scholarly journals IFN-α2a or IFN-β1a in combination with ribavirin to treat Middle East respiratory syndrome coronavirus pneumonia: a retrospective study

2015 ◽  
Vol 70 (7) ◽  
pp. 2129-2132 ◽  
Author(s):  
Sarah Shalhoub ◽  
Fayssal Farahat ◽  
Abdullah Al-Jiffri ◽  
Raed Simhairi ◽  
Omar Shamma ◽  
...  
Keyword(s):  
Middle East ◽  
Mortality Rate ◽  
Prognostic Indicator ◽  
Middle East Respiratory Syndrome ◽  
Rt Pcr ◽  
Respiratory Sample ◽  
Viral Shedding ◽  
Related Mortality ◽  
Overall Mortality ◽  
Significant Mortality

Abstract Objectives Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with significant mortality. We examined the utility of plasma MERS-CoV PCR as a prognostic indicator and compared the efficacies of IFN-α2a and IFN-β1a when combined with ribavirin in reducing MERS-CoV-related mortality rates. Methods We retrospectively analysed 32 patients with confirmed MERS-CoV infection, admitted between April 2014 and June 2014, by positive respiratory sample RT–PCR. Plasma MERS-CoV RT–PCR was performed at the time of diagnosis for 19 patients. Results The overall mortality rate was 69% (22/32). Ninety percent (9/10) of patients with positive plasma MERS-CoV PCR died compared with 44% (4/9) of those with negative plasma MERS-CoV PCR. Mortality rate in patients who received IFN-α2a was 85% (11/13) compared with 64% (7/11) in those who received IFN-β1a (P = 0.24). The mortality rate in patients with renal failure (14), including 8 on haemodialysis, was 100%. Age >50 years and diabetes mellitus were found to be significantly associated with mortality (OR = 26.1; 95% CI 3.58–190.76; P = 0.001 and OR = 15.74; 95% CI 2.46–100.67; P = 0.004, respectively). The median duration of viral shedding in patients who recovered was 11 days (range 6–38 days). Absence of fever was noted in 5/32 patients. Conclusions Plasma MERS-CoV RT–PCR may serve as an effective tool to predict MERS-CoV-associated mortality. Older age and comorbid conditions may have contributed to the lack of efficacy of IFN-α2a or IFN-β1a with ribavirin in treating MERS-CoV. Absence of fever should not exclude MERS-CoV.

scholarly journals Preclinical studies of immunogenity, protectivity, and safety of the combined vector vaccine for prevention of the middle east respiratory syndrome

Acta Naturae ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 114-123
Author(s):  
Inna V. Dolzhikova ◽  
D. M. Grousova ◽  
O. V. Zubkova ◽  
A. I. Tukhvatulin ◽  
A. V. Kovyrshina ◽  
...  
Keyword(s):  
Immune Response ◽  
Middle East ◽  
Mortality Rate ◽  
Receptor Gene ◽  
Human Adenovirus ◽  
T Cell Response ◽  
Middle East Respiratory Syndrome ◽  
Vector Vaccine ◽  
Humoral Immune ◽  
Cellular Immune

The Middle East Respiratory Syndrome (MERS) is an acute inflammatory disease of the respiratory system caused by the MERS-CoV coronavirus. The mortality rate for MERS is about 34.5%. Due to its high mortality rate, the lack of therapeutic and prophylactic agents, and the continuing threat of the spread of MERS beyond its current confines, developing a vaccine is a pressing task, because vaccination would help limit the spread of MERS and reduce its death toll. We have developed a combined vector vaccine for the prevention of MERS based on recombinant human adenovirus serotypes 26 and 5. Studies of its immunogenicity have shown that vaccination of animals (mice and primates) induces a robust humoral immune response that lasts for at least six months. Studies of the cellular immune response in mice after vaccination showed the emergence of a specific CD4+ and CD8+ T cell response. A study of the vaccine protectivity conducted in a model of transgenic mice carrying the human DPP4 receptor gene showed that our vaccination protected 100% of the animals from the lethal infection caused by the MERS-CoV virus (MERS-CoV EMC/2012, 100LD50 per mouse). Studies of the safety and tolerability of the developed vaccine in rodents, rabbits, and primates showed a good safety profile and tolerance in animals; they revealed no contraindications for clinical testing.

