Prof Christian Drosten MD a
, Prof Clemens-Martin Wendtner MD b Summary
Background
The
Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging
virus involved in cases and case clusters of severe acute respiratory
infection in the Arabian Peninsula, Tunisia, Morocco, France, Italy,
Germany, and the UK. We provide a full description of a fatal case of
MERS-CoV infection and associated phylogenetic analyses.
Methods
We
report data for a patient who was admitted to the Klinikum Schwabing
(Munich, Germany) for severe acute respiratory infection. We did
diagnostic RT-PCR and indirect immunofluorescence. From time of
diagnosis, respiratory, faecal, and urine samples were obtained for
virus quantification. We constructed a maximum likelihood tree of the
five available complete MERS-CoV genomes.
Findings
A
73-year-old man from Abu Dhabi, United Arab Emirates, was transferred
to Klinikum Schwabing on March 19, 2013, on day 11 of illness. He had
been diagnosed with multiple myeloma in 2008, and had received several
lines of treatment. The patient died on day 18, due to septic shock.
MERS-CoV was detected in two samples of bronchoalveolar fluid. Viral
loads were highest in samples from the lower respiratory tract (up to
1·2 × 106 copies per mL). Maximum virus
concentration in urine samples was 2691 RNA copies per mL on day 13;
the virus was not present in the urine after renal failure on day 14.
Stool samples obtained on days 12 and 16 contained the virus, with up to
1031 RNA copies per g (close to the lowest detection limit of the
assay). One of two oronasal swabs obtained on day 16 were positive, but
yielded little viral RNA (5370 copies per mL). No virus was detected in
blood. The full virus genome was combined with four other available full
genome sequences in a maximum likelihood phylogeny, correlating branch
lengths with dates of isolation. The time of the common ancestor was
halfway through 2011. Addition of novel genome data from an unlinked
case treated 6 months previously in Essen, Germany, showed a clustering
of viruses derived from Qatar and the United Arab Emirates.
Interpretation
We
have provided the first complete viral load profile in a case of
MERS-CoV infection. MERS-CoV might have shedding patterns that are
different from those of severe acute respiratory syndrome and so might
need alternative diagnostic approaches.
Funding
European Union; German Centre for Infection Research; German Research Council; and German Ministry for Education and Research.
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