develop non-specific flu-like symptoms, such as high-grade [[fever]], [[myalgia]], [[sore throat]], and [[cough]]. Many patients experience spontaneous self-resolution of symptoms a few days following the onset of symptoms. Patients with systemic chronic comorbidities and immunosuppression are at high risk of developing worsening clinical features, such as [[acute respiratory distress syndrome]] (ARDS), [[acute kidney injury]] (AKI), [[pericarditis]], [[disseminated intravascular coagulopathy]] (DIC), and [[septic shock]]. Approximately 30-40% of patients die following MERS-CoV infection. | |||
==Natural History== | ==Natural History== | ||
===Incubation Period=== | |||
*The incubation period for MERS-CoV ranges from 5 to 14 days.<ref name="pmid23678167">{{cite journal| author=de Groot RJ, Baker SC, Baric RS, Brown CS, Drosten C, Enjuanes L et al.| title=Middle East respiratory syndrome coronavirus (MERS-CoV): announcement of the Coronavirus Study Group. | journal=J Virol | year= 2013 | volume= 87 | issue= 14 | pages= 7790-2 | pmid=23678167 | doi=10.1128/JVI.01244-13 | pmc=PMC3700179 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23678167 }} </ref><ref name="pmid23782161">{{cite journal| author=Assiri A, McGeer A, Perl TM, Price CS, Al Rabeeah AA, Cummings DA et al.| title=Hospital outbreak of Middle East respiratory syndrome coronavirus. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 5 | pages= 407-16 | pmid=23782161 | doi=10.1056/NEJMoa1306742 | pmc=PMC4029105 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23782161 }} </ref> During this time, individuals who have been exposed and acquired the infection will remain asymptomatic. | |||
===Onset of Clinical Manifestations=== | |||
*Following transmission, patients typically first develop high-grade fever and non-specific flu-like symptoms, such as myalgia, dizziness, diaphoresis, sore throat, vomiting, diarrhea, cough, dyspnea, and abdominal pain. | |||
*Although the majority of patients develop symptoms, 15-20% may experience no or mild clinical manifestations. | |||
===Development of Worsening Symptoms=== | |||
*If left untreated, the majority of patients experience spontaneous self resolution of the infection. | |||
*Immunocompromised individuals or patients with significant comorbidities are at high risk of developing worsening symptoms and either pulmonary or extrapulmonary complications, including [[pneumonia]], [[acute respiratory distress syndrome]] ([[ARDS]]), [[acute kidney injury]], [[pericarditis]], [[disseminated intravascular coagulopathy]] ([[DIC]]), [[septic shock]], and death. | |||
==Complications== | ==Complications== | ||
MERS-CoV-associated complications include the following:<ref name=CDC>{{cite web | title = Updated Information on the Epidemiology of Middle East Respiratory Syndrome Coronavirus | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6238a4.htm }}</ref><ref name="MemishZumla2013">{{cite journal|last1=Memish|first1=Ziad A.|last2=Zumla|first2=Alimuddin I.|last3=Assiri|first3=Abdullah|title=Middle East Respiratory Syndrome Coronavirus Infections in Health Care Workers|journal=New England Journal of Medicine|volume=369|issue=9|year=2013|pages=884–886|issn=0028-4793|doi=10.1056/NEJMc1308698}}</ref><ref name="MemishZumla2013">{{cite journal|last1=Memish|first1=Ziad A.|last2=Zumla|first2=Alimuddin I.|last3=Al-Hakeem|first3=Rafat F.|last4=Al-Rabeeah|first4=Abdullah A.|last5=Stephens|first5=Gwen M.|title=Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections|journal=New England Journal of Medicine|volume=368|issue=26|year=2013|pages=2487–2494|issn=0028-4793|doi=10.1056/NEJMoa1303729}}</ref><ref name="Zakivan Boheemen2012">{{cite journal|last1=Zaki|first1=Ali M.|last2=van Boheemen|first2=Sander|last3=Bestebroer|first3=Theo M.|last4=Osterhaus|first4=Albert D.M.E.|last5=Fouchier|first5=Ron A.M.