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Epidemiological characteristics and initial clinical presentation of patients with laboratory-confirmed MERS-CoV infection in an emergency department

  • Zohair Al Aseri1
  • Jaffar A. Al-Tawfiq2,3,4
  • Mohammed Alnakhli5
  • Abdullah AlNooh5
  • Abdulaziz Alnassar5
  • Salah Alkhalid5
  • Abdulaziz Al Dughayman5
  • Tariq Wani6
  • Abdulkarim Alhetheel7
  • Mazin Barry8

1Departments of Emergency Medicine and Critical Care, College of Medicine, King Saud University, 11472 Riyadh, Saudi Arabia

2Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, 31311 Dhahran, Saudi Arabia

3Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA

4Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA

5Clinical Sciences Department, College of Medicine, Dar Al Uloom University, 13314 Riyadh, Saudi Arabia

6Research Center, King Fahad Medical City, 11525 Riyadh, Saudi Arabia

7Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, 11472 Riyadh, Saudi Arabia

8Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, 11472 Riyadh, Saudi Arabia

DOI: 10.22514/sv.2021.251

Submitted: 13 September 2021 Accepted: 25 November 2021

Online publish date: 29 December 2021

*Corresponding Author(s): Zohair Al Aseri E-mail: zohairalaseri@yahoo.com zalaseri@ksu.edu.sa

Abstract

Emergency departments have been implicated as a source of index cases of the Middle East Respiratory Syndrome (MERS) coronavirus infection. We describe the epidemiological characteristics and initial clinical presentation of patients with Middle East respiratory syndrome coronavirus infection in an emergency department at a hospital in Riyadh, in the Kingdom of Saudi Arabia. The records of all patients presenting to the emergency department who tested positive for Middle East respiratory syndrome coronavirus infection on real-time reverse transcriptase polymerase chain reaction testing from April 2014 to November 2019 were reviewed, and the outcomes were assessed. The clinical presentations and outcomes were compared according to sex. A total of 68 patients with Middle East respiratory syndrome coronavirus infection were identified, of whom 40 (58.8%) were female, and 28 (41.2%) were male. The mean age was 50.7 (standard deviation: 16.4) years, and female patients were younger (44.7 ± 13.1 years) than male patients (59.4 ± 16.9 years). Nineteen of the 68 patients (27.9%) were asymptomatic of whom the majority (16/19, 84%) were female (p = 0.012). The most common symptoms were fever (n = 29, 42.6%), cough (n = 25, 36.8%), upper respiratory tract infection (n = 23, 33.8%), and pneumonia (n = 15, 22.1%). Pneumonia, diarrhea, dyspnea, and vomiting/diarrhea were more common among male patients. Male patients were more likely than female patients to require hospital admission (78.6% vs. 30.0%), intensive care unit admission (64.3% vs. 15.0%), and invasive mechanical ventilation (32.1% vs. 10.0%). The most common presentation of Middle East respiratory syndrome coronavirus infection in this cohort was asymptomatic infection. A high proportion of asymptomatic infections has not been reported previously. The study did not identify typical clinical features of MERS patients. Male patients tended to develop more severe disease than female patients. A larger study is needed to confirm these findings.


Keywords

MERS-CoV; Emergency department; Clinical presentation; Outbreak


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Zohair Al Aseri,Jaffar A. Al-Tawfiq,Mohammed Alnakhli,Abdullah AlNooh,Abdulaziz Alnassar,Salah Alkhalid,Abdulaziz Al Dughayman,Tariq Wani,Abdulkarim Alhetheel,Mazin Barry. Epidemiological characteristics and initial clinical presentation of patients with laboratory-confirmed MERS-CoV infection in an emergency department. Signa Vitae. 2022.doi:10.22514/sv.2021.251.

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