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Mers cov
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first identified in Saudi Arabia in June 2012 and is associated with severe respiratory illness, often linked to underlying medical conditions. The disease has a median incubation period of 5-14 days, with symptoms ranging from asymptomatic to severe pneumonia and gastrointestinal issues. Transmission occurs primarily through close contact and healthcare settings, and while no specific treatment exists, management focuses on organ support and infection control.
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Mers cov
- 1. คลกเพอแกไขลกษณะชอเรองรองตนแบบ Middle East Respiratory Syndrome Coronavirus นพ. ขวญชย ประสทธวฒเวชช อายรศาสตรโรคระบบทางเดนหายใจและเวชบ%าบดวกฤต
- 2. Corona Virus § Coronaviruses primarilyinfect 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 humancoronavirus § 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 § June2012 § Kingdom of Saudi Arabia § Acute pneumonia with renal failure
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- 6. MERS CoV § All caseshave 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 § Likelyexperience 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 period5-14 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 allsymptomatic patients presented with respiratory symptoms
- 10. Chest radiograph Finding varybut 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 bloodcount 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 § Dropletsmaller < 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 insporadic 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 § Dosenot 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-specificinterventions Management largely depends on provision of organ support and vigilance for and prevention of complications
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- 17. Treatment Organ support andprevention 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 Airborne precautionsAir droplet precautions
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