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MERS-CoV.pptx
- 2. Group No.Student’s Name 2Mohamed Safar Almahmodi 3Aseel Ahmed Alzahrani 5Fahad Hamed Khalaf 5Ammar Ali Jammal 1Abdullah Abdulrahman Alshehri
- 3. -Case scenario -History -Examination -Investigation -Differential Diagnosis -Final diagnosis -Treatment -MERS-CoV -Epidemiology
- 4. A 59-year-old man from Jeddah City, Western Region. He became ill on 15 June 2014, was admitted to a hospital on 21 June 2014 with fever, cough, shortness of breath ,The doctor asked for sputum sample for testing using RT-PCR and was laboratory-confirmed with MERS-CoV within hours.
- 5. PERSONAL HISTORY • Age: 59 years old. • Sex: male. • Marital status: married. • Residence: Jeddah KSA. CHIEF COMPLAINT • cough. • Shortness of breath. • Fever. PAST HISTORY • Smoking • Camel shepherd • No Operation FAMILY HISTORY • Nothing significant.
- 6. GENERAL EXAMINATION -Heart rate: 97 Bpm. -Temperature: 39.5 c. -Blood Pressure: 118/79 mmHg
- 7. CBC: leukopenia. Lymphopenia. Thrombocytopenia. elevated LDH levels. Serology: ELISA. For detection of antibodies. RT-PCR. (DIAGNOSTIC) For sputum.
- 8. • Chest X-ray: Bilateral multifocal patchy airspace.
- 9. Other respiratory viruses severe acute respiratory syndrome (SARS) acute respiratory distress syndrome (ARDS) bacterial pneumonia
- 10. Making the diagnosis Molecular: RT-PCR Investigations HISTORY Chest X-ray Serologic: ELISA, IFA Radiological Laboratory
- 11. Molecular test rRT-PCR Confirmed case Negative ,but if Patient in suggestive clinical or epidemiological evidence. Confirmatory N gene test rRT-PCR repeat the test
- 12. Serological test Immunofluorescence Assay (IFA)Enzyme Linked Immunosorbent Assay (ELISA)
- 13. The patient was given: -Paracetamol as antipyretic. -O₂ supplementation After 3 days the patient was discharged as his condition was improved.
- 15. • Coronaviridae : enveloped, ssRNA • first identified in the mid-1960s. • 25 species in this family, 20 belong to the subfamily Coronavirinae. • Coronaviruses ( and Toroviruses ) have crown spikes like appearance . • Corona = Crown = تاج التاجية الفيروسات
- 17. Enveloped ssRNASpherical to pleomorphic Crown spikes like appearance
- 18. Zoonotic transmission ( Animal to Human ) : - First originated in bats . - Transmitted to camels by cross-species transmission (jumping) . - Camels : RH . - Transmitted to humans by : 1. direct contact . 2. undercooked meat . 3. diary product (unpasteuraized). - Camels – URT . - Man – LRT .
- 19. Human-to-human : • via large droplets and contact. • In most cases infection appear in : 1- hospital MERS outbreaks. 2- travelers returning from the Middle East and their close contacts .
- 20. • Attachment . • Budding .• Replication . • Avoid the immune response ( ↓ Type1 IFNs ) . • Epitopes . Protein S Protein N Protein M
- 21. • MERS grow in respiratory alveolar cells. Infected cells become vacuolated . • Glycoprotein (s) bind with cellular receptor on the alveolar cells, dipeptidyl peptidase 4 (DPP4) - (also named CD26)
- 22. • Virus causes cell damage ( by budding ) and inflammation • Cell damage --- inflammatory mediators --- increase secretion --- local inflammation and swelling. • Virus may reach the circulation and cause Viremia . • Complications of Viremia : Kidneys (mainly), GIT .
- 23. Type I IFNs play a key role in anti-viral immune response, and MERS-CoV can evade innate immunity and disrupt the IFN reactions .
- 27. • Severe acute respiratory illness: Fever Cough Shortness of breath Myalgia • Gastrointestinal distress : Diarrhea Nausea Vomiting
- 29. • 36% mortality among 1,917 laboratory-confirmed cases . • Renal failure.
- 30. • Diabetes in 68% • Chronic kidney disease in 49% • Hypertension in 34% • Chronic heart disease in 28% • Chronic lung disease in 26% • Smoking in 23%
- 32. • No treatment for MERS-CoV. • Care and management of complications. • Implementation of standard contact and airborne precautions. • Combination ribavirin-interferon therapy. • No vaccination
- 34. • Washing hands regularly . • Avoid personal contact with infected people. • Use tissue when coughing or sneezing. • Clean and disinfect frequently touched surfaces and objects.
Editor's Notes
- There are several investigations can be performed from cov infection Include: 1 CBC which may show leukopenia. Lymphopenia. Thrombocytopenia. elevated LDH levels. ElISA test also done to detect the antibodies But the diagnostic test is PCR to detect nucleic acid in the sp
- Chest X ray also done It show Bilateral multifocal patchy airspace.
