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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> |
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| ==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:<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="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=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><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>
| | ===General Appearance=== |
| *[[acute kidney injury#diagnosis|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#Physical Examination|pericarditis]]
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| *[[disseminated intravascular coagulation]]
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| *[[shock]]
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| ===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]] |
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| ===Lungs=== | | ===HEENT=== |
| ====Palpation====
| | *Tonsillar swelling |
| * Increased tactile [[fremitus]] suggests [[pneumonia]] as an alternative [[diagnosis]] | |
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| ====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]] |
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| ==References== | | ==References== |
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| {{WS}} | | {{WS}} |
| [[category:disease]] | | [[category:disease]] |
| [[Category:Infectious disease]]
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| [[category:virology]] | | [[category:virology]] |
| [[Category:Up-To-Date]] | | [[Category:Up-To-Date]] |