Middle East Respiratory Syndrome (MERS)

Symptoms of Middle East Respiratory Syndrome (MERS)

MERS is often mistaken for the flu due to its initial symptoms. However, a patient may be suspected of having MERS if they show the following symptoms:

1. High fever. A persistent, high fever is a common early symptom of MERS.
2. Cough. A persistent cough often accompanies MERS infection.
3. Difficulty breathing. Shortness of breath is one of the hallmark signs of MERS and can quickly escalate.
4. Chills or body chills. Patients may experience shaking chills as the infection progresses.
5. Chest pain. Discomfort in the chest can occur, especially as the respiratory system becomes more compromised.
6. Body aches. Muscle pain and general body soreness are common.
7. Sore throat. MERS can cause throat pain, similar to respiratory infections.
8. Weakness. Fatigue and a general sense of weakness are common with MERS.
9. Headache. Some patients report a severe headache as part of their symptoms.
10. Diarrhea. Gastrointestinal symptoms like diarrhea may also appear in some cases.
11. Nausea or vomiting. Some patients experience nausea and may vomit as the infection progresses.

If left untreated, these symptoms can lead to severe complications, such as pneumonia and kidney failure, both of which are life-threatening.

To confirm a MERS diagnosis, laboratory tests, including polymerase chain reaction (PCR) testing, are necessary. In this procedure, a healthcare provider collects respiratory samples from the patient, often from the lungs, to determine if the MERS coronavirus is present. PCR testing is the gold standard for confirming MERS, allowing healthcare professionals to diagnose and manage the infection accurately.

Diagnostic Procedures for Middle East Respiratory Syndrome (MERS)

Early and accurate diagnosis of MERS is essential to manage symptoms and prevent transmission. Here are the main diagnostic methods used to identify MERS:

1. Polymerase Chain Reaction (PCR) testing. PCR is the primary method for diagnosing MERS, as it can detect the virus’s genetic material in respiratory samples. Healthcare providers typically collect samples from the upper respiratory tract (such as a throat or nasal swab) or the lower respiratory tract (like sputum or bronchial fluid) and use PCR to confirm the presence of MERS-CoV. This test is highly specific and can identify the virus even in small quantities.
2. Serology testing. Serological tests detect antibodies against MERS-CoV in the blood, indicating either a current or past infection. This test is most useful for identifying previous exposure rather than diagnosing an active infection. In outbreak investigations or for tracking the spread of MERS, serology tests can help understand the extent of virus exposure in a population.
3. Imaging tests. Although not diagnostic, imaging tests such as chest X-rays or CT scans can help assess the severity of MERS in patients showing respiratory symptoms. These imaging tests may reveal lung inflammation, fluid buildup, or pneumonia, which are common complications of MERS.
4. Complete Blood Count (CBC) and blood chemistry tests. A CBC and blood chemistry tests provide information on a patient’s overall health and can reveal abnormalities associated with MERS infection, such as low lymphocyte levels or elevated liver enzymes. While these tests don’t confirm MERS, they help monitor the patient’s condition and guide supportive care.

Early identification of MERS through PCR testing and other diagnostic tools enables healthcare providers to implement appropriate isolation measures and begin supportive treatment to improve outcomes and limit the spread of the virus.

Complications of Untreated Middle East Respiratory Syndrome (MERS)

If left untreated, MERS can lead to severe and life-threatening complications, especially in vulnerable individuals such as the elderly, those with weakened immune systems, or people with chronic conditions. Here are the major complications that can arise from untreated MERS:

1. Severe pneumonia. MERS primarily affects the respiratory system, often resulting in severe pneumonia as the infection spreads to the lungs. This can cause difficulty breathing, a buildup of fluid in the lungs, and inflammation, leading to impaired oxygen exchange and respiratory distress.
2. Acute respiratory distress syndrome (ARDS). In advanced stages, MERS can lead to ARDS, a critical condition where the lungs become severely inflamed and filled with fluid, making it difficult for oxygen to enter the bloodstream. ARDS often requires intensive care, including mechanical ventilation, and can be fatal without timely intervention.
3. Kidney failure. MERS-CoV can also impact the kidneys, potentially leading to acute kidney injury or kidney failure. This complication is particularly dangerous, as it reduces the kidneys’ ability to filter waste from the blood, leading to toxin buildup and necessitating dialysis or other critical care measures.
4. Septic shock. Untreated MERS can lead to sepsis, a life-threatening inflammatory response to infection. In severe cases, this may progress to septic shock, where blood pressure drops dangerously low, reducing blood flow to organs and leading to multi-organ failure if not rapidly treated.
5. Multi-organ failure. MERS can spread beyond the lungs and kidneys to affect multiple organs, including the liver and heart. This can result in multi-organ failure, a critical condition in which multiple organs cease to function, requiring intensive medical support. Without prompt treatment, multi-organ failure is often fatal.
6. Blood clotting disorders. Severe MERS infection may lead to abnormal blood clotting, which can increase the risk of thrombosis (blood clots) and hemorrhage (uncontrolled bleeding). These complications further complicate the patient’s condition and elevate the risk of stroke, organ damage, or death.

Untreated MERS poses a high risk of fatal outcomes, particularly for individuals with underlying health issues or compromised immune systems. Timely diagnosis, supportive care, and monitoring are crucial in managing MERS and preventing these severe complications.

Causes of Middle East Respiratory Syndrome (MERS)

The cause of Middle East Respiratory Syndrome (MERS) is a coronavirus (MERS-CoV), similar to the virus that causes SARS. However, MERS is believed to originate from camels in the Middle East, which are thought to be the primary carriers. The virus can be contracted through the following means:

1. Direct contact with infected camels. Handling infected camels can lead to MERS transmission, as camels are suspected to be a major source of the virus.
2. Consumption of camel products. Products derived from camels, such as meat and milk, may carry MERS-CoV if they come from infected animals. Studies suggest that the MERS virus can survive in these products, so consuming raw or undercooked camel meat or unpasteurized camel milk increases the risk.
3. Inhalation of respiratory droplets from infected individuals. Although still under investigation, MERS is believed to spread through close contact with respiratory droplets from an infected person, especially in healthcare or caregiving settings. Evidence from outbreaks, like the one in South Korea, supports human-to-human transmission through close contact, though it is relatively uncommon. Those most at risk include family members and healthcare workers caring for MERS patients.

Currently, these are the known transmission pathways for MERS-CoV. While researchers are still studying whether other animals might carry the virus, studies indicate that MERS-CoV has not been detected in other animals like goats, cattle, sheep, buffalo, pigs, and most wild birds. This suggests that camels remain the primary animal source associated with MERS.

Prevention of Middle East Respiratory Syndrome (MERS)

Like other viral diseases, MERS can be prevented by following these recommended practices:

1. Frequent handwashing with soap and water. Regularly washing hands reduces the risk of spreading and contracting the virus.
2. Avoid touching the nose, mouth, and face with unwashed hands. This prevents the virus from entering the body through mucous membranes.
3. Cover the nose and mouth when near someone who is coughing. Use a tissue or cloth to cover the nose and mouth, which helps reduce exposure to respiratory droplets.
4. Maintain a clean environment. Regularly cleaning surfaces and surroundings can minimize the risk of viral transmission.
5. Avoid sharing personal items. Refrain from using others’ glasses, cups, and utensils, as these can carry infectious particles.
6. Thoroughly wash cooking ingredients. Ensure all ingredients, especially produce, are clean before cooking to avoid contamination.
7. Cook meat thoroughly, especially camel meat. Make sure that all meat is fully cooked, as MERS-CoV may survive in undercooked meat.
8. Avoid drinking raw camel milk. Always consume pasteurized or boiled milk to reduce the risk of infection.
9. Practice these precautions when traveling to areas with known MERS cases. If visiting regions with MERS activity, consistently follow these safety measures to reduce exposure.

The mortality rate of MERS is around 35%, partly because there is no specific treatment for it. Fortunately, MERS is less contagious than SARS, spreading mainly through close contact rather than casual interaction. If you develop symptoms such as fever and cough after traveling abroad, it’s essential to consult a healthcare provider promptly for evaluation and care.

