Research Looks at Critical MERS Patients as Cases Continue

MERS virus infections tied to underlying conditions in analysis of critically ill Saudi Arabian patients

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Middle East respiratory syndrome coronavirus (MERS-CoV) has been the focus of research as experts around the globe try to learn more about the new virus.

In a recent study, researchers focused on patients who had become critically ill while infected with MERS.

The study found that the majority of these critically ill patients had prior underlying conditions. Over half of the patients died, but very few health workers who were exposed to the patients became ill themselves.

"Limit your close contact with people while they are ill."

At the time of the latest update from the World Health Organization (WHO) on January 9, 178 confirmed cases of MERS, including 75 deaths, had been reported around the globe since September 2012.

WHO reported that most patients display symptoms of respiratory disease as their main illness, but diarrhea has also been common.

According to the authors of the new study, led by Yaseen M. Arabi, MD, of the College of Medicine at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia, information on patients who have become critically ill with MERS has been limited.

To learn more about these cases, Dr. Arabi and colleagues focused on three intensive care units and two tertiary care hospitals in Saudi Arabia. At these locations, 114 patients were tested for suspected MERS between December 2012 and August 2013.

Eleven patients (10 percent) were determined to be confirmed or likely MERS cases. An additional twelfth patient was a health care worker who later became critically ill with MERS.

The patients ranged in age from 36 to 83 years old, with an average age of 59. Eight of the patients ( 67 percent) were men.

Dr. Arabi and colleagues examined factors like the patients' symptoms, underlying conditions, illness severity, treatment in the hospital and final health outcome.

The researchers found that all 12 patients had at least one underlying condition, and on average, the patients had three underlying conditions. These issues included diabetes, heart problems like hypertension and myocardial infarction, kidney failure and obesity.

Only two of the patients reported animal exposure (to a camel and a domestic cat) before becoming ill.

The 12 patients all had respiratory failure that required mechanical ventilation to help them breathe.

Of the patients, all but one (92 percent) had extrapulmonary manifestations - or severe health event in an area outside of the lungs as a result of their infection. These included injury to the kidney, shock and low platelet counts in the blood.

Ninety days after being diagnosed with the virus, five (42 percent) were still alive. The average length of hospital stay was 41 days, except for the stay of one patient who was still admitted to a hospital when the study was submitted.

The researchers identified 520 health care workers who were exposed to these patients, only four of whom (1 percent) tested positive for MERS.

Dr. Arabi and colleagues concluded that MERS is associated with not only severe respiratory infections, but major problems involving other areas of the body and a high mortality rate, especially in those with chronic underlying conditions.

"Transmission to HCWs [health care workers] seems to be low, although human-to-human transmission does occur with unprotected exposure," the study authors wrote.

The researchers noted that the sample size was small. Further research is needed to confirm these findings and understand more about this virus.

The study was published online January 27 by the Annals of Internal Medicine. No conflicts of interest were reported.

Review Date: 
January 23, 2014
Last Updated:
January 28, 2014