Middle East Respiratory Syndrome ( coronavirus MERS) - Causes , Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

In recent years, more and more often in the media and public health authorities found information about the spread of new infections occurring hard to defeat light bodies.Still fresh in the memory of SARS (SARS, SARS), occurred in 2002-2003 in China and ending lethal to 10% of cases as a new kind of virus that can cause severe infection with its epidemic spread.BVRS last outbreak in 2015 in South Korea is especially worrisome because of its gradual spread.

Middle East Respiratory Syndrome (BVRS, MERS - MiddleEastrespiratorysyndrome) - an acute infectious disease caused by a new coronavirus (BVRS Cove, MERS-CoV), transmitted from animals and humans, is characterized by the occurrence of respiratory infections of varying severity from mild manifestations up to severe course withpneumonia, often ends lethally.

BVRS ​​patients

Official information (WHO, Rospotrebnadzor)

In September 2012 the first time in Saudi Arabia reported disease affecting the respiratory system caused by a new kind of corona

virus.First isolated new Middle East respiratory syndrome coronavirus (BVRS-Co-B).In retrospect, it revealed that the incidence of infection in Saudi Arabia took place in April 2012.It is believed that the circulation of the virus among animals occurs only in the Arabian Peninsula.sporadic (ie single) Since the registration of the first patient cases registered in Saudi Arabia (85% of all cases), Oman, Qatar, UAE, Iran, Jordan, Kuwait, Yemen, Egypt, Tunisia.The reservoir of infection in these countries are camels.Mortality reached 36%.For the Middle East beyond the infection was leaked in 2012.disease cases registered in Turkey, Germany, Austria, Italy, the Netherlands, Greece, France, the United Kingdom.Most of them were non-local character.Of the 15 cases, 7 have been lethal.To date, the last case of infection was registered in Germany in March 2015.

BVRS ​​- Arabian Peninsula - endemic region

International Committee on Taxonomy of Viruses May 15, 2013 has decided to use to refer to the virus following abbreviation: MiddleEastrespiratorysyndromecoronavirus (MERS-CoV), or a coronavirus in the Middle East Respiratory Syndrome (BVRS Cove).That is the name recommended for use in medical and scientific literature sources.

The largest outbreak BVRS ​​outside the Middle East recorded and flows in the Republic of Korea.From 20 May (the appearance of the first patient) on June 12, 2015 the total number of cases of 126 people (125 - in Korea and 1 - in China), 10 of them fatal (WHO official website is being monitored hourly).The majority of patients infected in close contact with the patient (family members, medical staff) without appropriate personal protective equipment, infection often occurs in hospitals.Under supervision there are more than 2500 contacts, closed thousands of educational institutions.

According to WHO from September 2012 to June 2015 was ill with 1,218 laboratory-confirmed BVRS ​​Cove, of which 449 ended lethally.

BVRS ​​outbreak in the Republic of Korea

Causes BVRS ​​

Pathogen - a new type of coronavirus of the family Coronaviridae, the same subfamily, genus Betacoronavirus, subgenus C, having the name of the coronavirus in the Middle East Respiratory Syndrome (BVRS Cove) iliMiddleEastrespiratorysyndromecoronavirus (a MERS-CoV).BVRS Cove belongs to the especially dangerous pathogens lethal pneumonia.This is representative of a large family of coronaviruses containing RNA in their genome.

BVRS ​​virus

source of infection.

natural reservoir of infection - animals: camels, patients, their content in biological fluids BVRS ​​Cove (dangerous milk, urine, blood, meat).Initially, suspicion of infection of the tank fell only on bats, and it is considered that the bats have become a source of infection for the camels.

BVRS ​​natural reservoir (Egyptian burial meshkokryl)

BVRS ​​reservoir of infection - camels

Another source of infection - a sick man with a clinically severe form of the disease.

transmission mechanisms are not well understood.Human infection from a sick animal is through the transfer factors - raw camel milk, insufficiently cooked camel meat, camel urine.Projected path of infection from animals - food, pin.

man from a sick person infected only through close contact without PPE - caring family members, medical staff.Among the ways the infection is not ruled out contact-household, respiratory.Free circulation of the virus in the air is not registered, therefore, free transmission of the virus has not been confirmed from person to person during an outbreak.

susceptibility of the population to BVRS ​​general, however, noted that most of the cases registered in adult age group of people with chronic diseases, that is, having a varying severity of immunodeficiency.During outbreaks recorded transmission of infection in health care facilities is among those who have no personal protective equipment.Often infected patients in the same ward with sick BVRS.

Clinical symptoms of the Middle East Respiratory Syndrome

Symptoms are similar to the manifestation of acute respiratory viral disease of varying severity - from asymptomatic to severe forms of pneumonia and an unfavorable outcome.The incubation period of 2-3 days to 2 weeks.Leading syndromes are:

1) ITS (infectious-toxic syndrome) - low-grade and febrile fever, symptoms of intoxication (headache, dizziness, weakness, myalgia, pain in eyeballs, fatigue)

2) Respiratory Syndrome - occurrence of cough in the initial periods of dry without sputum discharge, sometimes exhausting.In severe pneumonia quickly joins in which amplified the weakness, there is a high fever, increased cough, which becomes productive (there is a clear viscous sputum).

complication is the development of RDS (respiratornogodistress syndrome): the appearance of shortness of breath and respiratory failure on the background of the above symptoms.Amid serious current respiratory arrest may occur, which requires resuscitation.

often among the symptoms of the gastrointestinal tract symptoms recorded BVRS ​​(abdominal pain, diarrhea) and renal failure.

