This document discusses Middle East Respiratory Syndrome Coronavirus (MERS-CoV). It notes that the first case was identified in Saudi Arabia in 2012 and presented as acute pneumonia with renal failure. Most cases have links to the Middle East and common symptoms include severe respiratory illness, fever, cough and gastrointestinal issues. Chest imaging often shows signs of viral pneumonia. While human-to-human transmission is possible, current spread has been limited to close contacts. Treatment focuses on organ support and no medications have proven clearly effective. Infection control requires standard, contact and airborne precautions.

1. นพ. ขวัญชัย ประสิทธิ์วุฒิเวชช์
อายุรศาสตร์โรคระบบทางเดินหายใจและเวชบาบัดวิกฤติ

2. Corona Virus
 Coronaviruses primarily infect the upper respiratory and
gastrointestinal tract of mammals and birds
 Coronaviruses are believed to cause a significant
percentage of all common colds in human adults
 Coronaviruses can even cause pneumonia, either direct
viral pneumonia or a secondary bacterial pneumonia
 Coronaviruses also cause a range of diseases in farm
animals and domesticated pets

3. List of human coronavirus
 Human coronavirus 229E
 Human coronavirus OC43
 SARS-CoV
 Human coronavirus NL63
 Human coronavirus HKU1
 Middle east respiratory
syndrome coronavirus
Corona Virus

4. MERS CoV
1st case
 June 2012
 Kingdom of Saudi Arabia
 Acute pneumonia with renal failure

5. MERS CoV

6. MERS CoV
 All cases have had a direct or indirect link
with the Middle east
 Median age is 50 yrs, 64.5% were male
 Majority of patients experience severe
respiratory disease (63.4%)
 Patients who died had a higher median
age and propotion of male sex
 Most patients have underlying medical
conditions; chronic kidney disease
(13.3%), diabetics (10%), heart disease
(7.5%)
The WHO MERS-CoV research group, November 12, 2013

7. MERS CoV
Index cases
 Likely experience
severe and fatal
disease
 Requiring
hospitalization
Secondary cases
 Most are health
care setting
 Other in household
setting
 Cluster occurance
European Centre for Disease
Prevention and Control, May 1, 2014
Total cases : 424, Died 131

8. Clinical features
 Incubation period 5-14 days
 The duration of hospitalization to discharge 7 days
and to died 9 days, median time 4 days
 Clinical range from asymptomatic to very severe
pneumonia
 1/3 patients had gastrointestinal symptoms
Asymptomatic Pneumonia ARDS Septic shock Multi organ failure
13.5% 44.1% 12.4%
Gastrointestinal symptoms
26%

9. Clinical features
Pneumonia
 Fever
 Cough
 Dyspnea
 Tachypnea
 Desaturation
Systemic
symptoms
 Myalgia
 Arthralgia
Gastrointestinal
symptoms
 Nausea
 Vomiting
 Diarrhea
Nearly all symptomatic patients presented with
respiratory symptoms

10. Chest radiograph
Finding vary but are
consistent with viral
pneumonitis and ARDS
Bilateral hilar infiltration
Bilat or unilateral patchy infiltration
Segmented or lobar opacities
Ground glass appearance
Small pleural effusion
Lower lobes tend to be affected early
in the course of illness
Progressive rapidly

11. Common laboratory findings
Complete blood count
Leukopenia, paticularly lymphopenia
Viral load
Greatest in lower respiratory tract, found in upper respiratory tract and some in
blood, urine, stool
Co-infection with other respiratory viruses
Parainfluenza, rhinovirus, influenza, herpes simplex
Secondary nosocomially bacterial infection
Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter spp.

12. Transmission
Air borne transmission
 Droplet smaller < 10
micrometres
 Hang in air like invisible
smoke
 Droplets are loaded with
infectious particles
 Anthrax, Varicella zoster,
Mumps, Measles, Rubella,
Tuberculosis
Air droplet transmission
 Droplet larger > 10 micrometres
 Do not stay in the air
 Influenza

13. Transmission
MERS CoV
Zoonosis in sporadic case
 Camel and bat
Human to human transmission in secondary case
 Small air droplet
 Transmission did not extend beyond close contacts into the community
 Secondary attack rates among family members of patients appear to be low
Cluster
Defined as two or more persons with onset of symptoms within 14 day period
and are associated with specific setting

14. Transmission
MERS CoV
Epidemic potential
 Dose not yet have pandemic potential
 Sustained epidemic in an animal reservoir with sporadic spill-over into
humans
 Sustained human to human transmission causing a slowly growing human
epidemic

15. Treatment
Absent of pathogen-specific interventions
Management largely depends on provision of organ
support and vigilance for and prevention of
complications

16. Treatment

17. Treatment
Organ support and prevention of complication
 Lung-protective ventilatory strategies for ARDS
 Sepsis early directed goal therapy
 Antimicrobial treatment for co-infection
 Renal replacement therapy
 Cardiovascular support
 ECMO
Non useful drug
 High dose corticosteroid
 Interferons, Cyclosporin A, Ribavirin, Nitazoxanide,Immunoglobulins,
Lopinavir
 SARS CoV convalescent plasma

18. Infection control
Standard precautions
Contact
precautions
Air borne
precautionsAir droplet
precautions

19. Infection control

20. Infection control

21. Infection control

24. นพ. ขวัญชัย ประสิทธิ์วุฒิเวชช์
อายุรศาสตร์โรคระบบทางเดินหายใจและเวชบาบัดวิกฤติ