Browsing by Subject "MERS-CoV"

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    Asymptomatic coronavirus infection: MERS-CoV and SARS-CoV-2 (COVID-19)
    (Elsevier, 2020-05) Al-Tawfiq, Jaffar A.; Medicine, School of Medicine
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    The calm before the storm: clinical observations of Middle East respiratory syndrome (MERS) patients
    (Taylor & Francis, 2018) Al-Tawfiq, Jaffar A.; Hinedi, Kareem; Medicine, School of Medicine
    Background: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection emerged in 2012. The majority of cases occurred in the Kingdom of Saudi Arabia and the disease carries a high case fatality rate. Methods: We present three MERS-CoV cases and highlight the salient clinical features and laboratory, and radiographic characteristics. Results: Although all nasopharyngeal samples were negative, MERS CoV infection was confirmed by reverse transcription–polymerase chain reaction of the E gene (UpE) and open reading frame (ORF1b) on sputum samples. The Ct value of the ORF1 gene was 24.8–29.11. One patient had been on immune suppressive agent and two patients had diabetes mellitus. The average length of hospital stay was 10.6 days. Two patients received ribavirin and IFN-a2b in addition to supportive management. The clinical course for these patients started with a febrile period lasting five days, a reduction in fever was coinciding with increased respiratory rate and oxygen requirements. All patients were discharged home. None of the 50 contacts tested positive for MERS-CoV. Conclusion:Resolution of the fever was accompanied by an increase in oxygen requirements and respiratory rate also lasting several days. This was followed by resolution of all symptoms and return to normal.
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    Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: A cohort study
    (Elsevier, 2019) Alfaraj, Sarah; Al-Tawfiq, Jaffar A.; Alzahrani, Nojoom A.; Alanazi, Amal A.; Memish, Ziad A.; Medicine, School of Medicine
    Background Since the emergence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012, the virus had caused a high case fatality rate. The clinical presentation of MERS varied from asymptomatic to severe bilateral pneumonia, depending on the case definition and surveillance strategies. There are few studies examining the mortality predictors in this disease. In this study, we examined clinical predictors of mortality of Middle East Respiratory Syndrome (MERS) infection. Methods This is a retrospective analysis of symptomatic admitted patients to a large tertiary MERS-CoV center in Saudi Arabia over the period from April 2014 to March 2018. Clinical and laboratory data were collected and analysis was done using a binary regression model. Results A total of 314 symptomatic MERS-CoV patients were included in the analysis, with a mean age of 48 (±17.3) years. Of these cases, 78 (24.8%) died. The following parameters were associated with increased mortality, age, WBC, neutrophil count, serum albumin level, use of a continuous renal replacement therapy (CRRT) and corticosteroid use. The odd ratio for mortality was highest for CRRT and corticosteroid use (4.95 and 3.85, respectively). The use of interferon-ribavirin was not associated with mortality in this cohort. Conclusion Several factors contributed to increased mortality in this cohort of MERS-CoV patients. Of these factors, the use of corticosteroid and CRRT were the most significant. Further studies are needed to evaluate whether these factors were a mark of severe disease or actual contributors to higher mortality.
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    A cohort-study of patients suspected for MERS-CoV in a referral hospital in Saudi Arabia
    (Elsevier, 2017) Al-Tawfiq, Jaffar A.; Alfaraj, Sarah H.; Altuwaijri, Talal A.; Memish, Ziad A.; Department of Medicine, IU School of Medicine
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    Convalescent plasma therapy for coronavirus infection: experience from MERS and application in COVID-19
    (Taylor & Francis, 2020-12) Al-Tawfiq, Jaffar A.; Arabi, Yaseen; Medicine, School of Medicine
    The emergence of the COVID-19 pandemic has resulted in a very large number of infections and high number of mortality. There is no specific therapeutic options that are approved for clinical use. Administration of convalescent plasma as a possible therapy was used in the case of viral pneumonia including SARS and influenza. There have been multiple studies of COVID-19 patients utilizing convalescent plasma. These studies employed different dosage levels and different regiments, were observational and lacked control arms, and had variable outcomes. Two of these studies used plasma with anti-SARS-CoV-2 titers of >1:640 to >1:1000. A recent randomized controlled clinical trial showed no benefit of convalescent plasma in patients with severe diseases. However, the study was terminated early and thus further clinical trials are needed to show efficacy in patients with COVID-19 infection.
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    Drivers of MERS-CoV transmission: what do we know?
    (Taylor & Francis, 2016) Al-Tawfiq, Jaffar A.; Memish, Ziad A.; Medicine, School of Medicine
    Middle East Respiratory Syndrome coronavirus (MERS-CoV) emerged in 2012 has since resulted in sporadic cases, intra-familial transmission and major outbreaks in healthcare settings. The clinical picture of MERS-CoV includes asymptomatic infections, mild or moderately symptomatic cases and fatal disease. Transmissions of MERS-CoV within healthcare settings are facilitated by overcrowding, poor compliance with basic infection control measures, unrecognized infections, the superspreaders phenomenon and poor triage systems. The actual contributing factors to the spread of MERS-CoV are yet to be systematically studied, but data to date suggest viral, host and environmental factors play a major role. Here, we summarize the known factors for the diverse transmission of MERS-CoV.
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    Epidemiological characteristics and initial clinical presentation of patients with laboratory-confirmed MERS-CoV infection in an emergency department.
