1. Two cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in France were identified in this report.
2. Incubation time of the virus was observed to be up to 12 days, prolonged versus the one to nine day incubation in previously observed cases. This may have implications for quarantine requirements.
3. Diagnostic workup suggests sputum samples from the lower respiratory tract should be taken to test for MERS-CoV infection.
Evidence Level: 4 (Below Average)
Case Rundown: MERS-CoV was first identified in September 2012. Since then 44 cases have occurred worldwide. The focus of cases has largely been in Saudi Arabia, with spread throughout the Middle East, the UK and France. The present report is the first detailed clinical study of the virus in two patients. The first patient, a 64-year-old man, visited Dubai in April after which he developed chills, fever, and diarrhea on April 22nd. After the conditioned worsened and laboratory tests remained negative, he died of acute respiratory and renal failure on May 28th.
The second patient, a 51-year-old man admitted for left arm deep venous thrombosis, shared a room with the first patient for three days in April (26th to 29th). After discharge from the hospital on April 30th, he returned on May 8th with myalgia, asthenia and cough. He currently remains on extracorporeal membrane oxygenation (ECMO) while being treated in intensive care.
Both patients were confirmed to have the MERS-CoV. It is likely that the second patient contracted the virus from the first, and judging by the re-admission date the virus may have an incubation period of up to 12 days. Of note, nasopharyngeal samples from the upper respiratory tract were negative or inconclusive for both patients, and only lower respiratory tract samples had detectable virus levels. This evidence suggests sputum samples from the lower respiratory tract should be taken to test for MERS-CoV infection. As a case-report of two subjects, appropriate caution should be used when drawing conclusions. However this is the most detailed investigation to date on the MERS-CoV and may help to influence clinical care of emerging cases for a pathogen of which little is known.
By Marc Succi
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