Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection.
BACKGROUND
Since September 2012, 170 confirmed infections with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization, including 72 deaths. Data on critically ill patients with MERS-CoV infection are limited.


OBJECTIVE
To describe the critical illness associated with MERS-CoV.


METHODS
Case series.


METHODS
3 intensive care units (ICUs) at 2 tertiary care hospitals in Saudi Arabia.


METHODS
12 patients with confirmed or probable MERS-CoV infection.


METHODS
Presenting symptoms, comorbid conditions, pulmonary and extrapulmonary manifestations, measures of severity of illness and organ failure, ICU course, and outcome are described, as are the results of surveillance of health care workers (HCWs) and patients with potential exposure.


RESULTS
Between December 2012 and August 2013, 114 patients were tested for suspected MERS-CoV; of these, 11 ICU patients (10%) met the definition of confirmed or probable cases. Three of these patients were part of a health care-associated cluster that also included 3 HCWs. One HCW became critically ill and was the 12th patient in this case series. Median Acute Physiology and Chronic Health Evaluation II score was 28 (range, 16 to 36). All 12 patients had underlying comorbid conditions and presented with acute severe hypoxemic respiratory failure. Most patients (92%) had extrapulmonary manifestations, including shock, acute kidney injury, and thrombocytopenia. Five (42%) were alive at day 90. Of the 520 exposed HCWs, only 4 (1%) were positive.


CONCLUSIONS
The sample size was small.


CONCLUSIONS
MERS-CoV causes severe acute hypoxemic respiratory failure and considerable extrapulmonary organ dysfunction and is associated with high mortality. Community-acquired and health care-associated MERS-CoV infection occurs in patients with chronic comorbid conditions. The health care-associated cluster suggests that human-to-human transmission does occur with unprotected exposure.


BACKGROUND
None.
Yaseen M
YM
Arabi
Ahmed A
AA
Arifi
Hanan H
HH
Balkhy
Hani
H
Najm
Abdulaziz S
AS
Aldawood
Alaa
A
Ghabashi
Hassan
H
Hawa
Adel
A
Alothman
Abdulaziz
A
Khaldi
Basel
B
Al Raiy
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D018352:Coronavirus Infections / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D003428:Cross Infection / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy / Q000821:virology; D012141:Respiratory Tract Infections / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D012529:Saudi Arabia / Q000453:epidemiology; D013577:Syndrome; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous