Diseases Cached

Middle East Respiratory Syndrome: Symptoms, Treatments, Medications and Prevention

by · Published · Updated

Middle East Respiratory Syndrome (MERS) is a viral respiratory illness caused by the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). First identified in Saudi Arabia in 2012, the virus has since caused outbreaks in several countries, primarily in the Arabian Peninsula. MERS is part of the coronavirus family, which also includes Severe Acute Respiratory Syndrome (SARS) and COVID-19. The disease has a high mortality rate, especially among individuals with pre-existing health conditions, and can lead to severe respiratory distress, multi-organ failure, and death.

What is Middle East Respiratory Syndrome (MERS)?

Middle East Respiratory Syndrome (MERS) is a viral infection caused by MERS-CoV, a novel coronavirus. Like other coronaviruses, MERS-CoV primarily affects the respiratory system, but it can also lead to complications in other organs, such as the kidneys. MERS is zoonotic, meaning it originates in animals and can be transmitted to humans. Evidence suggests that dromedary camels are a significant reservoir for MERS-CoV, and they are believed to be the primary source of human infections. The virus can spread from animals to humans through direct or indirect contact with infected camels.

MERS can also spread from person to person, particularly in healthcare settings or through close contact with infected individuals. However, human-to-human transmission is generally less efficient, and large-scale community outbreaks are rare. The disease causes a wide range of symptoms, from mild respiratory illness to severe pneumonia, acute respiratory distress syndrome (ARDS), and multi-organ failure.

MERS has a high fatality rate, with approximately 35% of reported cases resulting in death. The majority of MERS cases have been reported in the Middle East, although isolated outbreaks have occurred in other parts of the world due to international travel.

Who is at Risk of Middle East Respiratory Syndrome?

Certain populations are at a higher risk of contracting MERS due to factors such as geographic location, occupation, and pre-existing health conditions. Understanding who is most vulnerable helps with early diagnosis, treatment, and implementation of preventive measures.

Populations at Higher Risk

1. Residents and Travelers to the Arabian Peninsula

MERS was first identified in Saudi Arabia, and the vast majority of cases have occurred in the Middle East, particularly in the Arabian Peninsula. Countries such as Saudi Arabia, Jordan, Qatar, the United Arab Emirates (UAE), and Oman have reported the highest number of MERS cases. Travelers to these regions, especially those visiting camel farms or participating in activities that involve close contact with camels, are at higher risk of exposure to MERS-CoV.

2. Healthcare Workers

Healthcare workers are at significant risk of contracting MERS, especially when treating patients with confirmed or suspected cases of the virus. Outbreaks of MERS have occurred in hospital settings due to inadequate infection control measures. Healthcare workers who come into close contact with infected individuals or handle contaminated medical equipment are particularly vulnerable to infection. In some outbreaks, healthcare facilities have been the epicenters of MERS transmission.

3. Individuals with Chronic Health Conditions

People with pre-existing health conditions, such as diabetes, chronic lung disease, heart disease, or kidney disease, are more likely to experience severe illness or complications if they contract MERS. The virus can exacerbate these underlying conditions, leading to higher mortality rates among this group.

4. Elderly Individuals

As with many respiratory infections, older adults are at increased risk of severe MERS infection. The immune system weakens with age, making it harder for elderly individuals to fight off the virus. Additionally, older adults are more likely to have underlying health conditions that can complicate the course of the disease.

5. People in Contact with Camels

Individuals who have close contact with dromedary camels, such as farmers, herders, and camel traders, are at higher risk of contracting MERS-CoV. The virus is believed to spread from camels to humans through direct contact with camel saliva, urine, or respiratory secretions. Consuming raw or undercooked camel meat or milk may also pose a risk.

6. Immunocompromised Individuals

People with weakened immune systems, including those undergoing chemotherapy, individuals with HIV/AIDS, or organ transplant recipients on immunosuppressive drugs, are at greater risk of severe MERS infection. These individuals may experience more severe symptoms and are more likely to develop complications such as ARDS or multi-organ failure.

Environmental and Behavioral Risk Factors

Several environmental and behavioral factors can increase the likelihood of contracting MERS:

  • Close Proximity to Camel Farms: Living or working near camel farms or markets increases the risk of exposure to MERS-CoV.
  • Handling Infected Animals or Animal Products: Direct contact with infected camels or consumption of contaminated camel products, such as milk, can lead to infection.
  • Inadequate Infection Control in Healthcare Settings: Insufficient use of personal protective equipment (PPE) and improper handling of infected patients or medical waste can contribute to the spread of MERS in hospitals.

Symptoms of Middle East Respiratory Syndrome

The symptoms of MERS range from mild to severe and typically appear 2 to 14 days after exposure to the virus. The illness can progress rapidly, and some individuals may develop life-threatening complications such as ARDS, multi-organ failure, or septic shock.

Mild Symptoms

In some cases, individuals infected with MERS-CoV may experience only mild respiratory symptoms or be asymptomatic. However, even individuals with mild symptoms can still transmit the virus to others, particularly in healthcare settings.

Common Mild Symptoms Include:

  • Fever: A low-grade fever (above 100.4°F or 38°C) is often the first sign of MERS infection.
  • Cough: A dry, persistent cough is common, although it may not initially be severe.
  • Shortness of Breath: Some individuals may experience mild difficulty breathing, especially if they have pre-existing respiratory conditions.
  • Muscle Aches (Myalgia): Muscle pain and general body aches can occur, resembling flu-like symptoms.
  • Sore Throat and Headache: These symptoms may be present in some individuals during the early stages of infection.

Severe Symptoms

In many cases, MERS can lead to severe respiratory illness and other complications, particularly in individuals with underlying health conditions. Severe cases require immediate medical attention, as they can quickly lead to respiratory failure and death.

Severe Symptoms Include:

1. Pneumonia

Pneumonia is a common complication of MERS, where the infection causes inflammation of the air sacs (alveoli) in the lungs, filling them with fluid or pus. This leads to:

  • Chest Pain: Pain or discomfort when breathing deeply or coughing.
  • Severe Cough: A worsening cough, often with difficulty clearing the airways.
  • High Fever: A persistent high fever (above 102°F or 39°C) may accompany pneumonia.

2. Acute Respiratory Distress Syndrome (ARDS)

ARDS is a life-threatening complication of MERS that occurs when the lungs cannot provide enough oxygen to the body’s organs. ARDS can develop rapidly and requires intensive medical intervention, often including mechanical ventilation.

  • Severe Shortness of Breath (Dyspnea): Difficulty breathing, even at rest, with rapid breathing (tachypnea).
  • Hypoxemia: Low oxygen levels in the blood, which can lead to cyanosis (bluish discoloration of the lips or extremities).
  • Respiratory Failure: Inability to breathe adequately without the help of mechanical ventilation.

3. Kidney Failure

MERS can affect multiple organ systems, and in severe cases, it may lead to acute kidney injury (AKI) or kidney failure. Symptoms of kidney failure include:

  • Reduced Urine Output: Difficulty urinating or producing very little urine.
  • Swelling (Edema): Swelling in the legs, feet, or ankles due to fluid retention.
  • Confusion or Lethargy: A sign of toxins building up in the body due to impaired kidney function.

4. Septic Shock

Septic shock is a rare but severe complication of MERS, occurring when the infection triggers a widespread inflammatory response throughout the body, leading to a drastic drop in blood pressure.

  • Low Blood Pressure (Hypotension): A significant drop in blood pressure, which can cause dizziness, confusion, or fainting.
  • Rapid Heart Rate (Tachycardia): The heart beats faster in an attempt to compensate for the low blood pressure.
  • Multi-Organ Failure: Failure of multiple organs, such as the heart, kidneys, and liver, due to inadequate oxygen supply.

Gastrointestinal Symptoms

In addition to respiratory symptoms, some individuals with MERS may experience gastrointestinal symptoms such as:

  • Nausea and Vomiting
  • Diarrhea
  • Abdominal Pain

These symptoms are more common in patients with severe disease and can complicate the overall clinical picture.

How is Middle East Respiratory Syndrome Diagnosed?

Diagnosing MERS involves a combination of clinical evaluation, laboratory testing, and imaging studies. Since the symptoms of MERS can resemble other respiratory infections, laboratory confirmation is essential for an accurate diagnosis.

Diagnostic Methods for Middle East Respiratory Syndrome

1. Patient History and Clinical Evaluation

The first step in diagnosing MERS is a thorough clinical evaluation, including taking a detailed patient history. Healthcare providers will ask about symptoms such as fever, cough, and shortness of breath, as well as any recent travel to regions where MERS is endemic or close contact with camels or infected individuals. Given that MERS symptoms can mimic other respiratory illnesses like influenza or pneumonia, laboratory tests are essential for confirming the diagnosis.

2. Polymerase Chain Reaction (PCR) Testing

PCR testing is the most reliable method for diagnosing MERS. This molecular test detects the genetic material of MERS-CoV in respiratory secretions, such as a nasal or throat swab. PCR testing can confirm the presence of the virus and differentiate it from other respiratory infections.

  • Real-time reverse transcription PCR (rRT-PCR) is the gold standard for diagnosing MERS, as it is highly sensitive and specific for detecting the virus.

3. Serological Testing

Serological tests detect antibodies (IgM and IgG) produced in response to MERS-CoV. These tests are not typically used for diagnosing acute infections but can help determine whether an individual has been exposed to the virus in the past or has a current infection. Serological tests are particularly useful for epidemiological studies and in cases where PCR testing is not readily available.

