Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission.
Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission.
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DOI：
10.1016/s0140-6736(13)60982-4
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发表时间：
2013-06-29
期刊：
影响因子：
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通讯作者：
MERS-CoV study group
中科院分区：
文献类型：
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作者：
Guery B;Poissy J;el Mansouf L;Séjourné C;Ettahar N;Lemaire X;Vuotto F;Goffard A;Behillil S;Enouf V;Caro V;Mailles A;Che D;Manuguerra JC;Mathieu D;Fontanet A;van der Werf S;MERS-CoV study group
一种名为中东呼吸综合征冠状病毒（MERS-CoV）的新型冠状病毒人类感染于2012年9月首次在沙特阿拉伯和中东发现，截至2013年5月23日，已有44例实验室确诊病例。我们报告了两例相关的中东呼吸综合征冠状病毒疾病的详细临床和病毒学数据，在法国一家医院，病毒从一名患者传播到另一名患者。患者1于2013年4月到访迪拜；患者2住在法国，没有出国旅行。两例患者均有潜在的免疫抑制疾病。针对MERS-CoV的upE和Orf1A基因，采用实时RT-PCR检测上呼吸道（鼻咽拭子）或下呼吸道（支气管肺泡灌洗、痰液）及全血、血浆和血清标本的MERS-CoV。两例患者的初始临床表现包括发热、寒战和肌痛，患者1出现腹泻。呼吸系统症状迅速成为主要，急性呼吸衰竭导致机械通气和体外膜氧合（ECMO）。两例患者均出现急性肾功能衰竭。MERS-CoV在病毒载量高的下呼吸道标本中检测到（例如，患者1的支气管肺泡灌洗标本中upE和Orf1a的周期阈值为22.9和24；患者2的诱导痰标本中upE和Orf1a的Ct值为22.5和23.9），而鼻咽标本呈弱阳性或不确定。这两个病人在同一个房间住了3天。第二个病例的潜伏期估计为9-12天。尽管在怀疑诊断为中东呼吸综合征冠状病毒之前没有采取具体的保护措施，但在医院工作人员中没有记录到二次传播。患者1因难治性多器官衰竭于5月28日死亡。从中东返回的有呼吸道症状的患者或与确诊病例接触的患者应进行隔离和mers冠状病毒调查，并进行下呼吸道样本分析，假定潜伏期为12天。免疫抑制也应作为一种危险因素加以考虑。法国公共卫生监测研究所，ANR资助Labex新发传染病综合生物学项目，以及欧洲共同体第七框架方案的imperie和predemic项目。
Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital. Patient 1 visited Dubai in April, 2013; patient 2 lives in France and did not travel abroad. Both patients had underlying immunosuppressive disorders. We tested specimens from the upper (nasopharyngeal swabs) or the lower (bronchoalveolar lavage, sputum) respiratory tract and whole blood, plasma, and serum specimens for MERS-CoV by real-time RT-PCR targeting the upE and Orf1A genes of MERS-CoV. Initial clinical presentation included fever, chills, and myalgia in both patients, and for patient 1, diarrhoea. Respiratory symptoms rapidly became predominant with acute respiratory failure leading to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Both patients developed acute renal failure. MERS-CoV was detected in lower respiratory tract specimens with high viral load (eg, cycle threshold [Ct] values of 22·9 for upE and 24 for Orf1a for a bronchoalveolar lavage sample from patient 1; Ct values of 22·5 for upE and 23·9 for Orf1a for an induced sputum sample from patient 2), whereas nasopharyngeal specimens were weakly positive or inconclusive. The two patients shared the same room for 3 days. The incubation period was estimated at 9–12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure. Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor. French Institute for Public Health Surveillance, ANR grant Labex Integrative Biology of Emerging Infectious Diseases, and the European Community's Seventh Framework Programme projects EMPERIE and PREDEMICS.