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      Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study

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          Abstract

          The Middle East respiratory syndrome coronavirus (MERS-CoV) is a life-threatening respiratory disease with a high case fatality rate; however, its risk factors remain unclear. We aimed to explore the influence of demographic factors, clinical manifestations and underlying comorbidities on mortality in MERS-CoV patients. Retrospective chart reviews were performed to identify all laboratory-confirmed cases of MERS-COV infection in Saudi Arabia that were reported to the Ministry of Health of Saudi Arabia between 23 April 2014 and 7 June 2016. Statistical analyses were conducted to assess the effect of sex, age, clinical presentation and comorbidities on mortality from MERS-CoV. A total of 281 confirmed MERS-CoV cases were identified: 167 (59.4%) patients were male and 55 (20%) died. Mortality predominantly occurred among Saudi nationals and older patients and was significantly associated with respiratory failure and shortness of breath. Of the 281 confirmed cases, 160 (56.9%) involved comorbidities, wherein diabetes mellitus, hypertension, ischemic heart disease, congestive heart failure, end-stage renal disease and chronic kidney disease were significantly associated with mortality from MERS-CoV and two or three comorbidities significantly affected the fatality rates from MERS-CoV. The findings of this study show that old age and the existence of underlying comorbidities significantly increase mortality from MERS-CoV.

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          Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.

          Theo M. Bestebroer, Albert Osterhaus, Sander van Boheemen … (2012)
          A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
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            Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

            Abdullah Assiri, Jaffar Al-Tawfiq, Abdullah A Al-Rabeeah … (2013)
            Summary Background Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities. Methods We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR. Findings 47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]). Interpretation Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition. Funding None.
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              Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus

              Abdullah Assiri, Allison McGeer, Trish M. Perl … (2013)
              In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care-acquired MERS-CoV infections. Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced. Between April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases). Person-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Epidemiol Infect
                Journal ID (iso-abbrev): Epidemiol. Infect
                Journal ID (publisher-id): HYG
                Title: Epidemiology and Infection
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 0950-2688
                ISSN (Electronic): 1469-4409
                Publication date Collection: 2019
                Publication date (Electronic): 5 November 2018
                Volume: 147
                Electronic Location Identifier: e35
                Affiliations
                [1 ]Department of Pharmaceutics, College of Pharmacy, King Saud University , 22452 Riyadh 11495, Saudi Arabia
                [2 ]College of Science, Princess Nourah Bint Abdulrahman University , Riyadh 12484, Saudi Arabia
                [3 ]Federal Ministry of Health , Khartoum 303, Sudan
                [4 ]Emergency medicine consultant, Emergency Department, Prince Mohamed Bin Abdulaziz Hospital , Ministry of Health, Riyadh 12455, Saudi Arabia
                [5 ]College of Medicine, Princess Nourah bint Abdulrahman University , Riyadh 12484, Saudi Arabia
                [6 ]Clinical Microbiology Department, Umeå University, Virology Unit , Sweden
                [7 ]Department of Clinical Pharmacy, College of Pharmacy, King Saud University , 22452 Riyadh 11495, Saudi Arabia
                Author notes
                Author for correspondence: F.Y. Alqahtani, E-mail: fyalqahtani@ 123456ksu.edu.sa
                Article
                Publisher Item ID: S0950268818002923 Publisher ID: 00292
                DOI: 10.1017/S0950268818002923
                PMC ID: 6518603
                PubMed ID: 30394248
                SO-VID: a1f63e61-3108-4c18-ac7b-825e2a304297
                Copyright © © The Author(s) 2018
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 February 2018
                Date revision received : 29 August 2018
                Date accepted : 03 October 2018
                Page count
                Tables: 4, References: 30, Pages: 5
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Public health
                Keywords: comorbidities,middle east respiratory syndrome coronavirus,mortality
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: comorbidities, middle east respiratory syndrome coronavirus, mortality

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