|title=Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia|journal=New England Journal of Medicine|volume=367|issue=19|year=2012|pages=1814–1820|issn=0028-4793|doi=10.1056/NEJMoa1211721}}</ref><ref name=WHO1>{{cite web | title = Novel coronavirus summary and literature update as of 17 May 2013 | url = http://www.who.int/csr/disease/coronavirus_infections/update_20130517/en/ }}</ref><ref name="DrostenSeilmaier2013">{{cite journal|last1=Drosten|first1=Christian|last2=Seilmaier|first2=Michael|last3=Corman|first3=Victor M|last4=Hartmann|first4=Wulf|last5=Scheible|first5=Gregor|last6=Sack|first6=Stefan|last7=Guggemos|first7=Wolfgang|last8=Kallies|first8=Rene|last9=Muth|first9=Doreen|last10=Junglen|first10=Sandra|last11=Müller|first11=Marcel A|last12=Haas|first12=Walter|last13=Guberina|first13=Hana|last14=Röhnisch|first14=Tim|last15=Schmid-Wendtner|first15=Monika|last16=Aldabbagh|first16=Souhaib|last17=Dittmer|first17=Ulf|last18=Gold|first18=Hermann|last19=Graf|first19=Petra|last20=Bonin|first20=Frank|last21=Rambaut|first21=Andrew|last22=Wendtner|first22=Clemens-Martin|title=Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection|journal=The Lancet Infectious Diseases|volume=13|issue=9|year=2013|pages=745–751|issn=14733099|doi=10.1016/S1473-3099(13)70154-3}}</ref><ref name="AssiriMcGeer2013">{{cite journal|last1=Assiri|first1=Abdullah|last2=McGeer|first2=Allison|last3=Perl|first3=Trish M.|last4=Price|first4=Connie S.|last5=Al Rabeeah|first5=Abdullah A.|last6=Cummings|first6=Derek A.T.|last7=Alabdullatif|first7=Zaki N.|last8=Assad|first8=Maher|last9=Almulhim|first9=Abdulmohsen|last10=Makhdoom|first10=Hatem|last11=Madani|first11=Hossam|last12=Alhakeem|first12=Rafat|last13=Al-Tawfiq|first13=Jaffar A.|last14=Cotten|first14=Matthew|last15=Watson|first15=Simon J.|last16=Kellam|first16=Paul|last17=Zumla|first17=Alimuddin I.|last18=Memish|first18=Ziad A.|title=Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus|journal=New England Journal of Medicine|volume=369|issue=5|year=2013|pages=407–416|issn=0028-4793|doi=10.1056/NEJMoa1306742}}</ref><ref name="GueryPoissy2013">{{cite journal|last1=Guery|first1=Benoit|last2=Poissy|first2=Julien|last3=el Mansouf|first3=Loubna|last4=Séjourné|first4=Caroline|last5=Ettahar|first5=Nicolas|last6=Lemaire|first6=Xavier|last7=Vuotto|first7=Fanny|last8=Goffard|first8=Anne|last9=Behillil|first9=Sylvie|last10=Enouf|first10=Vincent|last11=Caro|first11=Valérie|last12=Mailles|first12=Alexandra|last13=Che|first13=Didier|last14=Manuguerra|first14=Jean-Claude|last15=Mathieu|first15=Daniel|last16=Fontanet|first16=Arnaud|last17=van der Werf|first17=Sylvie|title=Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission|journal=The Lancet|volume=381|issue=9885|year=2013|pages=2265–2272|issn=01406736|doi=10.1016/S0140-6736(13)60982-4}}</ref><ref name="AssiriAl-Tawfiq2013">{{cite journal|last1=Assiri|first1=Abdullah|last2=Al-Tawfiq|first2=Jaffar A|last3=Al-Rabeeah|first3=Abdullah A|last4=Al-Rabiah|first4=Fahad A|last5=Al-Hajjar|first5=Sami|last6=Al-Barrak|first6=Ali|last7=Flemban|first7=Hesham|last8=Al-Nassir|first8=Wafa N|last9=Balkhy|first9=Hanan H|last10=Al-Hakeem|first10=Rafat F|last11=Makhdoom|first11=Hatem Q|last12=Zumla|first12=Alimuddin I|last13=Memish|first13=Ziad A|title=Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study|journal=The Lancet Infectious Diseases|volume=13|issue=9|year=2013|pages=752–761|issn=14733099|doi=10.1016/S1473-3099(13)70204-4}}</ref><ref name="ArabiArifi2014">{{cite journal|last1=Arabi|first1=Yaseen M.|last2=Arifi|first2=Ahmed A.|last3=Balkhy|first3=Hanan H.|last4=Najm|first4=Hani|last5=Aldawood|first5=Abdulaziz S.|last6=Ghabashi|first6=Alaa|last7=Hawa|first7=Hassan|last8=Alothman|first8=Adel|last9=Khaldi|first9=Abdulaziz|last10=Al Raiy|first10=Basel|title=Clinical Course and Outcomes of Critically Ill Patients With Middle East Respiratory Syndrome Coronavirus Infection|journal=Annals of Internal Medicine|volume=160|issue=6|year=2014|pages=389-397|issn=0003-4819|doi=10.7326/M13-2486}}</ref><ref name=WHO2>{{cite web | title = Background and summary of novel coronavirus infection - as of 21 December 2012 | url = http://www.who.int/csr/disease/coronavirus_infections/update_20121221/en/ }}</ref> | |||