- The differential diagnosis of mers corona v it could be : Viruses Such as: influenza, parainfluenza, adenovirus, respiratory syncytial virus SARS) is a serious form of pneumonia. It is caused by a virus ARDS) occurs when fluid builds up in the (alveoli) occurs in people who are already critically ill or who have significant injuries Bacterial infection: but the sputum was NOT purulent
- Now how to make the diagnosis of mers cov Look for the history Ask the pt if he: travel to endemic area Or be close contact with camels ,or infected patients Then do laboratory invst: such as pcr or serologic test & chest x-ray to confirmed the case
- Now the Pcr is a definitive diagnosis if it’s ve+ that mean you confirmed N gene test and the case (even if the patient have NO symptoms). and if the Reavers Transcription -PCR is negative but u suggestive a clinical or epidemiological evidence so repeat the test. LRT specimens are preferred, such as sputum,. URT specimen, including both nasopharyngeal and oropharyngeal swabs collected with synthetic fiber swabs with plastic shafts Stool (less priority)
- Then we have serological test ELISA &IFA: used to detect antibodies that bind to a viral protein. IFA: is a confirmatory test to detect specific antibodies And in the serum the anti body will present after 14 dys or more of onset symptom
- Treatment of our case
- we have 2 subfamilies : coronaviranie - Torovirane (بعد زمن الاكتشاف)
- HKU4-5 have the ability to recombine and cause cross species transmission. Cross species is transmitting of the virus form 1 specie to the other specie , and the virus will undergo different mutations that change it from the 1st specie form
- although the possibility of the other transmission ways was not eliminated ( fomite )
- Glycoprotein s (spikes) : attachment to host cells . Nucleocapsid (n) phosphoprotein : The N and M : budding viral particle . Membrane (m) glycoprotein : 1- mRNA transcription, replication . 2- avoid the immune response (inhibition of type I IFNs ) . Envelope : 1- attachment . Small role 2- carry the main antigenic epitopes .
- 1- cop : Alveolar capillary (asterisk) bounded by degenerate, vacuolated type I pulmonary epithelium. 2.1- DPP4 is expressed in type I and II alveolar cells - mainly bronchial epithelium and kidneys 2.2- cop : camels and humans have same receptors but different colonization site .
- damage triggers the production of inflammatory mediators, which increase nasal secretion and cause local inflammation and swelling. These responses in turn stimulate sneezing, obstruct the airway, and raise the temperature of the mucosa. Cop : congested vessels, inf cells ,constriction of the alveolar sacs,
- MERS-CoV is able to counteract the early innate immune response. Type I interferon (IFN) is essential in the role in antiviral innate immunity in which MERS - CoV is efficiently able to inhibit the activation of the Type I interferon response. MERS-CoV inducec T lymphocytes apoptosis after 48 -72 of infection
- As you see in this figure which published by The WHO the confirmed global cases of MERS-CoV since 2012 till now it is mostly localize in SA basically then secondly in republic of Korea It was reported that the majority of cases (> 85%) reported from Kingdom of Saudi Arabia additional cases reported in the Arabian Peninsula : from United Arab Emirates, Qatar, Oman, Jordan, Kuwait, Yemen, and Lebanon The second large outbreak has started in republic of Korea in 2015 The other cases reported to World Health Organization from outside the Arabian Peninsula include: patients with history of recent travel to the Arabian Peninsula close contacts of patients contracting infection during travel to the Arabian Peninsula And this explain the reason why it called Middle East Respiratory syndrome
- Most people confirmed to have MERS-CoV infection have had severe acute respiratory illness with nonspecific symptoms of: clinical features of MERS-CoV infection are nonspecific and include fever, cough, myalgia, Some people also had gastrointestinal symptoms including diarrhea and nausea/vomiting
- The disease has high mortality percent Among the 1,917 laboratory-confirmed cases . About 684 related deaths of MERS-CoV was confirmed as of February 21, 2017. which is more than 36% out of all cases . And one of the unique feature of MERS-CoV is Renal failure which may occur in some patient .
- older age, presence of comorbidities, and viral load each associated with increased mortality in patients with MERS-CoV And the comorbidities which may increase the mortality of MERS-CoV is :
- Until now there’s no specific treatment for MERS-CoV. But the Centers for Disease Control and Prevention indicate clinical management should include supportive care and management of complications implementation of standard, contact, and airborne precautions Also combination ribavirin-interferon therapy helps in improvement of some patient state . Also there’s no vaccination But the research into potential vaccines for MERS-CoV is in preliminary stages
- As similar to any other respiratory disease the prevention for hospitalized patients with MERS-CoV includes the main precautions focus on the communications of the patient with others and it includes: Wash your hands often with soap . Use tissue when coughing or sneezing. Avoid touching eyes, nose and mouth with unwashed hands. Avoid personal contact with infected people. Clean and disinfect frequently touched surfaces and objects.