scholarly journals Report of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection in Four Patients with Hematological Malignancies Treated at King Fahad Medical City, Riyadh, Saudi Arabia

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4903-4903 ◽  
Author(s):  
Ibraheem H Motabi ◽  
Syed Ziauddin A. Zaidi ◽  
Mamoun Hassan Ibrahim ◽  
Imran K Tailor ◽  
Nawal Faiez Alshehry ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Middle East ◽  
Supportive Care ◽  
Hematological Malignancies ◽  
Conflicts Of Interest ◽  
Lower Lobe ◽  
Middle East Respiratory Syndrome ◽  
Rt Pcr ◽  
Peak Period ◽  
Increased Risk

Abstract Introduction Respiratory viruses are an important cause of outbreaks of pneumonia in hematological malignancy patients. Recently, novel Middle East respiratory syndrome coronavirus (MERS-CoV) caused a cluster of life-threatening infections in Saudi Arabia (688 confirmed MERS-CoV infection cases with 282 deaths were reported to WHO by June 6, 2014 including 28% cases in HCW). Most patients had upper &/or lower respiratory tract symptoms but other features included abdominal pain, diarrhea, acute kidney injury & shock. Few hematology units were closed due to havoc. Here we report clinical features & outcome of 4 patients diagnosed at our unit during the peak period (mid-March through May 2015) including 2 who got chemotherapy (chemo) soon after recovery. Patient #1 A 62-yr-old male had free λ light chain multiple myeloma (MM) with spinal cord compression. After surgery & local radiation, he was sent to us with paraplegia & grade 4 infected sacral bedsore that needed inpatient care. He was started on CyBorD Cycle 2 on April 24, 2014. On May 2, he had a fever spike with shortness of breath (SOB) & cough. He was started on antibiotics. CXR revealed bilateral infiltrates & right sided pleural effusion. His O2 sat dropped & he needed CPAP. Oseltamivir was started & sputum was positive for MERS-CoV RT-PCR. He became afebrile with decreasing O2 requirement, CXR normalized & RT-PCR for MERS-CoV turned negative. Later he was able to receive 3rdcycle of CyBorD. Patient #2 A 65-yr-old lady came to us with B symptoms & huge organomegaly due to stage-IV DLBCL. On May 2, 2014 RCVP chemo was started. On day 6, she spiked fever with SOB, cough & was started on imipenem. CXR showed consolidation in right lower lobe. She needed 4L of O2/min. On May 10, 2014, she worsened with RR 32/min, O2 sat 79% on 15L O2/min & BP 79/47 mmHg. CXR revealed bilateral consolidation. She needed intubation & inotropic support in ICU. Vancomycin & oseltamivir were started & RT-PCR was positive for MERS-CoV on two nasopharyngeal swabs (NPS). LFT & RFT were normal but she continued to decline & died on May 13, 2014. Patient # 3 A 22-yr-old lady with past H/O AML t(8;21) was admitted on April 27, 2014 with 3 day H/O cough, fever & SOB. CXR had infiltrates in left lower lobe. She had severe pancytopenia & BMB confirmed relapsed AML. She had slightly raised LFT. Urine grew Ent. fecium. Antibiotics & voriconazole were used. She remained febrile over next 2 days. CT chest revealed extensive bilateral consolidation. She needed O2 up to 5L/Min for few days. RT-PCR for MERS-CoV was positive from NPS. She was initiated on oseltamivir. She became afebrile after 2 days & repeated RT-PCR for MERS-CoV was negative. Fludara, Ara-C (FA) chemo was started. She remained neutropenic for next 4 weeks but there was no recurrence of respiratory symptoms. BMB on day 28 of FA confirmed CR. CT chest revealed complete resolution of air space opacities. She was discharged with plan to undergo matched sibling donor Allo-HSCT. Patient #4 A 76-yr-old male with H/O HTN & CKD was diagnosed to have IgA κ MM. He was started on MPV chemo as inpatient due to logistic reasons. After 3 cycles of MPV, serum free κ chains decreased by 91% but remained on dialysis. On 21 April, 2014 he developed cough, SOB & fever. CXR revealed bilateral infiltrates & antibiotics were started. He worsened over next few days & CXR showed worsening bilateral consolidation. Eventually he needed intubation. He was treated with antimicrobials including voriconazole & oseltamir. RT-PCR for MERS-CoV was positive from NPS. Unfortunately he died few days later. Discussion: Patients with hematological malignancies are at increased risk of community & hospital-acquired infections. Recent outbreak of MERS-CoV infection has created a havoc among hematologists community. There is uncertainty about impact of MERS-CoV infection on continuation of chemo. We report 4 cases of hematological malignancies with MERS-CoV infection. Three of the 4 patients developed severe pneumonia & required intubation (2 died later) & one had milder form of pneumonia treated in isolation room. In addition to supportive care, all 4 received antimicrobials & oseltamivir. Chemo was safe soon after recovery from infection in the surviving 2 patients. We propose that during MERS-CoV epidemics, pneumonia can be treated with supportive care, antibiotics & oseltamivir. Chemo can be continued for the malignant disease soon after recovery. Further reports are needed to confirm our findings. Disclosures No relevant conflicts of interest to declare.

scholarly journals Verification and diagnostic evaluation of the RealStar® Middle East respiratory syndrome coronavirus (N gene) reverse transcription-PCR kit 1.0

2019 ◽  
Vol 14 (11) ◽  
pp. 941-948 ◽  
Author(s):  
Leonie-Sophie Hecht ◽  
Angeles Jurado-Jimenez ◽  
Markus Hess ◽  
Hussein El Halas ◽  
Gregor Bochenek ◽  
...  
Keyword(s):  
Middle East ◽  
Reverse Transcription ◽  
Diagnostic Procedure ◽  
Middle East Respiratory Syndrome ◽  
Diagnostic Evaluation ◽  
N Gene ◽  
Rt Pcr ◽  
Reverse Transcription Pcr ◽  
Confirmatory Assay ◽  
Pcr Targeting

Aim: We report the diagnostic evaluation of a confirmatory reverse transcription-PCR (RT-PCR) kit targeting the Middle East respiratory syndrome coronavirus (MERS-CoV) N gene. Material & methods: 33 patient samples from two collections sites in Riyadh, Saudi Arabia, which were pre-characterized via real-time RT-PCR targeting MERS-CoV orf1a and upE, and were tested using the MERS-CoV N gene, as a confirmatory assay. This diagnostic procedure follows a two-step diagnostics scheme, recommended by the WHO. Results: 18/33 samples tested positive, 11/33 tested negative for MERS-CoV RNA and 2/33 showed uncertain results. Conclusion: The results suggest, that the RealStar® MERS-CoV (N gene) RT-PCR kit 1.0 can be considered a suitable and reliable confirmatory assay in combination with the RealStar MERS-CoV RT-PCR kit 1.0 according to the diagnostic scheme recommended by WHO.