*[[Pneumonia]] | *[[Pneumonia]] | ||
*[[Acute respiratory distress syndrome]] | *[[Pericarditis]] | ||
*[[Acute respiratory distress syndrome]] (ARDS) | |||
*[[Acute kidney injury]] | *[[Acute kidney injury]] | ||
*[[ | *[[Spontaneous abortion]] among pregnant women | ||
*[[Disseminated intravascular | *[[Disseminated intravascular coagulopathy]] (DIC) | ||
*[[ | *[[Septic shock]] | ||
*[[Death]] | *[[Death]] | ||
==Prognosis== | ==Prognosis== | ||
*If left untreated, the majority of patients experience self-resolution with excellent prognosis. Patients with systemic chronic comorbidities have a poorer prognosis and are at a higher risk of development of complications and death. | |||
*Compared with other respiratory viruses, MERS-CoV is associated with higher risk of death (30% to 40%).<ref name=CDC1>{{cite web | title = Symptoms & Complications | url = http://www.cdc.gov/coronavirus/MERS/about/symptoms.html }}</ref> | |||
==References== | ==References== | ||
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{{WS}} | {{WS}} | ||
[[category:Disease]] | [[category:Disease]] | ||
[[category:Virology]] | [[category:Virology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
Latest revision as of 18:05, 18 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Following exposure, patients with MERS-CoV remain asymptomatic during the incubation period for 5 to 14 days. If left untreated, patients typically develop non-specific flu-like symptoms, such as high-grade fever, myalgia, sore throat, and cough. Many patients experience spontaneous self-resolution of symptoms a few days following the onset of symptoms. Patients with systemic chronic comorbidities and immunosuppression are at high risk of developing worsening clinical features, such as acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), pericarditis, disseminated intravascular coagulopathy (DIC), and septic shock. Approximately 30-40% of patients die following MERS-CoV infection.
Natural History
Incubation Period
- The incubation period for MERS-CoV ranges from 5 to 14 days.[1][2] During this time, individuals who have been exposed and acquired the infection will remain asymptomatic.
Onset of Clinical Manifestations
- Following transmission, patients typically first develop high-grade fever and non-specific flu-like symptoms, such as myalgia, dizziness, diaphoresis, sore throat, vomiting, diarrhea, cough, dyspnea, and abdominal pain.
- Although the majority of patients develop symptoms, 15-20% may experience no or mild clinical manifestations.
Development of Worsening Symptoms
- If left untreated, the majority of patients experience spontaneous self resolution of the infection.
- Immunocompromised individuals or patients with significant comorbidities are at high risk of developing worsening symptoms and either pulmonary or extrapulmonary complications, including pneumonia, acute respiratory distress syndrome (ARDS), acute kidney injury, pericarditis, disseminated intravascular coagulopathy (DIC), septic shock, and death.
Complications
MERS-CoV-associated complications include the following:[3][4][4][5][6][7][8][9][10][11][12]
- Acute respiratory distress syndrome (ARDS)
- Acute kidney injury
- Spontaneous abortion among pregnant women
- Disseminated intravascular coagulopathy (DIC)
- Septic shock
- Death
Prognosis
- If left untreated, the majority of patients experience self-resolution with excellent prognosis. Patients with systemic chronic comorbidities have a poorer prognosis and are at a higher risk of development of complications and death.
- Compared with other respiratory viruses, MERS-CoV is associated with higher risk of death (30% to 40%).[13]
References
- ↑ de Groot RJ, Baker SC, Baric RS, Brown CS, Drosten C, Enjuanes L; et al. (2013). "Middle East respiratory syndrome coronavirus (MERS-CoV): announcement of the Coronavirus Study Group". J Virol. 87 (14): 7790–2. doi:10.1128/JVI.01244-13. PMC 3700179. PMID 23678167.
