Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study

AbstractThe Middle East respiratory syndrome coronavirus (MERS-CoV) is a life-threatening respiratory disease with a high case fatality rate; however, its risk factors remain unclear. We aimed to explore the influence of demographic factors, clinical manifestations and underlying comorbidities on mortality in MERS-CoV patients. Retrospective chart reviews were performed to identify all laboratory-confirmed cases of MERS-COV infection in Saudi Arabia that were reported to the Ministry of Health of Saudi Arabia between 23 April 2014 and 7 June 2016. Statistical analyses were conducted to assess the effect of sex, age, clinical presentation and comorbidities on mortality from MERS-CoV. A total of 281 confirmed MERS-CoV cases were identified: 167 (59.4%) patients were male and 55 (20%) died. Mortality predominantly occurred among Saudi nationals and older patients and was significantly associated with respiratory failure and shortness of breath. Of the 281 confirmed cases, 160 (56.9%) involved comorbidities, wherein diabetes mellitus, hypertension, ischemic heart disease, congestive heart failure, end-stage renal disease and chronic kidney disease were significantly associated with mortality from MERS-CoV and two or three comorbidities significantly affected the fatality rates from MERS-CoV. The findings of this study show that old age and the existence of underlying comorbidities significantly increase mortality from MERS-CoV.

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Middle East Respiratory Syndrome (MERS) Infection in Hematological and Oncological Patients: A Case Series from a Tertiary Care Center in Saudi Arabia

Blood ◽

10.1182/blood-2019-123253 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5871-5871 ◽

Cited By ~ 1

Author(s):

Ahmed Alaskar ◽

Mohammed Bosaeed ◽

Hina Rehan ◽

May Anne Mendoza ◽

Bader Alahmari ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Clinical Presentation ◽

Conflicts Of Interest ◽

Tertiary Care ◽

Case Series ◽

Case Fatality ◽

Middle East Respiratory Syndrome ◽

Future Research ◽

Fatality Rate

We present the largest to date of a case series of nine patients with hematological and oncological malignancies who were infected with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV is a novel beta-coronavirus with a high fatality rate in comorbid patients. The majority of MERS cases globally were reported from Saudi Arabia (1983 cases, including 745 related deaths with a case-fatality rate of 37.5%) according to the WHO update of February 2019. All were clinically stable before acquiring the virus. Most of the cases had an active disease as relapse or refractory with three cases being neutropenic. The clinical presentation and radiological features of the patients were variable and inconsistent (Table 1). Diagnosis was confirmed with RT-PCR assays targeting upstream of the E gene and the open-reading frame gene 1a which had to be done repeatedly and required an average of 3 (with max. of 7) samples for a test to be positive (Table 2). All the patients developed respiratory failure, were admitted to the critical care unit (ICU) and required mechanical ventilation. The length of hospital stay ranged from 15 - 48, with an average of 24 days. Unfortunately, all nine patients died within days after admission to the ICU. In addition, the time from diagnosis to death has an average of 9 days ranging from 2-24 days, respectively. In conclusion, MERS CoV infection in hematology/oncology patients has a very poor prognosis regardless of the status of the underlying disease. The clinical presentation is not distinctive and confirming the diagnosis requires numerous respiratory samples. Measures to prevent nosocomial outbreaks should include proper compliance with personal protection equipment by health-care workers when managing patients with suspected and confirmed MERS-CoV infection and prompt isolation of infected patients. Future research is required to enhance our understanding of the disease and to evaluate superior diagnostic and therapeutic options. Disclosures No relevant conflicts of interest to declare.

