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

2015 ◽  
Vol 21 (11) ◽  
pp. 1981-1988 ◽  
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

scholarly journals Increase in Middle East Respiratory Syndrome-Coronavirus Cases in Saudi Arabia Linked to Hospital Outbreak With Continued Circulation of Recombinant Virus, July 1–August 31, 2015

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Abdullah M. Assiri ◽  
Holly M. Biggs ◽  
Glen R. Abedi ◽  
Xiaoyan Lu ◽  
Abdulaziz Bin Saeed ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Middle East ◽  
Recombinant Virus ◽  
Healthcare Facility ◽  
Middle East Respiratory Syndrome ◽  
Open Reading Frame ◽  
Viral Sequence ◽  
Reading Frame ◽  
Hospital Outbreak ◽  
Frameshift Deletion

Abstract During July–August 2015, the number of cases of Middle East respiratory syndrome (MERS) reported from Saudi Arabia increased dramatically. We reviewed the 143 confirmed cases from this period and classified each based upon likely transmission source. We found that the surge in cases resulted predominantly (90%) from secondary transmission largely attributable to an outbreak at a single healthcare facility in Riyadh. Genome sequencing of MERS coronavirus from 6 cases demonstrated continued circulation of the recently described recombinant virus. A single unique frameshift deletion in open reading frame 5 was detected in the viral sequence from 1 case.

scholarly journals A pandemic risk assessment of middle east respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia

2017 ◽  
Vol 24 (7) ◽  
pp. 1631-1638 ◽  
Author(s):  
Saleh A. Eifan ◽  
Islam Nour ◽  
Atif Hanif ◽  
Abdelrahman M.M. Zamzam ◽  
Sameera Mohammed AlJohani
Keyword(s):  
Risk Assessment ◽  
Saudi Arabia ◽  
Middle East ◽  
Middle East Respiratory Syndrome

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

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5871-5871 ◽  
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.

scholarly journals An Observational, Laboratory-Based Study of Outbreaks of Middle East Respiratory Syndrome Coronavirus in Jeddah and Riyadh, Kingdom of Saudi Arabia, 2014

2014 ◽  
Vol 60 (3) ◽  
pp. 369-377 ◽  
Author(s):  
Christian Drosten ◽  
Doreen Muth ◽  
Victor M. Corman ◽  
Raheela Hussain ◽  
Malaki Al Masri ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Middle East ◽  
Middle East Respiratory Syndrome ◽  
Nosocomial Transmission ◽  
Interferon Response ◽  
Nucleotide Polymorphisms ◽  
Diagnostic Laboratory ◽  
Virus Shedding ◽  
Negative Results ◽  
Sudden Rise

Abstract Background.  In spring 2014, a sudden rise in the number of notified Middle East respiratory syndrome coronavirus (MERS-CoV) infections occurred across Saudi Arabia with a focus in Jeddah. Hypotheses to explain the outbreak pattern include increased surveillance, increased zoonotic transmission, nosocomial transmission, and changes in viral transmissibility, as well as diagnostic laboratory artifacts. Methods.  Diagnostic results from Jeddah Regional Laboratory were analyzed. Viruses from the Jeddah outbreak and viruses occurring during the same time in Riyadh, Al-Kharj, and Madinah were fully or partially sequenced. A set of 4 single-nucleotide polymorphisms distinctive to the Jeddah outbreak were determined from additional viruses. Viruses from Riyadh and Jeddah were isolated and studied in cell culture. Results.  Up to 481 samples were received per day for reverse transcription polymerase chain reaction (RT-PCR) testing. A laboratory proficiency assessment suggested positive and negative results to be reliable. Forty-nine percent of 168 positive-testing samples during the Jeddah outbreak stemmed from King Fahd Hospital. All viruses from Jeddah were monophyletic and similar, whereas viruses from Riyadh were paraphyletic and diverse. A hospital-associated transmission cluster, to which cases in Indiana (United States) and the Netherlands belonged, was discovered in Riyadh. One Jeddah-type virus was found in Riyadh, with matching travel history to Jeddah. Virus isolates representing outbreaks in Jeddah and Riyadh were not different from MERS-CoV EMC/2012 in replication, escape of interferon response, or serum neutralization. Conclusions.  Virus shedding and virus functions did not change significantly during the outbreak in Jeddah. These results suggest the outbreaks to have been caused by biologically unchanged viruses in connection with nosocomial transmission.

scholarly journals Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia

2018 ◽  
Vol 13 (1) ◽  
pp. 126-130 ◽  
Author(s):  
Sarah H. Alfaraj ◽  
Jaffar A. Al-Tawfiq ◽  
Talal A. Altuwaijri ◽  
Ziad A. Memish
Keyword(s):  
Saudi Arabia ◽  
Middle East ◽  
Middle East Respiratory Syndrome
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