Clinical Course and Outcomes of Critically III Patients With Middle East Respiratory Syndrome Coronavirus Infection
Identifieur interne : 001E58 ( Main/Exploration ); précédent : 001E57; suivant : 001E59Clinical Course and Outcomes of Critically III Patients With Middle East Respiratory Syndrome Coronavirus Infection
Auteurs : Yaseen M. Arabi [Arabie saoudite] ; Ahmed A. Arifi ; Hanan H. Balkhy ; Hani Najm ; Abdulaziz S. Aldawood ; Alaa Ghabashi ; Hassan Hawa ; Adel Alothman ; Abdulaziz Khaldi ; BASEL AL RAIYSource :
- Annals of internal medicine [ 0003-4819 ] ; 2014.
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Abstract
Background: Since September 2012, 170 confirmed infections with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization, including 72 deaths. Data on critically ill patients with MERS-CoV infection are limited. Objective: To describe the critical illness associated with MERS-CoV. Design: Case series. Setting: 3 intensive care units (ICUs) at 2 tertiary care hospitals in Saudi Arabia. Patients: 12 patients with confirmed or probable MERS-CoV infection. Measurements: Presenting symptoms, comorbid conditions, pulmonary and extrapulmonary manifestations, measures of severity of illness and organ failure, ICU course, and outcome are described, as are the results of surveillance of health care workers (HCWs) and patients with potential exposure. Results: Between December 2012 and August 2013, 114 patients were tested for suspected MERS-CoV; of these, 11 ICU patients (10%) met the definition of confirmed or probable cases. Three of these patients were part of a health care-associated cluster that also included 3 HCWs. One HCW became critically ill and was the 12th patient in this case series. Median Acute Physiology and Chronic Health Evaluation II score was 28 (range, 16 to 36). All 12 patients had underlying comorbid conditions and presented with acute severe hypoxemic respiratory failure. Most patients (92%) had extrapulmonary manifestations, including shock, acute kidney injury, and thrombocytopenia. Five (42%) were alive at day 90. Of the 520 exposed HCWs, only 4 (1 %) were positive. Limitation: The sample size was small. Conclusion: MERS-CoV causes severe acute hypoxemic respiratory failure and considerable extrapulmonary organ dysfunction and is associated with high mortality. Community-acquired and health care-associated MERS-CoV infection occurs in patients with chronic comorbid conditions. The health care-associated cluster suggests that human-to-human transmission does occur with unprotected exposure.
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Arifi</name></author><author><name sortKey="Balkhy, Hanan H" sort="Balkhy, Hanan H" uniqKey="Balkhy H" first="Hanan H." last="Balkhy">Hanan H. Balkhy</name></author><author><name sortKey="Najm, Hani" sort="Najm, Hani" uniqKey="Najm H" first="Hani" last="Najm">Hani Najm</name></author><author><name sortKey="Aldawood, Abdulaziz S" sort="Aldawood, Abdulaziz S" uniqKey="Aldawood A" first="Abdulaziz S." last="Aldawood">Abdulaziz S. 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Arabi</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>King Saud bin Abdulaziz University for Health Sciences</s1><s2>Riyadh</s2><s3>SAU</s3></inist:fA14><country>Arabie saoudite</country><wicri:noRegion>King Saud bin Abdulaziz University for Health Sciences</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>King Abdulaziz Hospital</s1><s2>Al-Ahsa</s2><s3>SAU</s3></inist:fA14><country>Arabie saoudite</country><wicri:noRegion>King Abdulaziz Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Arifi, Ahmed A" sort="Arifi, Ahmed A" uniqKey="Arifi A" first="Ahmed A." last="Arifi">Ahmed A. Arifi</name></author><author><name sortKey="Balkhy, Hanan H" sort="Balkhy, Hanan H" uniqKey="Balkhy H" first="Hanan H." last="Balkhy">Hanan H. Balkhy</name></author><author><name sortKey="Najm, Hani" sort="Najm, Hani" uniqKey="Najm H" first="Hani" last="Najm">Hani Najm</name></author><author><name sortKey="Aldawood, Abdulaziz S" sort="Aldawood, Abdulaziz S" uniqKey="Aldawood A" first="Abdulaziz S." last="Aldawood">Abdulaziz S. Aldawood</name></author><author><name sortKey="Ghabashi, Alaa" sort="Ghabashi, Alaa" uniqKey="Ghabashi A" first="Alaa" last="Ghabashi">Alaa Ghabashi</name></author><author><name