Middle East Respiratory Syndrome Virus Pathogenesis

Area of Science:

• Virology
• Epidemiology
• Public Health

Background:

• Coronaviruses (CoVs) are RNA viruses infecting various species, with human CoVs (hCoVs) primarily affecting respiratory, enteric, and nervous systems.
• Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) emerged in 2002, followed by Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012.
• While bats may reservoir MERS-CoV, dromedary camels are strongly implicated as the primary source of human transmission, raising concerns about potential outbreaks.

Purpose of the Study:

• To provide an overview of MERS-CoV, its origins, transmission, clinical manifestations, and treatment strategies.
• To highlight the public health concerns associated with MERS-CoV emergence and spread.
• To compare the MERS-CoV case-fatality rate with that of SARS-CoV.

Main Methods:

• Literature review and synthesis of existing data on MERS-CoV.
• Analysis of MERS-CoV case origins, geographical distribution, and associated risk factors.
• Review of clinical presentations, complications, and therapeutic interventions for MERS-CoV.

Main Results:

• MERS-CoV cases are predominantly linked to the Middle East, with international spread reported.
• Patients with comorbidities like diabetes and renal failure exhibit higher mortality rates.
• MERS-CoV causes severe pneumonia and renal dysfunction, with complications including hyperkalemia, DIC, and multiorgan failure.

Conclusions:

• MERS-CoV presents a significant public health challenge due to its high mortality rate (around 30%), exceeding that of SARS-CoV (9.6%).
• First-line therapy involves a combination of type 1 interferon and lopinavir/ritonavir for 10-14 days.
• Convalescent plasma therapy is a potential option for patients unresponsive to antiviral treatments, particularly when administered early in the disease course.