4. Chest X-rays and CT Scans

Imaging studies, such as chest X-rays and CT scans, are essential for evaluating the extent of lung involvement in patients with MERS. These tests can reveal signs of pneumonia or ARDS, which are common complications of the virus.

  • Chest X-ray: Often shows patchy or diffuse infiltrates, indicating fluid buildup in the lungs.
  • CT Scan: Provides more detailed images and can help identify areas of lung consolidation or ground-glass opacities, which are associated with viral pneumonia.

5. Blood Tests

Blood tests are used to assess the patient’s overall health and organ function. Common blood tests include:

  • Complete Blood Count (CBC): This test may reveal low white blood cell counts (leukopenia) and low platelet counts (thrombocytopenia), which are often associated with severe MERS infections.
  • Liver and Kidney Function Tests: These tests assess the functioning of the liver and kidneys, as MERS can cause damage to these organs in severe cases.

Differential Diagnosis

Since MERS symptoms are non-specific and can resemble other respiratory infections, healthcare providers must differentiate it from illnesses such as:

  • COVID-19
  • Influenza
  • Community-acquired pneumonia
  • Other coronaviruses, such as SARS

Laboratory tests, patient history, and imaging help differentiate MERS from these other conditions.

Treatments for Middle East Respiratory Syndrome

There is no specific antiviral treatment for MERS, and management primarily focuses on supportive care to alleviate symptoms and prevent complications. Early intervention and supportive care in an intensive care unit (ICU) are crucial to improving outcomes, especially in patients with severe respiratory symptoms or multi-organ involvement.

Supportive Care

1. Oxygen Therapy

Patients with MERS who develop respiratory distress, such as shortness of breath or hypoxemia, may require supplemental oxygen. Oxygen can be delivered through:

  • Nasal Cannula or Oxygen Mask: For patients with mild to moderate respiratory distress.
  • Mechanical Ventilation: In cases of severe respiratory failure or ARDS, patients may require mechanical ventilation to assist with breathing and maintain adequate oxygen levels. Ventilators help keep the lungs functioning when they can no longer work independently.

2. Intensive Care Monitoring

Patients with severe MERS often require admission to an ICU for continuous monitoring and supportive care. This includes:

  • Fluid Management: Maintaining the right balance of fluids is essential. While hydration is important, excess fluids can worsen pulmonary edema, so careful monitoring is required.
  • Hemodynamic Support: Some patients may experience septic shock or dangerously low blood pressure (hypotension). In these cases, vasopressors (medications that constrict blood vessels) may be administered to stabilize blood pressure and improve circulation.

3. Antipyretics and Pain Management

Medications such as acetaminophen or ibuprofen are used to reduce fever and alleviate pain associated with MERS. These over-the-counter medications can help manage symptoms such as headaches, muscle pain, and discomfort.

4. Antibiotics (For Secondary Bacterial Infections)

While antibiotics do not treat viral infections like MERS, they may be prescribed if there is a concern about secondary bacterial infections, such as pneumonia. Secondary infections can complicate MERS cases, particularly in immunocompromised individuals.

Experimental and Investigational Treatments

Given that there is no specific antiviral medication for MERS, several investigational treatments have been explored during outbreaks. However, none have been proven to be definitively effective in clinical trials.

1. Antiviral Drugs

Certain antiviral drugs, such as ribavirin and lopinavir/ritonavir (used to treat HIV), have been tested for treating MERS. While some laboratory studies showed promise, clinical trials did not demonstrate clear benefits for MERS patients. These drugs are not routinely recommended for MERS treatment.

2. Corticosteroids

Corticosteroids, such as dexamethasone or methylprednisolone, have been used in some cases to reduce inflammation in the lungs, particularly in patients with ARDS. However, the use of corticosteroids in viral infections like MERS is controversial, as they can suppress the immune system and may worsen outcomes.

3. Convalescent Plasma Therapy

Convalescent plasma therapy involves transfusing plasma from recovered MERS patients into those currently battling the virus. The plasma contains antibodies that may help fight the infection. While this approach has been used in limited cases, more research is needed to determine its efficacy for MERS.

4. Monoclonal Antibodies

Researchers have been exploring the use of monoclonal antibodies to target MERS-CoV and neutralize the virus. These antibodies are engineered to specifically bind to viral proteins, preventing the virus from infecting cells. While this treatment shows potential, it remains in the investigational stage.

