Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission
Identifieur interne : 000059 ( PascalFrancis/Checkpoint ); précédent : 000058; suivant : 000060Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission
Auteurs : Benoit Guery [France] ; Julien Poissy [France] ; Loubna El Mansouf [France] ; Caroline Sejourne [France] ; Nicolas Ettahar [France] ; Xavier Lemaire [France] ; Fanny Vuotto [France] ; Anne Goffard [France] ; Sylvie Behillil [France] ; Vincent Enouf [France] ; Valérie Caro [France] ; Alexandra Mailles [France] ; Didier Che [France] ; Jean-Claude Manuguerra [France] ; Daniel Mathieu [France] ; Arnaud Fontanet [France] ; Sylvie Van Der Werf [France]Source :
- Lancet : (British edition) [ 0140-6736 ] ; 2013.
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- topic : Médecine.
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Abstract
Background Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital. Methods Patient 1 visited Dubai in April, 2013; patient 2 lives in France and did not travel abroad. Both patients had underlying immunosuppressive disorders. We tested specimens from the upper (nasopharyngeal swabs) or the lower (bronchoalveolar lavage, sputum) respiratory tract and whole blood, plasma, and serum specimens for MERS-CoV by real-time RT-PCR targeting the upE and Orf1A genes of MERS-CoV. Findings Initial clinical presentation included fever, chills, and myalgia in both patients, and for patient 1, diarrhoea. Respiratory symptoms rapidly became predominant with acute respiratory failure leading to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Both patients developed acute renal failure. MERS-CoV was detected in lower respiratory tract specimens with high viral load (eg, cycle threshold [Ct] values of 22.9 for upE and 24 for Orf1a for a bronchoalveolar lavage sample from patient 1; Ct values of 22.5 for upE and 23.9 for Orf1a for an induced sputum sample from patient 2), whereas nasopharyngeal specimens were weakly positive or inconclusive. The two patients shared the same room for 3 days. The incubation period was estimated at 9-12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure. Interpretation Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor. Funding French Institute for Public Health Surveillance, ANR grant Labex Integrative Biology of Emerging Infectious Diseases, and the European Community's Seventh Framework Programme projects EMPERIE and PREDEMICS.
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i1="09"><s1>Centre National de la Recherche Scientifique UMR3569</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Enouf, Vincent" sort="Enouf, Vincent" uniqKey="Enouf V" first="Vincent" last="Enouf">Vincent Enouf</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Institut Pasteur, National Reference Center for Influenza Viruses and Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Université Paris Diderot Sorbonne Paris Cité, Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Centre National de la Recherche Scientifique UMR3569</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Caro, Valerie" sort="Caro, Valerie" uniqKey="Caro V" first="Valérie" last="Caro">Valérie Caro</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Institut Pasteur, Cellule d'Intervention Biologique d'Urgence</s1><s2>Paris</s2><s3>FRA</s3><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Mailles, Alexandra" sort="Mailles, Alexandra" uniqKey="Mailles A" first="Alexandra" last="Mailles">Alexandra Mailles</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Institut de veille Sanitaire</s1><s2>Saint-Maurice</s2><s3>FRA</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Saint-Maurice</wicri:noRegion><wicri:noRegion>Institut de veille Sanitaire</wicri:noRegion><wicri:noRegion>Institut de veille Sanitaire</wicri:noRegion></affiliation></author><author><name sortKey="Che, Didier" sort="Che, Didier" uniqKey="Che D" first="Didier" last="Che">Didier Che</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Institut de veille Sanitaire</s1><s2>Saint-Maurice</s2><s3>FRA</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Saint-Maurice</wicri:noRegion><wicri:noRegion>Institut de veille Sanitaire</wicri:noRegion><wicri:noRegion>Institut de veille Sanitaire</wicri:noRegion></affiliation></author><author><name sortKey="Manuguerra, Jean Claude" sort="Manuguerra, Jean Claude" uniqKey="Manuguerra J" first="Jean-Claude" last="Manuguerra">Jean-Claude Manuguerra</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Institut Pasteur, Cellule d'Intervention Biologique d'Urgence</s1><s2>Paris</s2><s3>FRA</s3><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Mathieu, Daniel" sort="Mathieu, Daniel" uniqKey="Mathieu D" first="Daniel" last="Mathieu">Daniel Mathieu</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Pôle de Reanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Fontanet, Arnaud" sort="Fontanet, Arnaud" uniqKey="Fontanet A" first="Arnaud" last="Fontanet">Arnaud Fontanet</name><affiliation wicri:level="3"><inist:fA14 i1="12"><s1>Conservatoire National des Arts et Métiers</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="13"><s1>Institut Pasteur, Emerging Diseases Epidemiology Unit</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Der Werf, Sylvie Van" sort="Der Werf, Sylvie Van" uniqKey="Der Werf S" first="Sylvie Van" last="Der Werf">Sylvie Van Der Werf</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Institut Pasteur, National Reference Center for Influenza Viruses and Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Université