title: Kinetics and pattern of viral excretion in biological specimens of two MERS-CoV cases.
abstract: BACKGROUND
  Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging coronavirus involved in severe acute respiratory distress syndrome (ARDS) and rapid renal failure. Hospital outbreak and nosocomial transmission were reported, however, several issues remain on the viral excretion course.
  
  
  OBJECTIVE
  Describe the kinetics and pattern of viral excretion in two infected patients.
  
  
  METHODS
  After the initial diagnosis, blood, urine, rectal and respiratory samples were collected regularly, aliquoted and stored at -80°C. Real-time reverse transcriptase polymerase chain reaction assay targeted the UpE and Orf1a regions of the MERS-CoV genome.
  
  
  RESULTS
  In patient 1, who died of refractory ARDS and renal failure, MERS-CoV RNA was detected in pharyngeal and tracheal swabs, as well blood samples and urine samples until the 30th day. Rectal swabs were negative. Patient 2 also developed multiple-organ failure, but survived, with persisting renal insufficiency (creatinine clearance at 30 mL/min) and persistent interstitial syndrome albeit weaned off mechanical ventilation and no longer requiring oxygen. Tracheal aspirations were positive until the 33rd day, while nasopharyngeal swabs were negative. All other biological samples were negative.
  
  
  CONCLUSIONS
  Lower respiratory tract excretion of MERS-CoV could be observed for more than one month. The most severely ill patient presented an expression of the virus in blood and urine, consistent with a type-1 interferon mediated immunological response impaired in patient 1, but developed by patient 2. These results suggest that infection control precautions must be adequately evaluated in clinical wards and laboratories exposed to MERS-CoV.
authors: Pôle de Réanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2, Lille Cedex, France. Electronic address: julien_poissy@hotmail.fr.
authors: J
authors: J
authors: Poissy
authors: Laboratoire de Virologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2, Lille Cedex, France; Molecular & Cellular Virology of Hepatitis C, Center for Infection & Immunity of Lille (CIIL), Inserm U1019, CNRS UMR8204, Université Lille Nord de France, F-59000 Lille, France.
authors: A
authors: A
authors: Goffard
authors: Pôle de Réanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2, Lille Cedex, France.
authors: E
authors: E
authors: Parmentier-Decrucq
authors: Pôle de Réanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2, Lille Cedex, France.
authors: R
authors: R
authors: Favory
authors: Pôle de Réanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2, Lille Cedex, France.
authors: M
authors: M
authors: Kauv
authors: Host-Pathogen Translational Research Group, Université de Lille 2, Lille Cedex, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8204, F-59021 Lille, France; Institut National de la Santé et de la Recherche Médicale, U1019, F-59019 Lille, France; Département d'anesthésie-réanimation, Centre Hospitalier Régional et Universitaire de Lille, Lille Cedex, France.
authors: E
authors: E
authors: Kipnis
authors: Pôle de Réanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2, Lille Cedex, France.
authors: D
authors: D
authors: Mathieu
authors: S
authors: S
authors: van der Werf
authors: Host-Pathogen Translational Research Group, Université de Lille 2, Lille Cedex, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8204, F-59021 Lille, France; Institut National de la Santé et de la Recherche Médicale, U1019, F-59019 Lille, France; Département d'anesthésie-réanimation, Centre Hospitalier Régional et Universitaire de Lille, Lille Cedex, France; Service de maladies infectieuses, Centre Hospitalier Régional et Universitaire de Lille, Lille Cedex, France.
authors: B
authors: B
authors: Guery
mesh_terms: D001769:Blood / Q000821:virology; D018352:Coronavirus Infections / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification*; D012367:RNA, Viral / Q000032:analysis / Q000235:genetics / Q000302:isolation & purification; D060888:Real-Time Polymerase Chain Reaction; D012007:Rectum / Q000821:virology; D012137:Respiratory System / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013997:Time Factors; D014556:Urine / Q000821:virology; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral
keywords: Coronavirus; Kinetic; MERS-CoV; RNA detection; Respiratory tract infection