Common Medications for Middle East Respiratory Syndrome

Since there is no specific antiviral medication for MERS, treatment primarily focuses on managing symptoms and preventing complications. The following are commonly used in the treatment of MERS:

  1. Acetaminophen (Tylenol)
    • Used to reduce fever and alleviate muscle aches, headaches, and general discomfort.
    • Suitable for patients of all ages and commonly used in both mild and severe cases.
  2. Ibuprofen (Advil, Motrin)
    • An alternative to acetaminophen for managing fever and pain, although some concerns have been raised about its use in viral infections.
  3. Antibiotics (For Secondary Infections)
    • Antibiotics may be prescribed if there is a concern about secondary bacterial infections, such as pneumonia, in patients with MERS.
  4. Corticosteroids (e.g., Dexamethasone, Methylprednisolone)
    • Used to reduce lung inflammation in patients with ARDS or severe pneumonia.
    • The use of corticosteroids remains controversial due to potential side effects.
  5. Vasopressors (e.g., Norepinephrine, Dopamine)
    • Used to stabilize blood pressure in patients experiencing septic shock or severe hypotension.
  6. Mechanical Ventilation
    • While not a medication, mechanical ventilation is critical for patients with severe respiratory failure due to ARDS or pneumonia.

Where is Middle East Respiratory Syndrome Most Prevalent?

MERS is most prevalent in the Middle East, particularly in countries within the Arabian Peninsula. However, due to international travel and healthcare-associated outbreaks, cases have been reported in other parts of the world, including Asia, Europe, and North America.

Geographic Distribution of MERS

1. Saudi Arabia

Saudi Arabia is the epicenter of MERS, with the majority of cases reported in this country. The virus was first identified here in 2012, and most human infections have been linked to dromedary camels. Outbreaks have occurred in healthcare settings, leading to the spread of the virus among patients, healthcare workers, and close contacts.

2. Other Middle Eastern Countries

Several other countries in the Middle East have reported cases of MERS, including:

  • United Arab Emirates (UAE)
  • Jordan
  • Qatar
  • Oman
  • Kuwait

These countries have seen cases of MERS in both community settings and healthcare facilities, often linked to contact with camels or travel to Saudi Arabia.

3. South Korea

In 2015, South Korea experienced a significant MERS outbreak, which was the largest known outbreak outside the Arabian Peninsula. The outbreak was traced to a traveler who had visited the Middle East and later spread the virus within healthcare facilities, leading to dozens of cases and several deaths.

4. Other Regions

Isolated cases of MERS have been reported in other parts of the world, including Europe, North America, and Asia, often in travelers returning from the Middle East. These cases were usually contained through public health measures such as isolation, quarantine, and contact tracing.

Risk Factors for Geographic Spread

MERS is most prevalent in areas with close contact between humans and camels, particularly in regions where camel farming and trading are common. The virus is transmitted to humans through contact with infected camels or their products, and outbreaks can spread within healthcare settings when infection control measures are inadequate.

Prevention of Middle East Respiratory Syndrome

Preventing MERS relies on a combination of public health measures, personal hygiene practices, and infection control protocols, especially in healthcare settings. While no vaccine for MERS is currently available, the following preventive strategies can significantly reduce the risk of transmission.

Preventive Measures

1. Avoid Close Contact with Camels

People living in or traveling to areas where MERS is prevalent should avoid direct contact with dromedary camels, especially if the camels appear sick. It is also advisable to avoid consuming raw or undercooked camel meat or drinking unpasteurized camel milk.

2. Hand Hygiene

Frequent handwashing with soap and water or using alcohol-based hand sanitizers is essential for preventing the spread of MERS. Hands should be washed after touching animals, handling animal products, or coming into contact with potentially contaminated surfaces.

3. Wearing Personal Protective Equipment (PPE)

Healthcare workers and individuals caring for patients with MERS should wear appropriate PPE, including gloves, masks, gowns, and face shields. This helps prevent direct contact with respiratory secretions and reduces the risk of transmission.

4. Environmental Cleaning and Disinfection

Regular cleaning and disinfection of high-touch surfaces, such as doorknobs, phones, and countertops, are important to prevent the virus from spreading via contaminated surfaces. Disinfectants that are effective against coronaviruses should be used.

5. Travel Restrictions and Screening

During outbreaks, international travel restrictions and screening measures can help prevent the virus from spreading across borders. Travelers returning from MERS-endemic areas should monitor their health and seek medical attention if they develop symptoms such as fever or cough.

6. Infection Control in Healthcare Settings

Hospitals and healthcare facilities should implement strict infection control protocols to prevent the spread of MERS among patients and healthcare workers. This includes isolating confirmed or suspected MERS patients, using PPE, and following proper sanitation procedures.

Future Directions: Vaccine Development

Research into MERS vaccines is ongoing, and several vaccine candidates are currently in development. While no vaccine for MERS is yet available, the knowledge gained from MERS vaccine research has informed the development of vaccines for other coronaviruses, such as SARS-CoV-2 (COVID-19). A MERS vaccine could significantly reduce the risk of future outbreaks and provide protection to high-risk populations.

Related Posts:

You may also like...