scholarly journals Engineering a Replication-Competent, Propagation-Defective Middle East Respiratory Syndrome Coronavirus as a Vaccine Candidate

mBio ◽  
2013 ◽  
Vol 4 (5) ◽  
Author(s):  
Fernando Almazán ◽  
Marta L. DeDiego ◽  
Isabel Sola ◽  
Sonia Zuñiga ◽  
Jose L. Nieto-Torres ◽  
...  
Keyword(s):  
Middle East ◽  
Mortality Rate ◽  
Bacterial Artificial Chromosome ◽  
Cdna Clone ◽  
Reverse Genetics ◽  
Infectious Virus ◽  
Vaccine Candidate ◽  
Artificial Chromosome ◽  
Middle East Respiratory Syndrome ◽  
E Protein

ABSTRACTMiddle East respiratory syndrome coronavirus (MERS-CoV) is an emerging coronavirus infecting humans that is associated with acute pneumonia, occasional renal failure, and a high mortality rate and is considered a threat to public health. The construction of a full-length infectious cDNA clone of the MERS-CoV genome in a bacterial artificial chromosome is reported here, providing a reverse genetics system to study the molecular biology of the virus and to develop attenuated viruses as vaccine candidates. Following transfection with the cDNA clone, infectious virus was rescued in both Vero A66 and Huh-7 cells. Recombinant MERS-CoVs (rMERS-CoVs) lacking the accessory genes 3, 4a, 4b, and 5 were successfully rescued from cDNA clones with these genes deleted. The mutant viruses presented growth kinetics similar to those of the wild-type virus, indicating that accessory genes were not essential for MERS-CoV replication in cell cultures. In contrast, an engineered mutant virus lacking the structural E protein (rMERS-CoV-ΔE) was not successfully rescued, since viral infectivity was lost at early passages. Interestingly, the rMERS-CoV-ΔE genome replicated after cDNA clone was transfected into cells. The infectious virus was rescued and propagated in cells expressing the E protein intrans, indicating that this virus was replication competent and propagation defective. Therefore, the rMERS-CoV-ΔE mutant virus is potentially a safe and promising vaccine candidate to prevent MERS-CoV infection.IMPORTANCESince the emergence of MERS-CoV in the Arabian Peninsula during the summer of 2012, it has already spread to 10 different countries, infecting around 94 persons and showing a mortality rate higher than 50%. This article describes the development of the first reverse genetics system for MERS-CoV, based on the construction of an infectious cDNA clone inserted into a bacterial artificial chromosome. Using this system, a collection of rMERS-CoV deletion mutants has been generated. Interestingly, one of the mutants with the E gene deleted was a replication-competent, propagation-defective virus that could only be grown in the laboratory by providing E protein intrans, whereas it would only survive a single virus infection cyclein vivo. This virus constitutes a vaccine candidate that may represent a balance between safety and efficacy for the induction of mucosal immunity, which is needed to prevent MERS-CoV infection.

scholarly journals Co-infections of MERS-CoV with other respiratory viruses in Saudi Arabia

2020 ◽  
Vol 21 (4) ◽  
pp. 284-289
Author(s):  
K. Al-Quthami ◽  
W.S. Al-Waneen ◽  
B.O. Al Johnyi
Keyword(s):  
Saudi Arabia ◽  
Middle East ◽  
Fast Track ◽  
Respiratory Viruses ◽  
Middle East Respiratory Syndrome ◽  
Respiratory Pathogen ◽  
Fisher Exact Test ◽  
Rt Pcr ◽  
Pcr Multiplex ◽  
Arabie Saoudite