    (MRE Press, 2022) Al Aseri, Zohair; Al-Tawfiq, Jaffar A.; Alnakhli, Mohammed; AlNooh, Abdullah; Alnassar, Abdulaziz; Alkhalid, Salah; Al Dughayman, Abdulaziz; Wani, Tariq; Alhetheel, Abdulkarim; Barry, Mazin; Medicine, School of Medicine
    Emergency departments have been implicated as a source of index cases of the Middle East Respiratory Syndrome (MERS) coronavirus infection. We describe the epidemiological characteristics and initial clinical presentation of patients with Middle East respiratory syndrome coronavirus infection in an emergency department at a hospital in Riyadh, in the Kingdom of Saudi Arabia. The records of all patients presenting to the emergency department who tested positive for Middle East respiratory syndrome coronavirus infection on real-time reverse transcriptase polymerase chain reaction testing from April 2014 to November 2019 were reviewed, and the outcomes were assessed. The clinical presentations and outcomes were compared according to sex. A total of 68 patients with Middle East respiratory syndrome coronavirus infection were identified, of whom 40 (58.8%) were female, and 28 (41.2%) were male. The mean age was 50.7 (standard deviation: 16.4) years, and female patients were younger (44.7 ± 13.1 years) than male patients (59.4 ± 16.9 years). Nineteen of the 68 patients (27.9%) were asymptomatic of whom the majority (16/19, 84%) were female (p=0.012). The most common symptoms were fever (n=29, 42.6%), cough (n=25, 36.8%), upper respiratory tract infection (n=23, 33.8%), and pneumonia (n=15, 22.1%). Pneumonia, diarrhea, dyspnea, and vomiting/diarrhea were more common among male patients. Male patients were more likely than female patients to require hospital admission (78.6% vs. 30.0%), intensive care unit admission (64.3% vs. 15.0%), and invasive mechanical ventilation (32.1% vs. 10.0%). The most common presentation of Middle East respiratory syndrome coronavirus infection in this cohort was asymptomatic infection. A high proportion of asymptomatic infections has not been reported previously. The study did not identify typical clinical features of MERS patients. Male patients tended to develop more severe disease than female patients. A larger study is needed to confirm these findings.
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    First Confirmed Case of Middle East Respiratory Syndrome Coronavirus Infection in the Kingdom of Bahrain: In a Saudi Gentleman after Cardiac Bypass Surgery
    (Hindawi, 2017-08) Seddiq, Nahed; Al-Qahtani, Manaf; Al-Tawfiq, Jaffar A.; Bukamal, Mazar; Medicine, School of Medicine
    Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is well known to cause severe respiratory infection and was first reported in the Kingdom of Saudi Arabia in 2012. We report here the first confirmed MERS-CoV infection in the Kingdom of Bahrain in a Saudi gentleman who was admitted electively for coronary bypass surgery, postoperatively developed an acute respiratory illness, and tested positive for MERS-CoV. 40 close contacts, all healthcare workers, were traced and followed with no documented secondary cases.
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    Hematologic, hepatic, and renal function changes in hospitalized patients with Middle East respiratory syndrome coronavirus
    (Wiley, 2017-06) Al-Tawfiq, J. A.; Hinedi, K.; Abbasi, S.; Babiker, M.; Sunji, A.; Eltigani, M.; Medicine, School of Medicine
    Background There are no longitudinal data on the changes in hematologic, hepatic, and renal function findings in patients with Middle East respiratory syndrome coronavirus (MERS‐CoV) infection. Methods This is a retrospective cohort study of 16 MERS‐CoV patients, to describe the hematological, hepatic, and renal findings of patients with MERS‐CoV. Results During the 21 days of observation, there was no significant change in the hepatic panel or creatinine tests. There was a significant increase in the mean ± SD of the white blood cell count from 8.3 ± 4.6 to 14.53 ± 7 (P value = 0.001) and an increase in mean ± SD of the absolute neutrophil count from 6.33 ± 4.2 to 12 ± 5.5 (P value = 0.015). Leukocytosis was observed in 31% (5/16) of the patients on day 1 and in 80% (4/5) on day 21. Transient leukopenia developed in 6% (1/16) of the patients on day 1 and in 13% (1/8) on day 8. None of the patients had neutropenia. Lymphopenia was a prominent feature with a rate of 44% (7/16) of the patients on day 1 and 60% (3/5) on day 21. Lymphocytosis was not a feature of MERS‐CoV infection. Thrombocytopenia developed in 31% (5/16) of the patients on day 1 and 40% (2/5) on day 21. Thrombocytosis was not a prominent feature and was observed in 6% (1/16) of the patients on day 1 and 17% (1/6) on day 9. Conclusions Patients with MERS‐CoV infection showed variable hematologic parameters over time. Lymphocytosis and neutropenia were not features of MERS‐CoV infection.
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    The impact of co-infection of influenza A virus on the severity of Middle East Respiratory Syndrome Coronavirus
    (Elsevier, 2017-05) Alfaraj, Sarah H.; Al-Tawfiq, Jaffar A.; Alzahrani, Nojoom A.; Altwaijri, Talal A.; Memish, Ziad A.; Medicine, School of Medicine
    Ho and colleagues recently drew attention to the consequences of co-infection with Influenza and HIV.1 We present four cases of combined infection with influenza and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection. Nasopharyngeal swabs or tracheal aspirates were tested for MERS-CoV using real-time reverse-transcription polymerase chain reaction (RT-PCR).2, 3 Samples were tested for Influenza A, B and H1N1 by rapid molecular test (GenEXper for detection of flu A, B and 2009 H1N1, Cepheid).