title: Clinicopathologic, Immunohistochemical, and Ultrastructural Findings of a Fatal Case of Middle East Respiratory Syndrome Coronavirus Infection in the United Arab Emirates, April 2014.
abstract: Middle East respiratory syndrome coronavirus (MERS-CoV) infection causes an acute respiratory illness and is associated with a high case fatality rate; however, the pathogenesis of severe and fatal MERS-CoV infection is unknown. We describe the histopathologic, immunohistochemical, and ultrastructural findings from the first autopsy performed on a fatal case of MERS-CoV in the world, which was related to a hospital outbreak in the United Arab Emirates in April 2014. The main histopathologic finding in the lungs was diffuse alveolar damage. Evidence of chronic disease, including severe peripheral vascular disease, patchy cardiac fibrosis, and hepatic steatosis, was noted in the other organs. Double staining immunoassays that used anti-MERS-CoV antibodies paired with immunohistochemistry for cytokeratin and surfactant identified pneumocytes and epithelial syncytial cells as important targets of MERS-CoV antigen; double immunostaining with dipeptidyl peptidase 4 showed colocalization in scattered pneumocytes and syncytial cells. No evidence of extrapulmonary MERS-CoV antigens were detected, including the kidney. These results provide critical insights into the pathogenesis of MERS-CoV in humans.
authors: Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Dianna L
authors: DL
authors: Ng
authors: Communicable Diseases Department, Abu Dhabi, United Arab Emirates.
authors: Farida
authors: F
authors: Al Hosani
authors: Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: M Kelly
authors: MK
authors: Keating
authors: Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Susan I
authors: SI
authors: Gerber
authors: Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Tara L
authors: TL
authors: Jones
authors: Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Maureen G
authors: MG
authors: Metcalfe
authors: Gastroenteritis and Respiratory Virus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Suxiang
authors: S
authors: Tong
authors: Gastroenteritis and Respiratory Virus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Ying
authors: Y
authors: Tao
authors: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; International Research and Programs Branch, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Negar N
authors: NN
authors: Alami
authors: Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Lia M
authors: LM
authors: Haynes
authors: Emergency and Disaster Department, Abu Dhabi, United Arab Emirates.
authors: Mowafaq Ali
authors: MA
authors: Mutei
authors: Pathology and Laboratory Medicine Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
authors: Laila
authors: L
authors: Abdel-Wareth
authors: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Timothy M
authors: TM
authors: Uyeki
authors: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: David L
authors: DL
authors: Swerdlow
authors: Health Authority-Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: Maha
authors: M
authors: Barakat
authors: Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: szaki@cdc.gov.
authors: Sherif R
authors: SR
authors: Zaki
mesh_terms: D018352:Coronavirus Infections / Q000473:pathology*; D018819:Dipeptidyl Peptidase 4 / Q000276:immunology; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000648:ultrastructure; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000235:genetics / Q000276:immunology* / Q000302:isolation & purification; D011859:Radiography; D014479:United Arab Emirates
chemical_list: D018819:Dipeptidyl Peptidase 4