Background: The Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a member of the coronaviruses called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). The co-infections of MERS-CoV with other respiratory viruses have been documented in rare cases in the scientific literature. This study was carried out to determine whether confection of MERS-CoV occurs with other respiratory viruses in Saudi Arabia.Methods: Nasopharyngeal swabs samples of 57 MERS-CoV positive outpatients were collected using flocked swabs. Nucleic acid was extracted from each sample using commercial NucliSens easyMAG system. Amplification was performed by multiplex RT-PCR using Fast Track Diagnostics Respiratory Pathogen 33. Data were analyzed with SPSS software version 19 and comparison of variables was done with Fisher Exact test, with p value <0.05 considered significant.Results: Six of the total 57 MERS-COV patients (35 males, 22 females) were positive for co-infection of MERS CoV with other respiratory viruses, giving a prevalence rate of 10.5%, with 14.5% (5/35) in males and 4.5% (1/22) in females (OR=3.500, 95% CI=0.3806-32.188, p=0.3889). The prevalence of co-infections was significantly higher among non-Saudis (23.8%, 5/21) than Saudis (2.8%, 1/36) (OR=0.09143, 95% CI=0.009855-0.8485, p=0.0217), and among the age group 18-34 years (25%, 3/12) than other age groups (X2=3.649, p=0.1613). Human rhinovirus (HRV) was found in 2 of the 6 (33.3%) patients with co-infection while the other viruses were found in each of the remaining 4 patients.Conclusion: Our study confirms that MERS-CoV co-infects with other respiratory viruses in Saudi Arabia. Keywords: MERS-CoV; URTI; Co-infection; Coronavirus   French title: Co-infections de MERS-CoV avec d'autres virus respiratoires en Arabie saoudite Contexte: Le syndrome respiratoire du Moyen-Orient (MERS) est une maladie respiratoire virale causée par un membre des coronavirus appelé coronavirus du syndrome respiratoire du Moyen-Orient (MERS-CoV). Les co-infections de MERS-CoV avec d'autres virus respiratoires ont été documentées dans de rares cas dans la littérature scientifique. Cette étude a été réalisée pour déterminer si la confection du MERS-CoV se produit avec d'autres virus respiratoires en Arabie saoudite. Méthodes: Des écouvillons nasopharyngés de 57 patients ambulatoires positifs au MERS-CoV ont été prélevés à l'aide d'écouvillons floqués. L'acide nucléique a été extrait de chaque échantillon en utilisant le système NucliSens easyMAG commercial. L'amplification a été réalisée par RT-PCR multiplex en utilisant Fast Track Diagnostics Respiratory Pathogen 33. Les données ont été analysées avec le logiciel SPSS version 19 et la comparaison des variables a été effectuée avec le test Fisher Exact, avec une valeur p<0,05 considérée comme significative. Résultats: Six des 57 patients MERS-COV (35 hommes, 22 femmes) étaient positifs pour la co-infection de MERS CoV avec d'autres virus respiratoires, donnant un taux de prévalence de 10,5%, avec 14,5% (5/35) chez les hommes et 4,5% (1/22) chez les femelles (OR 3.500, 95% CI 0.3806-32.188, p=0.3889). La prévalence des co-infections était plus élevée chez les non-saoudiens (23.8%, 5/21) que chez les saoudiens (2.8%, 1/36) (OR=0.09143, 95% CI=0.009855-0.8485, p=0.0217) et parmi le groupe d'âge de 18 à 34 ans (25%, 3/12) que dans les autres groupes d'âge (X2=3.649, p=0.1613). Le rhinovirus humain (VRC) a été trouvé chez 2 des 6 (33,3%) patients co-infectés tandis que les autres virus ont été trouvés chez chacun des 4 patients restants. Conclusion: Notre étude confirme que le MERS-CoV co-infecte avec d'autres virus respiratoires en Arabie Saoudite. Mots-clés: MERS-CoV; URTI; Co-infection; Coronavirus

scholarly journals Middle East respiratory syndrome in Morocco: four years of surveillance and evaluation of the management of suspected cases

2018 ◽  
Vol 6 (1) ◽  
pp. 93
Author(s):  
Tahar Bajjou ◽  
Khalid Ennibi ◽  
Idriss Lahlou Amine ◽  
Farida Hilali ◽  
Abdelilah Laraqui ◽  
...  
Keyword(s):  
Middle East ◽  
Teaching Hospital ◽  
Management Plan ◽  
Case Definition ◽  
Pcr Detection ◽  
Middle East Respiratory Syndrome ◽  
Rt Pcr ◽  
Travel History ◽  
Suspect Case