Risk Factors for Middle East Respiratory Syndrome (MERS)

The likelihood of contracting Middle East Respiratory Syndrome (MERS) can increase due to the following factors:

1. Being very young or elderly. Children have underdeveloped immune systems, making them more susceptible to viral infections like MERS. Similarly, elderly individuals experience a natural decline in immune function, making it easier for various infections, including MERS, to take hold.
2. Having chronic diseases. Individuals with chronic illnesses, such as diabetes, lung disease, or heart conditions, have weakened immune defenses. This makes them more vulnerable to severe outcomes if they contract MERS, as their bodies are already managing ongoing health challenges.
3. Having cancer. Cancer patients are at higher risk for infections, including MERS, due to the impact of cancer cells on healthy tissue and immune function. Chemotherapy and other cancer treatments further weaken the immune system, heightening the susceptibility to MERS.
4. Taking immunosuppressant medications. Immunosuppressants are drugs that reduce immune activity, often prescribed for autoimmune diseases or post-organ transplant care. While these medications help prevent rejection or control immune responses, they can also increase vulnerability to infections like MERS, as the suppressed immune system is less able to fight off viruses.

These factors increase susceptibility to MERS by weakening the immune system, making it easier for the virus to enter and multiply within the body. Individuals in high-risk groups should take extra precautions, particularly in areas with known MERS cases, to reduce their exposure and protect their health.

Middle East Respiratory Syndrome (MERS) FAQs

Here are answers to frequently asked questions about MERS, including its causes, symptoms, prevention, and treatment.

1. What is Middle East Respiratory Syndrome (MERS)?
   MERS is a respiratory illness caused by the MERS coronavirus (MERS-CoV). First identified in Saudi Arabia in 2012, MERS primarily affects the respiratory system, causing symptoms like fever, cough, and shortness of breath. Severe cases can lead to life-threatening complications, such as pneumonia and kidney failure.
2. How is MERS transmitted?
   MERS is thought to be transmitted to humans through close contact with infected camels, as they are considered primary carriers. Human-to-human transmission can occur through respiratory droplets from an infected person, particularly in healthcare or close-contact settings, though it requires close contact.
3. What are the symptoms of MERS?
   Common symptoms include fever, cough, and shortness of breath. Other symptoms may include chills, chest pain, sore throat, muscle pain, headache, diarrhea, nausea, and vomiting. Severe cases can progress to pneumonia, respiratory distress, and organ failure.
4. Who is most at risk for MERS?
   Those at highest risk include people with weakened immune systems, chronic illnesses (like diabetes, lung disease, or heart disease), the elderly, and healthcare workers who may be exposed to infected patients. People in close contact with camels are also at increased risk.
5. Can MERS be prevented?
   While there is no vaccine for MERS, certain preventive measures can help reduce the risk. These include frequent handwashing, avoiding contact with camels or camel products (such as raw milk or undercooked meat), and using respiratory precautions in healthcare settings. Travelers to areas with known MERS cases should take these precautions as well.
6. Is there a treatment for MERS?
   Currently, there is no specific antiviral treatment for MERS. Management focuses on supportive care to relieve symptoms, such as oxygen therapy, fluid replacement, and other measures to stabilize the patient. Severe cases may require intensive care, including ventilator support.
7. Is MERS contagious?
   MERS can spread between people, but it requires close contact, typically through respiratory droplets. It is less contagious than other coronaviruses like SARS or COVID-19 and usually spreads in healthcare or family settings where there is close contact with infected individuals.
8. What should I do if I suspect I have MERS?
   If you have symptoms of MERS, such as fever, cough, or difficulty breathing, and have recently been in contact with camels, traveled to an area with known MERS cases, or been exposed to someone with MERS, seek medical attention promptly. Early diagnosis can help manage symptoms and prevent the spread of infection.
9. How does MERS affect the body?
   MERS primarily affects the respiratory system, but in severe cases, it can impact other organs, including the kidneys and liver. Complications like pneumonia, acute respiratory distress syndrome (ARDS), kidney failure, and multi-organ failure can occur if the infection is not managed effectively.
10. What should healthcare workers know about MERS?
    Healthcare workers should use personal protective equipment (PPE) and follow infection control protocols when treating suspected or confirmed MERS cases. Close monitoring and respiratory precautions are critical to protecting healthcare staff and preventing nosocomial (hospital-based) transmission.