Novel human coronavirus infection: Difference between revisions
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* Not already explained by any other infection or etiology, including all clinically indicated tests for [[community-acquired pneumonia]] according to local management guidelines. | * Not already explained by any other infection or etiology, including all clinically indicated tests for [[community-acquired pneumonia]] according to local management guidelines. | ||
===Confirmed Case=== | ===Confirmed Case=== | ||
* A person with laboratory confirmation of infection with the novel [[coronavirus]]. | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 06:27, 31 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Human betacoronavirus 2c EMC/2012; novel coronavirus
Overview
Novel human coronavirus is a new strain of coronavirus that has not been previously identified in humans. A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. A novel coronavirus (human betacoronavirus 2c EMC/2012) has caused a handful of infections in three countries in the Middle East. Although it does not seem to transmit between humans, it can cause severe disease and death, and scientists are watching closely for new cases
Historical Perspective
The virus first emerged in the Middle East, and was discovered on September 2012 in a Qatari patient who had recently traveled to Saudi Arabia.[1] He is being treated for the respiratory disease, which has led to renal failure.[2] The first known case was a Saudi Arabian who died in early 2012. The World Health Organisation (WHO) announced that it is "engaged in further characterizing the novel coronavirus" and that it has "immediately alerted all its Member States about the virus and has been leading the coordination and providing guidance to health authorities and technical health agencies."[3] Virologist Ron Fouchier has speculated that the virus might originate from bats.[4]
Saudi Arabia's Ministry of Health was concerned that the virus might affect the October 2012 Hajj, the Islamic pilgrimage to Mecca, as Muslims making the Hajj may have been infected.[5]
Following the high-profile publicity of SARS outbreaks, there has been a renewed interest in coronaviruses in the field of virology. For many years, scientists knew only about the existence of two human coronaviruses (HCoV-229E and HCoV-OC43). The discovery of SARS-CoV added another human coronavirus to the list. By the end of 2004, three independent research labs reported the discovery of a fourth human coronavirus. It has been named NL63, NL or the New Haven coronavirus by the different research groups.[6] The naming of this fourth coronavirus is still a controversial issue, because the three labs are still battling over who actually discovered the virus first and hence earns the right to name the virus. Early in 2005, a research team at the University of Hong Kong reported finding a fifth human coronavirus in two pneumonia patients, and subsequently named it HKU1.
Classification
- HCoV-229E
- HCoV-OC43
- SARS-CoV
- NL63/NL/New Haven coronavirus
- HKU1-CoV
- HCoV-EMC
- Novel Coronavirus 2012
Pathophysiology
Transmission
- The cases occurring in the same family raises the possibility of limited human-to-human transmission. Alternatively, it is possible that the infected family members were exposed to the same source of infection, for example, in a household or workplace.
- There is currently no direct evidence that the human cases were exposed through direct contact with animals.
- The route taken by this coronavirus to infect humans is still not clear. It could, for example, be carried by intermediate animal hosts, or in foodstuffs contaminated by the faeces of bats or other infected animals.
Cytopathic Effects
The virus replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. [7]
This coronavirus seems to differ from the SARS virus in some important ways. SARS virus binds to the ACE-2 receptor on human cells deep in the lungs, it causes serious disease in the lower respiratory tract but is relatively difficult to contract and is not easily spread by coughing or sneezing. The researchers have determined that the new coronavirus does not bind to the ACE-2 receptor, but declined to elaborate on which receptor it does use. But ruling out the ACE-2 receptor has immediate practical implications all the reagents and therapeutic strategies developed for the SARS virus will be of little use.[8]
The same team of researchers also found that cells from bats, pigs and humans can all be infected in the lab with the coronavirus. This suggests that it can spread among mammals and that it might jump readily between mammal species.
Genetics
The partial genetic sequences of a virus isolated from bats match the coronavirus found in humans.
WHO recognizes that the emergence of a new coronavirus capable of causing severe disease raises concerns because of experience with SARS. Although this novel coronavirus is distantly related to the SARS CoV, they are different. Based on current information, it does not appear to transmit easily between people, unlike the SARS virus.
Epidemiology and Demographics
As of November 30, 2012, nine laboratory confirmed cases have been reported to WHO - five from Saudi Arabia, two from Qatar, and two from Jordan. The onset of illness was between April - November 2012. Among the nine cases, five were fatal. Based on available information, the clinical picture consists of febrile illness and pneumonia.[9]
Five cases were associated with two clusters. The first cluster of two cases, both fatal, occurred near Amman, Jordan, in April 2012. Stored samples from these two cases tested positive retrospectively for the novel coronavirus. This cluster was temporally associated with cases of illness among workers in a hospital. A second cluster occurred in October, 2012, in Saudi Arabia. Of the four individuals in the household, three were laboratory confirmed cases, two of them died.