Mortality in BVRS ​​reaches 30-35%.The most common adverse outcome occurs in elderly patients with immunodeficiency and related lung diseases, diabetes, oncology and others.

Immunity after suffering BVRS ​​short, re-infection is not excluded.

Diagnosis of Middle East Respiratory Syndrome

1. preliminary diagnosis - clinical and epidemiological.Clinical symptoms of infection
fairly nonspecific.Differential diagnosis should be done with the whole group of SARS, and in favor of BVRS ​​in the case of severe forms will indicate the rapid development of viral pneumonia and respiratory failure.Carefully assembled epid.anamnez doctor may approve in suspected BVRS.WHO recommends considering as a potential patient with BVRS ​​person with symptoms of SARS complicated RDS in the presence of exposure to troubled areas (Middle East) for the next 14 days preceding illness.

2. final diagnosis is made after the laboratory research and testing positive for BVRS ​​Cove.
A) One of the important methods of early diagnosis BVRS ​​method is RT-PCR in biological material (blood, urine, secretions from the nose, more reliable results - the study of samples from the lower DP - tracheal aspirates, bronchoalveolar lavage).RT-PCR would allow to identify the genetic material of the virus at the early stages of the disease.
B) Serological diagnosis of paired serum samples taken at intervals of 21 days for the presence of specific antibodies (ELISA, CFT, RIHA), diagnostic titers can be detected within 5-6 days after infection.The first serum in the first week of illness.
B) Virologic method - virus isolation in cell culture by their infection with the virus and the subsequent developments.

BVRS ​​diagnosis

Materials for the study sent to the laboratory as soon as possible.In case of delay required freezing with dry ice.Transportation (in individual containers after a special marking) in accordance with international rules of transportation of materials containing especially dangerous viruses (transportation without proper safety measures may lead to infection of the employee performing the transport).

Table 1. Types of clinical samples for examination for the presence of BVRS ​​Cove and recommendations for the handling of samples

sample type transport medium Transportation in lab Category Dangerous Goods Note
combinations-rovanny swab from the nose and throat transport medium for viruses on the ice. biologists cal material, Category B (Biological substance, Category B) In samples of this type has been detected virus
Nasopharyngeal swab
whole blood to detect the virus EDTA anticoagulant Get induring the 1st week of illness
Sputum (expectoration in natural *) not apply on the ice.When transporting more than 24 hours. - Freezing with dry ice Make sure that the material is derived from lower DP
Broncho-alveolar wash (by broncho-alveolar lavage) possible reduction in virus concentration, but the material is suitable
tracheal aspirate
Nasopharyngeal aspirate
tissue sample (including lung tissue), taken by biopsy transport medium for viruses or physical.solution
Serum for serology or virus detection not apply Paired samples after 21 days

Treatment of Middle East Respiratory Syndrome

1. Organizational-regime activities - hospitalization epidemic indications.Patients suspected BVRS ​​hospitalized in separate wards.Bed rest for the duration of fever and the development of severe complications.A balanced diet.

2. Drug therapy includes:
- causal treatment of a number of drugs interferon - vellferon, Betaferon in adequate doses, equivalent to the treatment of chronic viral hepatitis C. In severe forms of ribavirin is effective at a concentration of 8-12 mg / ml intravenously.Only such high doses could have a cytopathic effect on BVRS ​​Cove.
- Detoxification Therapy (gemodez, reambirin, reopoligljukin and other infusions) amount to an average of 800 ml / day.
- Posindromalnaya therapy (corticosteroids, surfactant agents, etc.).
Antibiotic therapy with the threat of bacterial adherence.

3. If required intubation and mechanical ventilation in the translation.

BVRS ​​- Chamber with patient

Prevention of Middle East Respiratory Syndrome

specific prophylaxis (vaccination) is not developed.

in disadvantaged areas by BVRS:
- observe good personal hygiene measures (hand washing) after visiting the markets, farms, stables and other places where the camels are;
- avoid any contact with sick animals;
- not to eat raw meat and camel milk (milk should undergo pasteurisation process, and the meat - enough heat treatment);

WHO does not regulate restrictions on visits by BVRS ​​disadvantaged areas, to trade and to monitor persons arriving from the Middle East, however, recommended to be vigilant, to strengthen by epid.nadzoru measures for SARS among passengers or migrant - workers from the Middle East.

1) In this regard, the Ministry of Health of the Russian Federation recommends not to travel to dysfunctional Middle East unnecessarily.
2) Health care workers who provide care BVRS ​​ill, it is recommended not to neglect the personal protective equipment for the prevention of droplet and contact-household way of infection - an individual mask, gown, gloves, eye protection.
3) Persons staying in the Middle East, remain vigilant for 2 weeks (the incubation period) from the date of arrival and in case of SARS symptoms seek immediate medical care in the community, to immediately report the fact of the trip.
4) Health care workers in the event of a patient with symptoms of SARS, especially its severe form, be sure to collect epid.anamnez the fact of departure to any country in the Middle East in the past 2 weeks from the disease.
5) Rospotrebnadzor laboratories ensured the readiness of Hygiene and Epidemiology Center and the Center for Vector to conduct specific studies on coronavirus infection.
6) Rospotrebnadzor organized continuity of the work with legal entities which can carry out the tour operator activities.

infectious disease doctor Bykov NI