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Staphylococcus-induced glomerulonephritis: potential role for corticosteroids

BMJ Case Reports ◽

10.1136/bcr-2020-237011 ◽

2021 ◽

Vol 14 (1) ◽

pp. e237011

Author(s):

Rui Filipe Nogueira ◽

Nuno Oliveira ◽

Vítor Sousa ◽

Rui Alves

Keyword(s):

Kidney Function ◽

Potential Role ◽

Graft Infection ◽

Clinical Manifestations ◽

Rapidly Progressive Glomerulonephritis ◽

Vascular Graft Infection ◽

Systemic Corticosteroids ◽

Life Threatening ◽

Stage Renal Disease ◽

End Stage

Staphylococcus aureus is a troublesome pathogen, responsible for a broad range of clinical manifestations, ranging from benign skin infections to life-threatening conditions such as endocarditis and osteomyelitis. The kidney can be affected through a rapidly progressive glomerulonephritis mediated by an inflammatory reaction against a superantigen deposited in the glomerulus during the infection’s course. This glomerulopathy has a poor prognosis, often leading to chronically impaired kidney function, eventually progressing to end-stage renal disease. Treatment rests on antibiotherapy. Despite the inflammatory role in this disease’s pathophysiology, most authors discourage a simultaneous immunosuppressive approach given the concomitant infection. However, there are some reports of success after administration of systemic corticosteroids in these patients. We present a 66-year-old man with a staphylococcus-induced glomerulonephritis brought on by a vascular graft infection, with rapidly deteriorating kidney function despite extraction of the infected graft and 3 weeks of antibiotherapy with achievement of infection control. Kidney function improved after the introduction of corticosteroids. This case highlights the potential role of corticosteroids in selected cases of staphylococcus-induced glomerulonephritis, particularly those in which the infection is under control.

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Peritoneal Dialysis in Iran and the Middle East

Peritoneal Dialysis International ◽

10.1177/089686080902902s44 ◽

2009 ◽

Vol 29 (2_suppl) ◽

pp. 217-221 ◽

Cited By ~ 10

Author(s):

Iraj Najafi

Keyword(s):

Saudi Arabia ◽

Peritoneal Dialysis ◽

Middle East ◽

End Stage Renal Disease ◽

National Income ◽

Number Of Patients ◽

The Mean ◽

Per Capita ◽

Stage Renal Disease ◽

End Stage

The countries of the Middle East have a cumulative population of 261.1 million and a mean gross national income per capita of US$9500. The total number of patients with end-stage renal disease (ESRD) in the Middle East is almost 100000, the mean prevalence being 430 per million population (pmp). The first implementation of intermittent peritoneal dialysis (PD) in the Middle East occurred in Turkey in 1968; continuous ambulatory PD started in Saudi Arabia, Turkey, and Kuwait in the 1980s; and automated PD, in Turkey in 1998. The total active PD patients in the region number approximately 8170. With 5750 patients, Turkey ranks first, followed by Iran and Saudi Arabia with 1150 and 771 patients respectively. Penetration of PD with respect to the ESRD population is 7.5%, and with respect to dialysis overall is 10.2%. The dialysis rate in the region, 312 pmp, is almost half the European number of 581 pmp, with a PD prevalence of 32 pmp (range: 0 – 81 pmp). The number of active PD patients has risen dramatically in the main countries since the end of the 1990s: Turkey, to 5750 from 1030; Saudi Arabia, to 771 from 132; and Iran to 1150 from 0.

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Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012–2020

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00853-0 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

An-Ran Zhang ◽

Wen-Qiang Shi ◽

Kun Liu ◽

Xin-Lou Li ◽

Ming-Jin Liu ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Transportation Network ◽

