Chapter: Middle East Respiratory Syndrome
McMaster Section Editor(s): Paul M. O’Byrne
Section Editor(s) in Interna Szczeklika: Ewa Niżankowska-Mogilnicka, Filip Mejza
McMaster Author(s): Mark Loeb
Author(s) in Interna Szczeklika: Jan Kuś, Miłosz Jankowski
How to Cite This Chapter: Loeb M, Kuś J, Jankowski M. Middle East Respiratory Syndrome. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.126.96.36.199 Accessed July 23, 2019.
Last Updated: February 20, 2016
Last Reviewed: March 1, 2017
Main Documents Taken Into Account:
National Clinical Guideline Centre (UK). Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults.
London: National Institute for Health and Care Excellence (UK); 2014 Dec. PubMed PMID: 25520986.
Woodhead M, Blasi F, Ewig S, et al; Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections--summary.
Clin Microbiol Infect. 2011 Nov;17 Suppl 6:1-24. doi: 10.1111/j.1469-0691.2011.03602.x. PubMed PMID: 21951384.
Limper AH, Knox KS, Sarosi GA, et al; American Thoracic Society Fungal Working Group. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients.
Am J Respir Crit Care Med. 2011 Jan 1;183(1):96-128. doi: 10.1164/rccm.2008-740ST. PubMed PMID: 21193785.
Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009.
Thorax. 2009 Oct;64 Suppl 3:iii1-55. doi: 10.1136/thx.2009.121434. PubMed PMID: 19783532.
Torres A, Ewig S, Lode H, Carlet J; European HAP working group. Defining, treating and preventing hospital acquired pneumonia: European perspective.
Intensive Care Med. 2009 Jan;35(1):9-29. doi: 10.1007/s00134-008-1336-9. PubMed PMID: 18989656.
Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. PubMed PMID: 17278083.
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416. PubMed PMID: 15699079.
Definition, Etiology, PathogenesisTop
Middle East respiratory syndrome (MERS) is an infectious disease caused by a zoonotic coronavirus termed MERS-CoV that emerged in 2012 in Saudi Arabia. Cases of infection have been reported mainly in residents of and visitors to the Arabian Peninsula and Eastern Asia. Transmission is from animals (camels are the suspected source) to humans via unknown route; human-to-human transmission requires close person-to-person contact.
Clinical features range from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and sepsis. Initial symptoms include fever and cough, often with headache and muscle and joint pain; later patients develop dyspnea, sometimes nausea and vomiting, rarely abdominal pain and diarrhea.
Chest radiographs reveal unilateral or bilateral infiltrates, interstitial changes, and pleural fluid. Laboratory tests show leukopenia with lymphopenia, low platelet counts, and increased lactate dehydrogenase levels.
1. Polymerase chain reaction (bronchoalveolar lavage fluid, sputum, smear or aspirate from the nasal cavity or oropharynx).
2. Serology (serum sample collected in the first week of illness and 2-3 weeks later).
No antiviral treatment is available. Administer oxygen or use mechanical ventilation when necessary. In the case of bacterial superinfection, administer antibiotics.
While caring for the patient, wear a filtration mask (at least as effective as the N95 mask), gloves, gown, and protective goggles or face shield. The patient should be transferred to a hospital equipped with an isolation room complying with airborne infection isolation room (AIIR) standards.