United States
- There are no reports of anyone in United States getting infected and sick with the novel coronavirus. Risk of getting infected with this virus is estimated to be low.
- WHO and CDC have not issued any travel alerts for countries in the Arabian Peninsula or neighboring countries. Your risk of getting infected with the novel coronavirus while in these countries is estimated to be low.
Natural History, Complications and Prognosis
Complications
Case Definitions
In accordance with new data regarding geographic spread of the virus, case definitions have been updated.[11]
Patient Under Investigation
- A person with an acute respiratory infection, which may include fever (≥ 38°C , 100.4°F) and cough.
AND
- Suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence of consolidation).
AND
- Travel to or residence in the Arabian Peninsula or neighboring countries where infection with novel coronavirus has recently been reported and where transmission could have occurred.
AND
- Not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.
Close contacts of laboratory confirmed cases may also be considered PUIs. CDC requests that state and local health departments report PUIs for novel coronavirus to CDC.
Probable Case
- A person fitting the definition above of a patient under investigation with clinical, radiological, or histopathological evidence of pulmonary parenchyma disease (e.g. pneumonia or ARDS) but no possibility of laboratory confirmation either because the patient or samples are not available or there is no testing available for other respiratory infections.
AND
- Close contact with a laboratory confirmed case.
AND
- Not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.
Confirmed Case
- A person with laboratory confirmation of infection with the novel coronavirus.
Diagnosis
History and Symptoms
In confirmed cases of illness in humans, common symptoms have been acute, serious respiratory illness with fever, cough, shortness of breath, and breathing difficulties. Based on current clinical experience, the infection generally presents as pneumonia. It has caused kidney failure and death in some cases. It is important to note that the current understanding of the illness caused by this infection is based on a limited number of cases and may change as more information becomes available.
Physical Examination
Vital Signs
- Temperature: Fever
Throat
Lungs
Laboratory Findings
Lab tests (polymerase chain reaction or PCR) for the novel coronavirus are available at CDC and other international labs. Otherwise, these tests are not routinely available.
Other Diagnostic Studies
The United Kingdom's Health Protection Agency is working on the genetic sequence of the virus, based on the sequence obtained from the Qatari case.[12]
Treatment
Medical Therapy
There are no specific treatments for illnesses caused by the novel coronavirus. Many of the symptoms caused by this virus can be treated and therefore treatment should be based on the symptoms of the patient. Medical care is supportive and highly effective.
Prevention
- There is no vaccine currently available.
- Exactly how people become infected with this virus is not known at this time. However, some general measures that would be prudent and help prevent the acquisition of any respiratory illness are to avoid close contact, when possible, with anyone who shows symptoms of illness (coughing and sneezing), and to maintain good hand hygiene.
- Health care workers : Health care workers come into contact with patients with many different infectious illnesses more often than the general public. Therefore WHO recommends that health care workers consistently apply appropriate infection prevention and control measures.
- Any clusters of Severe Acute Respiratory Illness (SARI) in healthcare workers in the United States should be thoroughly investigated. Occurrence of a SARI cluster of unknown etiology should prompt immediate notification of local public health for further notification and testing.
External Links
Related Chapters
References
- ↑ Nebehay, Stephanie (26 September 2012). "WHO issues guidance on new virus, gears up for haj". Reuters. Retrieved 27 September 2012.
- ↑ Falco, Miriam (24 September 2012). "New SARS-like virus poses medical mystery". CNN. Retrieved 27 September 2012.
- ↑ "Novel coronavirus infection". World Health Organisation. 25 September 2012. Retrieved 27 September 2012.
- ↑ Doucleff, Michaeleen (28 September 2012). "Holy Bat Virus! Genome Hints At Origin Of SARS-Like Virus". NPR. Retrieved 29 September 2012.
- ↑ Moisse, Katie (27 September 2012). "Saudi Health Officials Brace for Hajj Pilgrimage to Mecca". ABC News. Retrieved 27 September 2012.
- ↑ van der Hoek L, Pyrc K, Jebbink MF; et al. (2004). "Identification of a new human coronavirus". Nat Med. 10 (4): 368&ndash, 73. doi:10.1038/nm1024.
- ↑ Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA (2012). "Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia". The New England Journal of Medicine. 367 (19): 1814–20. doi:10.1056/NEJMoa1211721. PMID 23075143. Retrieved 2012-12-29. Unknown parameter
|month=ignored (help) - ↑ "www.who.int" (PDF). Retrieved 2012-12-30.
- ↑ "How threatening is the new coronavirus?". BBC. 24 September 2012. Retrieved 27 September 2012.