- ↑ Assiri A, McGeer A, Perl TM, Price CS, Al Rabeeah AA, Cummings DA; et al. (2013). "Hospital outbreak of Middle East respiratory syndrome coronavirus". N Engl J Med. 369 (5): 407–16. doi:10.1056/NEJMoa1306742. PMC 4029105. PMID 23782161.
- ↑ "Updated Information on the Epidemiology of Middle East Respiratory Syndrome Coronavirus".
- ↑ 4.0 4.1 Memish, Ziad A.; Zumla, Alimuddin I.; Assiri, Abdullah (2013). "Middle East Respiratory Syndrome Coronavirus Infections in Health Care Workers". New England Journal of Medicine. 369 (9): 884–886. doi:10.1056/NEJMc1308698. ISSN 0028-4793.
- ↑ Zaki, Ali M.; van Boheemen, Sander; Bestebroer, Theo M.; Osterhaus, Albert D.M.E.; Fouchier, Ron A.M. (2012). "Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia". New England Journal of Medicine. 367 (19): 1814–1820. doi:10.1056/NEJMoa1211721. ISSN 0028-4793.
- ↑ "Novel coronavirus summary and literature update as of 17 May 2013".
- ↑ Drosten, Christian; Seilmaier, Michael; Corman, Victor M; Hartmann, Wulf; Scheible, Gregor; Sack, Stefan; Guggemos, Wolfgang; Kallies, Rene; Muth, Doreen; Junglen, Sandra; Müller, Marcel A; Haas, Walter; Guberina, Hana; Röhnisch, Tim; Schmid-Wendtner, Monika; Aldabbagh, Souhaib; Dittmer, Ulf; Gold, Hermann; Graf, Petra; Bonin, Frank; Rambaut, Andrew; Wendtner, Clemens-Martin (2013). "Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection". The Lancet Infectious Diseases. 13 (9): 745–751. doi:10.1016/S1473-3099(13)70154-3. ISSN 1473-3099.
- ↑ Assiri, Abdullah; McGeer, Allison; Perl, Trish M.; Price, Connie S.; Al Rabeeah, Abdullah A.; Cummings, Derek A.T.; Alabdullatif, Zaki N.; Assad, Maher; Almulhim, Abdulmohsen; Makhdoom, Hatem; Madani, Hossam; Alhakeem, Rafat; Al-Tawfiq, Jaffar A.; Cotten, Matthew; Watson, Simon J.; Kellam, Paul; Zumla, Alimuddin I.; Memish, Ziad A. (2013). "Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus". New England Journal of Medicine. 369 (5): 407–416. doi:10.1056/NEJMoa1306742. ISSN 0028-4793.
- ↑ Guery, Benoit; Poissy, Julien; el Mansouf, Loubna; Séjourné, Caroline; Ettahar, Nicolas; Lemaire, Xavier; Vuotto, Fanny; Goffard, Anne; Behillil, Sylvie; Enouf, Vincent; Caro, Valérie; Mailles, Alexandra; Che, Didier; Manuguerra, Jean-Claude; Mathieu, Daniel; Fontanet, Arnaud; van der Werf, Sylvie (2013). "Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission". The Lancet. 381 (9885): 2265–2272. doi:10.1016/S0140-6736(13)60982-4. ISSN 0140-6736.
- ↑ Assiri, Abdullah; Al-Tawfiq, Jaffar A; Al-Rabeeah, Abdullah A; Al-Rabiah, Fahad A; Al-Hajjar, Sami; Al-Barrak, Ali; Flemban, Hesham; Al-Nassir, Wafa N; Balkhy, Hanan H; Al-Hakeem, Rafat F; Makhdoom, Hatem Q; Zumla, Alimuddin I; Memish, Ziad A (2013). "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study". The Lancet Infectious Diseases. 13 (9): 752–761. doi:10.1016/S1473-3099(13)70204-4. ISSN 1473-3099.
- ↑ Arabi, Yaseen M.; Arifi, Ahmed A.; Balkhy, Hanan H.; Najm, Hani; Aldawood, Abdulaziz S.; Ghabashi, Alaa; Hawa, Hassan; Alothman, Adel; Khaldi, Abdulaziz; Al Raiy, Basel (2014). "Clinical Course and Outcomes of Critically Ill Patients With Middle East Respiratory Syndrome Coronavirus Infection". Annals of Internal Medicine. 160 (6): 389–397. doi:10.7326/M13-2486. ISSN 0003-4819.
- ↑ "Background and summary of novel coronavirus infection - as of 21 December 2012".
- ↑ "Symptoms & Complications".