Case Fatality ◽

Middle East Respiratory Syndrome ◽

World Health ◽

Spatial Diffusion ◽

Risk Of Death ◽

Animal Contact ◽

History Of

Abstract Background The ongoing transmission of the Middle East respiratory syndrome coronavirus (MERS-CoV) in the Middle East and its expansion to other regions are raising concerns of a potential pandemic. An in-depth analysis about both population and molecular epidemiology of this pathogen is needed. Methods MERS cases reported globally as of June 2020 were collected mainly from World Health Organization official reports, supplemented by other reliable sources. Determinants for case fatality and spatial diffusion of MERS were assessed with Logistic regressions and Cox proportional hazard models, respectively. Phylogenetic and phylogeographic analyses were performed to examine the evolution and migration history of MERS-CoV. Results A total of 2562 confirmed MERS cases with 150 case clusters were reported with a case fatality rate of 32.7% (95% CI: 30.9‒34.6%). Saudi Arabia accounted for 83.6% of the cases. Age of ≥ 65 years old, underlying conditions and ≥ 5 days delay in diagnosis were independent risk factors for death. However, a history of animal contact was associated with a higher risk (adjusted OR = 2.97, 95% CI: 1.10–7.98) among female cases < 65 years but with a lower risk (adjusted OR = 0.31, 95% CI: 0.18–0.51) among male cases ≥ 65 years old. Diffusion of the disease was fastest from its origin in Saudi Arabia to the east, and was primarily driven by the transportation network. The most recent sub-clade C5.1 (since 2013) was associated with non-synonymous mutations and a higher mortality rate. Phylogeographic analyses pointed to Riyadh of Saudi Arabia and Abu Dhabi of the United Arab Emirates as the hubs for both local and international spread of MERS-CoV. Conclusions MERS-CoV remains primarily locally transmitted in the Middle East, with opportunistic exportation to other continents and a potential of causing transmission clusters of human cases. Animal contact is associated with a higher risk of death, but the association differs by age and sex. Transportation network is the leading driver for the spatial diffusion of the disease. These findings how this pathogen spread are helpful for targeting public health surveillance and interventions to control endemics and to prevent a potential pandemic. Graphical abstract

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Limited Genetic Diversity Detected in Middle East Respiratory Syndrome-Related Coronavirus Variants Circulating in Dromedary Camels in Jordan

Viruses ◽

10.3390/v13040592 ◽

2021 ◽

Vol 13 (4) ◽

pp. 592

Author(s):

Stephanie N. Seifert ◽

Jonathan E. Schulz ◽

Stacy Ricklefs ◽

Michael Letko ◽

Elangeni Yabba ◽

...

Keyword(s):

Genetic Diversity ◽

Middle East ◽

United Arab Emirates ◽

Sequence Data ◽

Case Fatality ◽

High Sensitivity ◽

Middle East Respiratory Syndrome ◽

Full Genome Sequence ◽

Genome Sequences ◽

Dromedary Camels

Middle East respiratory syndrome-related coronavirus (MERS-CoV) is a persistent zoonotic pathogen with frequent spillover from dromedary camels to humans in the Arabian Peninsula, resulting in limited outbreaks of MERS with a high case-fatality rate. Full genome sequence data from camel-derived MERS-CoV variants show diverse lineages circulating in domestic camels with frequent recombination. More than 90% of the available full MERS-CoV genome sequences derived from camels are from just two countries, the Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE). In this study, we employ a novel method to amplify and sequence the partial MERS-CoV genome with high sensitivity from nasal swabs of infected camels. We recovered more than 99% of the MERS-CoV genome from field-collected samples with greater than 500 TCID50 equivalent per nasal swab from camel herds sampled in Jordan in May 2016. Our subsequent analyses of 14 camel-derived MERS-CoV genomes show a striking lack of genetic diversity circulating in Jordan camels relative to MERS-CoV genome sequences derived from large camel markets in KSA and UAE. The low genetic diversity detected in Jordan camels during our study is consistent with a lack of endemic circulation in these camel herds and reflective of data from MERS outbreaks in humans dominated by nosocomial transmission following a single introduction as reported during the 2015 MERS outbreak in South Korea. Our data suggest transmission of MERS-CoV among two camel herds in Jordan in 2016 following a single introduction event.