Background: In early 2014, Morocco took steps to prevent the Middle East respiratory syndrome disease from entering into the country. Several facilities have been equipped to accommodate suspected cases. We aimed to report the plan prepared by Morocco to prevent the importation of this infection and to evaluate our experience in the monitoring of suspected cases.Methods: We analyze the data on the forms of surveillance witch collect demographic informations, symptoms, hospitalization, travel history, risk contacts and MERS-CoV test results.Results: Since 2014, 152 patients were addressed to the Mohammed 5 Military Teaching Hospital for suspicion of MERS-CoV. The compliance with the suspect case definition was positive in 78 cases. Of these patients, 93.6% were Moroccans. All of them came from the Middle East and 77% returned from a Hajj trip. The most reported symptoms were fever (92.3%) and cough (84.6%). The most reported underlying conditions were asthma (17.9%) and diabetes (12.8%). All of these patients were negative for RT-PCR detection of MERS-CoV.Conclusions: Moroccan pilgrims go to Hajj despite the warnings of the WHO. To date, Morocco has not reported any cases of MERS-CoV. Overall, the management plan to prevent importation and transmission of MERS-Cov is satisfactory.

scholarly journals Viral Shedding and Environmental Cleaning in Middle East Respiratory Syndrome Coronavirus Infection

2015 ◽  
Vol 47 (4) ◽  
pp. 252 ◽  
Author(s):  
Joon Young Song ◽  
Hee Jin Cheong ◽  
Min Joo Choi ◽  
Ji Ho Jeon ◽  
Seong Hee Kang ◽  
...  
Keyword(s):  
Middle East ◽  
Middle East Respiratory Syndrome ◽  
Environmental Cleaning ◽  
Viral Shedding ◽  
Coronavirus Infection

scholarly journals Viral Shedding and Antibody Response in 37 Patients With Middle East Respiratory Syndrome Coronavirus Infection

2015 ◽  
pp. civ951 ◽  
Author(s):  
Victor M. Corman ◽  
Ali M. Albarrak ◽  
Ali Senosi Omrani ◽  
Mohammed M. Albarrak ◽  
Mohamed Elamin Farah ◽  
...  
Keyword(s):  
Middle East ◽  
Antibody Response ◽  
Middle East Respiratory Syndrome ◽  
Viral Shedding ◽  
Coronavirus Infection

scholarly journals Predictors of mortality in Middle East respiratory syndrome (MERS)

Thorax ◽  
2017 ◽  
Vol 73 (3) ◽  
pp. 286-289 ◽  
Author(s):  
Ki-Ho Hong ◽  
Jae-Phil Choi ◽  
Seon-Hui Hong ◽  
Jeewon Lee ◽  
Ji-Soo Kwon ◽  
...  
Keyword(s):  
Middle East ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
High Viral Load ◽  
Middle East Respiratory Syndrome ◽  
Viral Control ◽  
Monocyte Chemoattractant Protein 1 ◽  
Viral Shedding ◽  
Pneumonia Severity Index Score ◽  
Hospital Days

We evaluated the clinical characteristics, cytokine/chemokine concentrations, viral shedding and antibody kinetics in 30 patients with Middle East respiratory syndrome (MERS), including 6 non-survivors admitted to 3 MERS-designated hospitals. Old age, low albumin, altered mentality and high pneumonia severity index score at admission were risk factors for mortality. In addition, severe signs of inflammation at initial presentation (at hospital days 1-4), such as high inducible protein-10 (p=0.0013), monocyte chemoattractant protein-1 (p=0.0007) and interleukin 6 (p=0.0007) concentrations, and poor viral control (high viral load at hospital days 5–10, p<0.001) without adequate antibody titres (low antibody titre at hospital days 11–16, p=0.07) during the course of disease, were associated with mortality.

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