sortKey="Hawa, Hassan" sort="Hawa, Hassan" uniqKey="Hawa H" first="Hassan" last="Hawa">Hassan Hawa</name></author><author><name sortKey="Alothman, Adel" sort="Alothman, Adel" uniqKey="Alothman A" first="Adel" last="Alothman">Adel Alothman</name></author><author><name sortKey="Khaldi, Abdulaziz" sort="Khaldi, Abdulaziz" uniqKey="Khaldi A" first="Abdulaziz" last="Khaldi">Abdulaziz Khaldi</name></author><author><name sortKey="Basel Al Raiy" sort="Basel Al Raiy" uniqKey="Basel Al Raiy" last="Basel Al Raiy">BASEL AL RAIY</name></author></analytic><series><title level="j" type="main">Annals of internal medicine</title><title level="j" type="abbreviated">Ann. intern. med.</title><idno type="ISSN">0003-4819</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Annals of internal medicine</title><title level="j" type="abbreviated">Ann. intern. med.</title><idno type="ISSN">0003-4819</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Coronavirus</term><term>Evolution</term><term>Human</term><term>Infection</term><term>Medicine</term><term>Middle East respiratory syndrome</term><term>Patient</term><term>Prognosis</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Infection</term><term>Evolution</term><term>Pronostic</term><term>Homme</term><term>Malade</term><term>Coronavirus</term><term>Médecine</term><term>Syndrome respiratoire du Moyen-Orient</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term><term>Médecine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Since September 2012, 170 confirmed infections with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization, including 72 deaths. Data on critically ill patients with MERS-CoV infection are limited. Objective: To describe the critical illness associated with MERS-CoV. Design: Case series. Setting: 3 intensive care units (ICUs) at 2 tertiary care hospitals in Saudi Arabia. Patients: 12 patients with confirmed or probable MERS-CoV infection. Measurements: Presenting symptoms, comorbid conditions, pulmonary and extrapulmonary manifestations, measures of severity of illness and organ failure, ICU course, and outcome are described, as are the results of surveillance of health care workers (HCWs) and patients with potential exposure. Results: Between December 2012 and August 2013, 114 patients were tested for suspected MERS-CoV; of these, 11 ICU patients (10%) met the definition of confirmed or probable cases. Three of these patients were part of a health care-associated cluster that also included 3 HCWs. One HCW became critically ill and was the 12th patient in this case series. Median Acute Physiology and Chronic Health Evaluation II score was 28 (range, 16 to 36). All 12 patients had underlying comorbid conditions and presented with acute severe hypoxemic respiratory failure. Most patients (92%) had extrapulmonary manifestations, including shock, acute kidney injury, and thrombocytopenia. Five (42%) were alive at day 90. Of the 520 exposed HCWs, only 4 (1 %) were positive. Limitation: The sample size was small. Conclusion: MERS-CoV causes severe acute hypoxemic respiratory failure and considerable extrapulmonary organ dysfunction and is associated with high mortality. Community-acquired and health care-associated MERS-CoV infection occurs in patients with chronic comorbid conditions. 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Balkhy</name><name sortKey="Basel Al Raiy" sort="Basel Al Raiy" uniqKey="Basel Al Raiy" last="Basel Al Raiy">BASEL AL RAIY</name><name sortKey="Ghabashi, Alaa" sort="Ghabashi, Alaa" uniqKey="Ghabashi A" first="Alaa" last="Ghabashi">Alaa Ghabashi</name><name sortKey="Hawa, Hassan" sort="Hawa, Hassan" uniqKey="Hawa H" first="Hassan" last="Hawa">Hassan Hawa</name><name sortKey="Khaldi, Abdulaziz" sort="Khaldi, Abdulaziz" uniqKey="Khaldi A" first="Abdulaziz" last="Khaldi">Abdulaziz Khaldi</name><name sortKey="Najm, Hani" sort="Najm, Hani" uniqKey="Najm H" first="Hani" last="Najm">Hani Najm</name></noCountry><country name="Arabie saoudite"><noRegion><name sortKey="Arabi, Yaseen M" sort="Arabi, Yaseen M" uniqKey="Arabi Y" first="Yaseen M." last="Arabi">Yaseen M. Arabi</name></noRegion><name sortKey="Arabi, Yaseen M" sort="Arabi, Yaseen M" uniqKey="Arabi Y" first="Yaseen M." last="Arabi">Yaseen M. 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