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Molecular Epidemiology of Hospital Outbreak of Middle East Respiratory Syndrome, Riyadh, Saudi Arabia, 2014

Emerging Infectious Diseases ◽

10.3201/eid2111.150944 ◽

2015 ◽

Vol 21 (11) ◽

pp. 1981-1988 ◽

Cited By ~ 37

Author(s):

Shamsudeen F. Fagbo ◽

Leila Skakni ◽

Daniel K.W. Chu ◽

Musa A. Garbati ◽

Mercy Joseph ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Molecular Epidemiology ◽

Middle East Respiratory Syndrome ◽

Hospital Outbreak

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Ifosfamide May Be Safely Used in Patients with End Stage Renal Disease on Hemodialysis

Sarcoma ◽

10.1155/2009/575629 ◽

2009 ◽

Vol 2009 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Sheron Latcha ◽

Robert G. Maki ◽

Gary K. Schwartz ◽

Carlos D. Flombaum

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Response To Therapy ◽

Common Side Effect ◽

Pharmacokinetic Data ◽

Life Threatening ◽

Stage Renal Disease ◽

End Stage ◽

Metastatic Sarcoma ◽

Radiographic Improvement

Background. Pharmacokinetic data on clearance of ifosfamide in hemodialysis patients are limited. Consequently, these patients are excluded from therapy with this agent. We review the outcomes for patients at our institution with end stage renal disease on dialysis who received ifosfamide for metastatic sarcoma.Patients and Methods. We treated three patients with end stage renal disease on hemodialysis with escalating doses of ifosfamide. Data on radiographic response to therapy, WBC and platelet counts, signs or symptoms of infection, neuropathy and bladder toxicity are reported. Starting doses of ifosfamide were based on review of the literature available with subsequent modifications based on each patient's prior exposure to myelosuppressive agents and on symptoms of neurotoxicity and the degree of myelosuppression following each cycle of chemotherapy.Results. Myelosuppression was the most common side effect from therapy, but no patient developed a life threatening infection, neurotoxicity, or hematuria. One patient developed epistaxis in the setting of thrombocytopenia while on warfarin therapy. All patients had clinical evidence for therapeutic response and two had documented radiographic improvement following ifosfamide administration.Conclusion. Ifosfamide can be used safely in combination with hemodialysis in patients with end stage renal disease.

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Diagnostic delays in 537 symptomatic cases of Middle East respiratory syndrome coronavirus infection in Saudi Arabia

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2017.07.008 ◽

2017 ◽

Vol 62 ◽

pp. 47-51 ◽

Cited By ~ 15

Author(s):

Anwar E. Ahmed

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Middle East Respiratory Syndrome ◽

Coronavirus Infection ◽

Diagnostic Delays

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Origins and pathogenesis of Middle East respiratory syndrome-associated coronavirus: recent advances

F1000Research ◽

10.12688/f1000research.11827.1 ◽

2017 ◽

Vol 6 ◽

pp. 1628 ◽

Cited By ~ 13

Author(s):

Stephen A. Goldstein ◽

Susan R. Weiss

Keyword(s):

Immune Response ◽

Middle East ◽

Animal Models ◽

Case Fatality ◽

Innate Immune ◽

Middle East Respiratory Syndrome ◽

Live Virus ◽

Novel Proteins ◽

Significant Research ◽

African Bats

Middle East respiratory syndrome-associated coronavirus (MERS-CoV) has been a significant research focus since its discovery in 2012. Since 2012, 2,040 cases and 712 deaths have been recorded (as of August 11, 2017), representing a strikingly high case fatality rate of 36%. Over the last several years, MERS-CoV research has progressed in several parallel and complementary directions. This review will focus on three particular areas: the origins and evolution of MERS-CoV, the challenges and achievements in the development of MERS-CoV animal models, and our understanding of how novel proteins unique to MERS-CoV counter the host immune response. The origins of MERS-CoV, likely in African bats, are increasingly clear, although important questions remain about the establishment of dromedary camels as a reservoir seeding human outbreaks. Likewise, there have been important advances in the development of animal models, and both non-human primate and mouse models that seem to recapitulate human disease are now available. How MERS-CoV evades and inhibits the host innate immune response remains less clear. Although several studies have identified MERS-CoV proteins as innate immune antagonists, little of this work has been conducted using live virus under conditions of actual infection, but rather with ectopically expressed proteins. Accordingly, considerable space remains for major contributions to understanding unique ways in which MERS-CoV interacts with and modulates the host response. Collectively, these areas have seen significant advances over the last several years but continue to offer exciting opportunities for discovery.

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