Makindo Medical Notes

Middle East Resp Syndrome (MERS) Coronavirus: Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain medications.

About

• Middle East Respiratory Syndrome (MERS) is a viral respiratory illness caused by the MERS coronavirus (MERS-CoV).
• It was first identified in Saudi Arabia in 2012, but it has since been reported in other countries, particularly in the Middle East, as well as in Asia, Europe, and the United States.
• Direct contact with camels is an important risk factor, as camels are considered a natural reservoir for the virus. Human-to-human transmission can also occur, especially in healthcare settings.

Aetiology

• MERS-CoV is a new strain of coronavirus that causes severe respiratory illness in humans.
• The incubation period ranges from 2 to 14 days, with symptoms typically appearing within 5-6 days after exposure.
• Transmission occurs through respiratory droplets from coughing and sneezing, direct contact with infected individuals, or contact with contaminated surfaces.

Clinical

• Respiratory Symptoms: Fever, cough, and shortness of breath, which can progress to severe pneumonia.
• Gastrointestinal Symptoms: Diarrhea, nausea, vomiting, and abdominal pain have been reported in some patients.
• Severe Illness: Can lead to acute respiratory distress syndrome (ARDS), septic shock, and multi-organ failure, particularly in patients with underlying medical conditions like diabetes, chronic kidney disease, or immunosuppression.
• Atypical Presentations: Fever may be absent, especially in very young, elderly, or immunocompromised patients.

Investigations

• U&E: Monitor for acute kidney injury (AKI) and electrolyte imbalances.
• ABG: Evaluate for hypoxemia and respiratory failure.
• PCR: Polymerase chain reaction testing of upper and lower respiratory secretions is the standard diagnostic test to confirm MERS-CoV infection.
• CXR/CT: May show signs of bilateral pneumonia, ARDS, or ground-glass opacities.

Prevention

• Animal Contact: Avoid contact with camels, as well as drinking raw camel milk or raw camel urine, and consuming undercooked camel meat.
• Infection Control: Implement standard, contact, and airborne precautions in healthcare settings, particularly when handling suspected or confirmed cases.
• Personal Protective Equipment (PPE): Healthcare workers should use masks, gloves, gowns, and eye protection when caring for MERS patients.
• Isolation: Patients with suspected MERS should be isolated to prevent transmission.

Management

• Supportive Care: Focus on maintaining ABCs (airway, breathing, circulation), including oxygen therapy, IV fluids, and vasopressors if needed.
• Advanced Care: Severe cases may require admission to ITU/HDU for mechanical ventilation and advanced supportive measures.
• Antiviral Therapy: No specific antiviral treatment exists for MERS-CoV, though some investigational drugs have been studied in clinical trials.
• Infection Control Measures: Use of PPE, hand hygiene, and proper disinfection protocols are crucial in preventing the spread of MERS in healthcare settings.
• Home Isolation: Patients with mild symptoms may be advised to stay home and avoid contact with others until they have fully recovered.

References

• World Health Organization (WHO): MERS-CoV
• Centers for Disease Control and Prevention (CDC): MERS-CoV
• MERS-CoV: Review of Current Literature and Future Prospects