Middle East respiratory syndrome coronavirus infection physical examination: Difference between revisions

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==Overview==
==Overview==
[[MERS|Middle East Respiratory Syndrome]] ([[MERS]]) is a [[viral]] [[respiratory disease|respiratory illness]]. It is caused by an emerging [[coronavirus]], specifically a ''betacoronavirus'' called [[Middle east respiratory syndrome coronavirus|MERS-CoV]] ([[Middle east respiratory syndrome coronavirus|Middle East Respiratory Syndrome Coronavirus]]), first discovered in 2012. Being a relatively novel [[virus]], there is no [[virus]]-specific [[prevention]] or treatment options for [[MERS]] patients. Attending to the fact that a [[vaccine]] hasn't been developed yet, enhancing [[infection]] prevention and control measures is critical to prevent the possible spread of [[MERS-CoV]] in hospitals and communities. Persons with [[symptoms]] suspicious of [[MERS-CoV]] [[infection]] need medical evaluation. [[Physical examination]] by a health care provider may reveal [[fever]], [[hypothermia]], [[tachypnea]], [[hypotension]], [[tachycardia]], and/or low [[oxygen saturation]]. Additionally, people who are struggling to [[breathe]], [[confusion|confused]] or who have [[cyanosis]] require immediate attention.<ref name="pmid24841273">{{cite journal| author=Dyall J, Coleman CM, Hart BJ, Venkataraman T, Holbrook MR, Kindrachuk J et al.| title=Repurposing of clinically developed drugs for treatment of Middle East Respiratory Coronavirus Infection. | journal=Antimicrob Agents Chemother | year= 2014 | volume=  | issue=  | pages=  | pmid=24841273 | doi=10.1128/AAC.03036-14 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24841273  }} </ref><ref name=WHO>{{cite web | title = Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do | url = http://www.who.int/csr/disease/coronavirus_infections/InterimGuidance_ClinicalManagement_NovelCoronavirus_11Feb13u.pdf }}</ref><ref name=CDC>{{cite web | title = MERS Prevention and Treatment | url = http://www.cdc.gov/coronavirus/MERS/about/prevention.html }}</ref>
Patients with MERS-CoV infection typically present with vital signs derangement, such as high-grade fever, tachycardia, tachypnea, and decreased oxygen saturation. Signs on physical examination may include decreased breath sounds, crackles, dullness on percussion, and increased tactile fremitus on pulmonary auscultation. Signs of complications may also be present, such as profound hypotension (suggestive of shock) or pericardial rub (suggestive of pericarditis).<ref name="pmid24841273">{{cite journal| author=Dyall J, Coleman CM, Hart BJ, Venkataraman T, Holbrook MR, Kindrachuk J et al.| title=Repurposing of clinically developed drugs for treatment of Middle East Respiratory Coronavirus Infection. | journal=Antimicrob Agents Chemother | year= 2014 | volume=  | issue=  | pages=  | pmid=24841273 | doi=10.1128/AAC.03036-14 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24841273  }} </ref><ref name=WHO>{{cite web | title = Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do | url = http://www.who.int/csr/disease/coronavirus_infections/InterimGuidance_ClinicalManagement_NovelCoronavirus_11Feb13u.pdf }}</ref><ref name=CDC>{{cite web | title = MERS Prevention and Treatment | url = http://www.cdc.gov/coronavirus/MERS/about/prevention.html }}</ref>


==Physical Examination==
==Physical Examination==
Patients infected by [[MERS-CoV]] usually present to the hospital in critically ill condition, although some studies have reported some mild or even asymptomatic cases.<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=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>
Typical signs on physical examination for MERS-CoV primary infection are shown below. Additionally, signs for MERS-CoV-associated [[Middle East respiratory syndrome coronavirus infection #Natural history, complications & prognosis|complications]] may also be present.
According to the progression of the disease, the physical findings will change and are usually suggestive of [[respiratory infection]]. However, in critically ill patients other systems may be affected, in which case, physical evaluation may include extrapulmonary findings. These findings may be suggestive of:
===General Appearance===
*acute kidney injury
*Hospitalized patients are usually sick-looking and may be in a critically ill condition.<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>
*pericarditis
*disseminated intravascular coagulation
*shock


===Vital Signs===
===Vital Signs===
* [[Hypotension]] (< 90 mm Hg)
* [[Hypotension]]  
* [[Tachycardia]] (> 125 beats/min)
* [[Tachycardia]]  
* [[Tachypnea]]
* [[Tachypnea]]
* [[Fever]]
* [[Fever]] (typically high-grade)
* [[Decreased oxygen saturation]]
* [[Decreased oxygen saturation]]


===Lungs===
===HEENT===
====Palpation====
*Tonsillar swelling
* Increased tactile [[fremitus]] suggests [[pneumonia]] as an alternative [[diagnosis]]


====Percussion====
===Cardiothoracic===
* Dullness on [[percussion]] suggests [[pneumonia]] as an alternative diagnosis
*[[Stridor]]
 
*Decreased [[breath sounds]]
====Auscultation====
*[[Crackles]], [[rhonchi]], [[wheezing]] on pulmonary auscultation
* Decreased breath sounds
*Dullness on thoracic percussion
*Increased [[tactile fremitus]]
*High intensity [[egophony]]


==References==
==References==
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{{WS}}
{{WS}}
[[category:disease]]
[[category:disease]]
[[Category:Infectious 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

Patients with MERS-CoV infection typically present with vital signs derangement, such as high-grade fever, tachycardia, tachypnea, and decreased oxygen saturation. Signs on physical examination may include decreased breath sounds, crackles, dullness on percussion, and increased tactile fremitus on pulmonary auscultation. Signs of complications may also be present, such as profound hypotension (suggestive of shock) or pericardial rub (suggestive of pericarditis).[1][2][3]

Physical Examination

Typical signs on physical examination for MERS-CoV primary infection are shown below. Additionally, signs for MERS-CoV-associated complications may also be present.

General Appearance

  • Hospitalized patients are usually sick-looking and may be in a critically ill condition.[3][4]

Vital Signs

HEENT

  • Tonsillar swelling

Cardiothoracic

References

  1. Dyall J, Coleman CM, Hart BJ, Venkataraman T, Holbrook MR, Kindrachuk J; et al. (2014). "Repurposing of clinically developed drugs for treatment of Middle East Respiratory Coronavirus Infection". Antimicrob Agents Chemother. doi:10.1128/AAC.03036-14. PMID 24841273.
  2. "Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do" (PDF).
  3. 3.0 3.1 "MERS Prevention and Treatment".
  4. 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.

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