Bronchoalveolar Lavage (BAL) Fluid (see Bronchoscopy, [[Bronchoscopy]])
Endotracheal Aspirate
Sputum
Recommended as First Line Testing by the CDC
Upper Respiratory Tract Specimen
Samples
Nasopharyngeal Aspirate
Should Also Be Obtained
Acute and Convalescent Paired Serum Samples
Should Be Obtained: not helpful in acute setting, but may yield useful epidemiologic data
Stool Sample
May Give Information Regarding the Pattern of Viral Shedding: pattern is currently unknown
Blood MERS-CoV Polymerase Chain Reaction (PCR)
May Be Diagnostic
Clinical Manifestations
General Comments
Incubation Time: 5.2 days (2-14 days)
Clinical Features: resemble that of the Severe Acute Respiratory Syndrome Coronavirus (SAR-CoV) (see Severe Acute Respiratory Syndrome Coronavirus, [[Severe Acute Respiratory Syndrome Coronavirus]]) [MEDLINE]: severe hypoxemia, failure of NIPPV, etc
However, Cases of MERS-CoV Reported All Had Underlying Co-Morbid Diseases (As Noted Above) (Ann Intern Med, 2014) [MEDLINE]
In Addition, All MERS-CoV Cases Required ICU Care (Ann Intern Med, 2014) [MEDLINE]
In contrast, in Canadian series of SARS-CoV, only 19% of cases reqired ICU care (JAMA, 2003) [MEDLINE]
Ribavirin and Interferon-Beta (see Ribavirin, [[Ribavirin]] and xxxx, [[xxxx]])
Data support use in SAR-CoV, but efficacy in MERS-CoV is unknown
Inhaled Nitric Oxide (iNO) (see Nitric Oxide, [[Nitric Oxide]])
While this has been shown to inhibit in vitro replication of SARS-CoV,its effect on MERS-CoV is unknown
References
Critically ill patients with severe acute respiratory syndrome. JAMA. 2003 Jul 16;290(3):367-73 [MEDLINE]
Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367:1814–1820 [MEDLINE]
Patient with new strain of coronavirus is treated in intensive care at London hospital. BMJ. 2012;345:e6455. doi: 10.1136/bmj.e6455 [MEDLINE]
Person-to-person spread of the MERS coronavirus—an evolving picture. N Engl J Med 2013;369(5):466-467 [MEDLINE]
Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med 2013;369(5):407-416 [MEDLINE]
Middle East respiratory syndrome coronavirus (MERS-CoV): announcement of the Coronavirus Study Group. J Virol. 2013;87:7790–7792 [MEDLINE]
Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection. Lancet Infect Dis. 2013;13:745-51 [MEDLINE]
Spread, circulation, and evolution of the Middle East respiratory syndrome coronavirus. MBio 2014;5(1) [MEDLINE]
Clinical Course and Outcomes of Critically Ill Patients With Middle East Respiratory Syndrome Coronavirus. Ann Intern Med. 2014 Jan 28 [MEDLINE]
Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828–835 [MEDLINE]