title: Virological and serological analysis of a recent Middle East respiratory syndrome coronavirus infection case on a triple combination antiviral regimen.
abstract: Serological, molecular and phylogenetic analyses of a recently imported case of Middle East respiratory syndrome coronavirus (MERS-CoV) in Greece are reported. Although MERS-CoV remained detectable in the respiratory tract secretions of the patient until the fourth week of illness, viraemia was last detected 2 days after initiation of triple combination therapy with pegylated interferon, ribavirin and lopinavir/ritonavir, administered from Day 13 of illness. Phylogenetic analysis of the virus showed close similarity with other human MERS-CoVs from the recent Jeddah outbreak in Saudi Arabia. Immunoglobulin G (IgG) titres peaked 3 weeks after the onset of illness, whilst IgM levels remained constantly elevated during the follow-up period (second to fifth week of illness). Serological testing confirmed by virus neutralisation assay detected an additional case that was a close contact of the patient.
authors.affiliation: Department of Microbiology, University of Athens, Medical School, 75 Mikras Asias Street, 115 27 Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Spanakis
authors.affiliation: Hellenic Centre for Disease Control and Prevention, Athens, Greece; Department of Internal Medicine, University of Athens Medical School, Athens, Greece.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsiodras
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Bart L
authors.initials: BL
authors.lastname: Haagmans
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: V Stalin
authors.initials: VS
authors.lastname: Raj
authors.affiliation: First Department of Respiratory Medicine, University of Athens Medical School and 'Sotiria' Chest Diseases Hospital, Athens, Greece.
authors.forename: Kostantinos
authors.initials: K
authors.lastname: Pontikis
authors.affiliation: First Department of Respiratory Medicine, University of Athens Medical School and 'Sotiria' Chest Diseases Hospital, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Koutsoukou
authors.affiliation: First Department of Respiratory Medicine, University of Athens Medical School and 'Sotiria' Chest Diseases Hospital, Athens, Greece.
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Koulouris
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Albert D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Marion P G
authors.initials: MP
authors.lastname: Koopmans
authors.affiliation: Department of Microbiology, University of Athens, Medical School, 75 Mikras Asias Street, 115 27 Athens, Greece. Electronic address: atsakris@med.uoa.gr.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tsakris
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D018352:Coronavirus Infections / Q000188:drug therapy* / Q000821:virology; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006115:Greece; D006801:Humans; D061466:Lopinavir; D008297:Male; D065207:Middle East Respiratory Syndrome Coronavirus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology; D010802:Phylogeny; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000821:virology; D012254:Ribavirin / Q000627:therapeutic use*; D019438:Ritonavir; D014766:Viremia; D017201:Virus Shedding
chemical_list: D000998:Antiviral Agents; D004338:Drug Combinations; C558899:lopinavir-ritonavir drug combination; D061466:Lopinavir; D012254:Ribavirin; D019438:Ritonavir
keywords: Antiviral treatment; Coronavirus; MERS; MERS-CoV; Phylogeny; Serology