Middle East respiratory syndrome coronavirus infection pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

MERS-CoV has a strong tropism for the non-ciliated bronchial epithelium. The virus has the capacity to evade the innate immune system and inhibit interferon production. It uses the DPP4 (or CD26) receptor to bind to the host cell and to release viral nucleocapsid into the cellular cytoplasm. Once inside the cell, viral replication follows and proteins are expressed. The viral genes encode 4 structural proteins and 5 accessory proteins.

Pathophysiology

Incubation Period

  • The incubation period for MERS infection is 5–7 days, with a range of 2–14 days.[1][2]
  • Immunocompromised patients can present with longer incubation periods of up to 20 days.

Cellular Pathogenesis

Genome

The betacoronavirus contains a genome composed of 30,119 nucleotides that encodes structural and non-structural proteins. The genome is considered the largest among all RNA virus genomes, reaching 27-32 kb in size.

Protein Expression

The structural proteins expressed by the betacoronavirus include:[5][13]

All 4 structural proteins are encoded by genes located at the 3' end of the RNA chain. In addition to the 4 structural proteins, the genome encodes 5 accessory proteins involved in viral assembly and evasion of the host immune system.[14][13]

Tropism

Transmission

  • MERS-CoV is thought to have a zoonotic activity, whereby transmission occurs from animals to humans.
  • Although bats are the natural host of the betacoronavirus, it is unknown if MERS coronavirus transmission to humans is through bats, through an intermediate animal hosts following crossover and subsequent adaptation, or through a completely different host.
  • Limited data is available to confirm or rule out human-to-human transmission.

Associated Conditions

References

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