title: Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study.
abstract: BACKGROUND
  Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities.
  
  
  METHODS
  We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR.
  
  
  RESULTS
  47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]).
  
  
  CONCLUSIONS
  Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition.
  
  
  BACKGROUND
  None.
authors.affiliation: Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Assiri
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Al-Rabeeah
authors.forename: Fahad A
authors.initials: FA
authors.lastname: Al-Rabiah
authors.forename: Sami
authors.initials: S
authors.lastname: Al-Hajjar
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Barrak
authors.forename: Hesham
authors.initials: H
authors.lastname: Flemban
authors.forename: Wafa N
authors.initials: WN
authors.lastname: Al-Nassir
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Balkhy
authors.forename: Rafat F
authors.initials: RF
authors.lastname: Al-Hakeem
authors.forename: Hatem Q
authors.initials: HQ
authors.lastname: Makhdoom
authors.forename: Alimuddin I
authors.initials: AI
authors.lastname: Zumla
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000032:analysis; D002648:Child; D017714:Community-Acquired Infections / Q000401:mortality / Q000473:pathology / Q000821:virology; D017934:Coronavirus / Q000302:isolation & purification*; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection / Q000401:mortality / Q000473:pathology / Q000821:virology; D003967:Diarrhea / Q000821:virology; D005260:Female; D005334:Fever / Q000473:pathology; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012529:Saudi Arabia / Q000453:epidemiology; D013921:Thrombocytopenia / Q000473:pathology; D055815:Young Adult
chemical_list: D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases
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