Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission

Details

Serval ID
serval:BIB_8127E24045E3
Type
Article: article from journal or magazin.
Collection
Publications
Title
Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission
Journal
Lancet
Author(s)
Guery B., Poissy J., el Mansouf L., Sejourne C., Ettahar N., Lemaire X., Vuotto F., Goffard A., Behillil S., Enouf V., Caro V., Mailles A., Che D., Manuguerra J. C., Mathieu D., Fontanet A., van der Werf S.
Working group(s)
M. ERS-CoV study group
ISSN
1474-547X (Electronic)
ISSN-L
0140-6736
Publication state
Published
Issued date
2013
Volume
381
Number
9885
Pages
2265-72
Language
english
Notes
Guery, Benoit
Poissy, Julien
el Mansouf, Loubna
Sejourne, Caroline
Ettahar, Nicolas
Lemaire, Xavier
Vuotto, Fanny
Goffard, Anne
Behillil, Sylvie
Enouf, Vincent
Caro, Valerie
Mailles, Alexandra
Che, Didier
Manuguerra, Jean-Claude
Mathieu, Daniel
Fontanet, Arnaud
van der Werf, Sylvie
eng
Case Reports
Research Support, Non-U.S. Gov't
England
Lancet. 2013 Jun 29;381(9885):2265-72. doi: 10.1016/S0140-6736(13)60982-4. Epub 2013 May 30.
Abstract
BACKGROUND: Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital. METHODS: Patient 1 visited Dubai in April, 2013; patient 2 lives in France and did not travel abroad. Both patients had underlying immunosuppressive disorders. We tested specimens from the upper (nasopharyngeal swabs) or the lower (bronchoalveolar lavage, sputum) respiratory tract and whole blood, plasma, and serum specimens for MERS-CoV by real-time RT-PCR targeting the upE and Orf1A genes of MERS-CoV. FINDINGS: Initial clinical presentation included fever, chills, and myalgia in both patients, and for patient 1, diarrhoea. Respiratory symptoms rapidly became predominant with acute respiratory failure leading to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Both patients developed acute renal failure. MERS-CoV was detected in lower respiratory tract specimens with high viral load (eg, cycle threshold [Ct] values of 22.9 for upE and 24 for Orf1a for a bronchoalveolar lavage sample from patient 1; Ct values of 22.5 for upE and 23.9 for Orf1a for an induced sputum sample from patient 2), whereas nasopharyngeal specimens were weakly positive or inconclusive. The two patients shared the same room for 3 days. The incubation period was estimated at 9-12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure. INTERPRETATION: Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor. FUNDING: French Institute for Public Health Surveillance, ANR grant Labex Integrative Biology of Emerging Infectious Diseases, and the European Community's Seventh Framework Programme projects EMPERIE and PREDEMICS.
Keywords
Coronavirus/genetics, Coronavirus Infections/*diagnosis/diagnostic imaging/transmission/virology, Cross Infection/diagnosis/diagnostic imaging/transmission/*virology, Fatal Outcome, France/epidemiology, Humans, Infectious Disease Incubation Period, Lung/diagnostic imaging, Male, Middle Aged, Radiography, Real-Time Polymerase Chain Reaction, Travel
Pubmed
Create date
29/04/2021 10:59
Last modification date
30/04/2021 6:38
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