Middle East Respiratory Syndrome (MERS-CoV): What have we learned?

Middle East Respiratory Syndrome (MERS-CoV): What have we learned?

By Alex Koyfman MD (@EMHighAK)

Edited by Stephen Alerhand MD


Your next 3 patients…

#1: Physician who did an international health stint in United Arab Emirates 1 week ago
#2 & #3: Husband and wife with fever/sob/n/v who arrived from Jordan 10 days ago



– Coronavirus is responsible for severe viral PNA in humans. It was first called novel human coronavirus.
– 1st reported case in Sept 2012 (Saudi Arabia), 1st actual case in April 2012 (Jordan)
– Most common in Arabian Peninsula (Jordan, Iraq, Kuwait, Bahrain, Qatar, United Arab Emirates, Oman, Yemen, Saudi Arabia)
– Close contact transmission; does not spread like influenza; like SARS but more deadly
– Incubation 2-14 days; source unclear (?camels)
– 1st US cases: May 2014 (Indiana, Florida)


Clinical Presentation + Imaging Findings

– Many present asymptomatically or as a simple URI
– Typically 50 years old, M > F; those with multiple co-morbidities are more significantly affected
– Severe acute respiratory illness: fever/chills, HA, non-productive cough, SOB, muscle aches, n/v/loose stools  =>  PNA / ARDS / respiratory failure, AKI, multiple organ dysfunction syndrome

Three Criteria

1) fever
2) PNA or ARDS or symptoms of respiratory illness
3) a) history of travel from countries in or near Arabian Peninsula within 14 days or b) close contact with a symptomatic traveler or c) part of cluster of patients with severe acute respiratory illness of unclear etiology



– bilateral sub-pleural and basilar ground-glass opacities


Supportive care; no antiviral or vaccine available
Standard/contact/airborne precautions for healthcare providers; patients need isolation similar to TB

Why do we care

25-50% mortality; higher in those with multiple co-morbidities
-Hajj pilgrimage Oct 2-6, 2014
-Travel to US from Middle East peaks between April and September

Further Reading


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