EMmedonline



• Middle East Respiratory Syndrome (MERS) is an illness caused by coronavirus MERS-CoV.

• MERS primarily affects respiratory system.

Incubation Period : 2 – 14 days

Clinical Features

• Fever, chills/rigors

• Headache

• non productive cough, dyspnea

• Myalgia

• Sore throat, coryza

• Nausea, vomiting, diarrhea, abdominal pain

• Patients can progress rapidly to respiratory failure, ARDS, refractory hypoxemia

• Extrapulmonary complications including AKI, hepatic inflammation, septic shock has been reported.

Investigations

• Chest X-Ray

  • Unilateral or bilateral patchy densities or opacities

  • Interstitial infiltrates

  • Consolidation

  • Pleural effusions

• Respiratory specimen

  • Nasal/Nasopharyngeal/ throat swabs from upper respiratory tract.

  • Sputum, endotracheal aspirate, bronchoalveolar lavage from lower respiratory tract.

  • Testing is done by RT-PCR.

  • Testing is done for Influenza A,B, RSV parainfluenza virus, rhinovirus, adenovirus, coronavirus.

Treatment

• Oxygen

  • Give supplemental oxygen therapy to patients with signs of severe respiratory distress, hypoxaemia (Spo₂ < 90%) or shock.

• Fluid resuscitation

   

  • IV fluids should be used judiciously.

  • Aggressive fluid resuscitation may lead to respiratory impairement.

• Steroids are not recommended. May used when patient requires multiple inotropic support.

• ARDS

  • Consider NIV for mild ARDS.

  • In mechanically ventilated patients, lung protective strategy is used.

    • Tidal volume : 6 ml/kg predicted body weight.

    • Pplat < 30 cmH₂O

    • PaO₂ : 55 – 80 mmHg

  • Neuromuscular blockers and sedation is used for initial 48 hours.

  • Prone ventilation.

  • Recruitment maneuver and high PEEP improves oxygenation.

Prevention

• Currently there is no vaccine.

• All health care workers should use standard Personal Protective Equipment.

• N95 mask should be used by the healthcare workers performing aerosol generating procedures.

• CDC Recommends to

  • Wash your hands with soap and water for 20 seconds.

  • Covering nose and mouth with tissue while coughing or sneezing.

  • Avoid touching eye, nose and mouth with unwashed hands.

  • Avoid personal contact, such as kissing or sharing cups or eating utensils.

  • Clean and disinfect frequently touched surface.

Updated on 3/3/2015

Reference

• http://www.cdc.gov/coronavirus/mers/clinical-features.html

• http://www.cdc.gov/coronavirus/MERS/about/prevention.html

• http://www.cdc.gov/coronavirus/mers/case-def.html

• Clinical Management of Severe Acute Respiratory Infections when novel coronavirus is suspected : What to do and what not to do. Interim Guidance Document. WHO.2013