Virologic Features in a Case of MERS-CoV Infection

June 19, 2013
Urine and stool, as well as respiratory tract samples, tested positive for the Middle East respiratory syndrome coronavirus. 

Researchers recently reported details of a fatal case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. The patient — a 73-year-old man — had multiple myeloma and was on treatment that included steroids. He reportedly had contact with a sick camel before illness onset. After being hospitalized in Abu Dhabi with progressive respiratory failure, he was transferred to a hospital in Munich (day 11 of illness); he died on day 18 of illness. At the time of the present report, no infection had been observed in healthcare workers who had contact with the patient.

In Munich, sequential clinical samples were collected from the patient and tested for MERS-CoV by reverse-transcription polymerase chain reaction and indirect immunofluorescence. Concentrations of the virus were highest in bronchoalveolar fluid samples. Urine (collected on days 12 and 13 of illness) and stool samples (collected on days 12 and 16) and one of two oronasal samples also tested positive for the virus at low levels. No virus was detected in blood. Suction catheters that had been refrigerated as long as 5 days also tested positive.

The investigators sequenced the MERS-CoV genome from respiratory samples and conducted phylogenetic analysis using four other available MERS-CoV genome sequences. The estimated time of a common ancestor was mid-2011. The virus clustered with a virus from a patient from Qatar treated in the U.K.

Comment: Many features resemble those already reported. Virus was found in low concentrations in stool and urine — in contrast to the prominent fecal shedding previously documented in SARS patients. Whether the presence of virus in urine reflects primary kidney infection or systemic infection is unclear. The positive test results for refrigerated suction catheters suggest that the virus may survive outside the body under appropriate environmental conditions. Editorialists urge the development of an international therapeutic protocol to help identify effective intervention strategies.
— Mary E. Wilson, MD

Citation(s):

Drosten C et al. Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection. Lancet Infect Dis 2013 Jun 17; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1473-3099(13)70154-3)

Guery B and van der Werf S. Coronavirus: Need for a therapeutic approach. Lancet Infect Dis 2013 Jun 17; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1473-3099(13)70153-1)