Middle East respiratory syndrome coronavirus

Background

• Abbreviation: MERS or MERS CoV
• New coronavirus was first described in September 2012, when it was reported to have caused fatal acute lower respiratory illness in a man in Saudi Arabia.
• First US case reported in Indiana on May 1, 2014

Differential Diagnosis

Causes of Pneumonia

Bacteria

• Gram-positive
  • Streptococcus pneumoniae
  • Staphylococcus aureus
• Gram-negative
  • Haemophilus influenzae
  • Klebsiella pneumoniae
  • Escherichia coli
  • Pseudomonas aeruginosa
  • Moraxella catarrhalis
• Atypical pneumonia
  • Chlamydophila pneumoniae
  • Chlamydophila psittaci
  • Mycoplasma pneumoniae
  • Coxiella burnetti
  • Legionella pneumophila

Viral

• Common
  • Influenza
  • Respiratory syncytial virus
  • Parainfluenza
• Rarer
  • Adenovirus
  • Metapneumovirus
  • Severe acute respiratory syndrome (SARS)
  • Middle east respiratory syndrome coronavirus (MERS)
• Cause other diseases, but sometimes cause pneumonia
  • Herpes simplex virus
  • Varicella-zoster (VZV)
  • Measles
  • Rubella
  • Cytomegalovirus
  • Smallpox
  • Dengue

Fungal

• Histoplasmosis
• Coccidioidomycosis
• Blastomycosis
• Pneumocystis jirovecii pneumonia (PCP)
• Sporotrichosis
• Cryptococcosis
• Aspergillosis
• Candidiasis

Parasitic

• Ascariasis
• Schistosomiasis
• Toxoplasma gondii

Evaluation

CDC Case Definition

A patient with (needs all three):

1. Fever AND
2. Pneumonia or ARDS (based on clinical or radiological evidence) AND
3. One of the below:
   • history of travel from countries in or near the Arabian Peninsula^ within 14 days before symptom onset; OR
   • close contact^^ with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula^; OR
   • is a member of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments.

^Countries considered in or near the Arabian Peninsula: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

^^Close contact is defined as

• any person who provided care for the patient, including a healthcare worker or family member, or had similarly close physical contact; or
• any person who stayed at the same place (e.g. lived with, visited) as the patient while the patient was ill.

Management

Immediately contact the Acute Communicable Disease Control Program (ACDC) at 213-240-7941, ask for the Administrator on Duty (AOD), if a patient meets criteria

See Also

The CDC guidance on MERS-CoV is available at http://www.cdc.gov/coronavirus/ncv/case-def.html

References

Authors

Neil Young