Paris Diderot Sorbonne Paris Cité, Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Centre National de la Recherche Scientifique UMR3569</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0220381</idno><date 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Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Poissy, Julien" sort="Poissy, Julien" uniqKey="Poissy J" first="Julien" last="Poissy">Julien Poissy</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Pôle de Reanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="El Mansouf, Loubna" sort="El Mansouf, Loubna" uniqKey="El Mansouf L" first="Loubna" last="El Mansouf">Loubna El Mansouf</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Service de Maladies Infectieuses, Centre Hospitalier de Douai</s1><s2>Douai</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Douai</settlement></placeName></affiliation></author><author><name sortKey="Sejourne, Caroline" sort="Sejourne, Caroline" uniqKey="Sejourne C" first="Caroline" last="Sejourne">Caroline Sejourne</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Service de Reanimation, Centre Hospitalier de Douai</s1><s2>Douai</s2><s3>FRA</s3><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Douai</settlement></placeName></affiliation></author><author><name sortKey="Ettahar, Nicolas" sort="Ettahar, Nicolas" uniqKey="Ettahar N" first="Nicolas" last="Ettahar">Nicolas Ettahar</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Unité de Maladies Infectieuses, Centre Hospitalier de Valenciennes</s1><s2>Valenciennes</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Valenciennes</settlement></placeName></affiliation></author><author><name sortKey="Lemaire, Xavier" sort="Lemaire, Xavier" uniqKey="Lemaire X" first="Xavier" last="Lemaire">Xavier Lemaire</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Service de Maladies Infectieuses, Centre Hospitalier de Douai</s1><s2>Douai</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Douai</settlement></placeName></affiliation></author><author><name sortKey="Vuotto, Fanny" sort="Vuotto, Fanny" uniqKey="Vuotto F" first="Fanny" last="Vuotto">Fanny Vuotto</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Members listed at end of paper Service de Gestion du Risque Infectieux, Vigilances et Infectiologie, Hopital Huriez, Pavilion Fourrier, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Goffard, Anne" sort="Goffard, Anne" uniqKey="Goffard A" first="Anne" last="Goffard">Anne Goffard</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Laboratoire de Virologie, Centre de Biologie Pathologie, Centre Hospitalier Regional et Universitaire de Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Behillil, Sylvie" sort="Behillil, Sylvie" uniqKey="Behillil S" first="Sylvie" last="Behillil">Sylvie Behillil</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Institut Pasteur, National Reference Center for Influenza Viruses and Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Université Paris Diderot Sorbonne Paris Cité, Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Centre National de la Recherche Scientifique UMR3569</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Enouf, Vincent" sort="Enouf, Vincent" uniqKey="Enouf V" first="Vincent" last="Enouf">Vincent Enouf</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Institut Pasteur, National Reference Center for Influenza Viruses and Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Université Paris Diderot Sorbonne Paris Cité, Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Centre National de la Recherche Scientifique UMR3569</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Caro, Valerie" sort="Caro, Valerie" uniqKey="Caro V" first="Valérie" last="Caro">Valérie Caro</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Institut Pasteur, Cellule d'Intervention Biologique d'Urgence</s1><s2>Paris</s2><s3>FRA</s3><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Mailles, Alexandra" sort="Mailles, Alexandra" uniqKey="Mailles A" first="Alexandra" last="Mailles">Alexandra Mailles</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Institut de veille Sanitaire</s1><s2>Saint-Maurice</s2><s3>FRA</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Saint-Maurice</wicri:noRegion><wicri:noRegion>Institut de veille Sanitaire</wicri:noRegion><wicri:noRegion>Institut de veille Sanitaire</wicri:noRegion></affiliation></author><author><name sortKey="Che, Didier" sort="Che, Didier" uniqKey="Che D" first="Didier" last="Che">Didier Che</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Institut de veille Sanitaire</s1><s2>Saint-Maurice</s2><s3>FRA</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Saint-Maurice</wicri:noRegion><wicri:noRegion>Institut de veille Sanitaire</wicri:noRegion><wicri:noRegion>Institut de veille Sanitaire</wicri:noRegion></affiliation></author><author><name sortKey="Manuguerra, Jean Claude" sort="Manuguerra, Jean Claude" uniqKey="Manuguerra J" first="Jean-Claude" last="Manuguerra">Jean-Claude Manuguerra</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Institut Pasteur, Cellule d'Intervention Biologique d'Urgence</s1><s2>Paris</s2><s3>FRA</s3><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Mathieu, Daniel" sort="Mathieu, Daniel" uniqKey="Mathieu D" first="Daniel" last="Mathieu">Daniel Mathieu</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Pôle de Reanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Fontanet, Arnaud" sort="Fontanet, Arnaud" uniqKey="Fontanet A" first="Arnaud" last="Fontanet">Arnaud Fontanet</name><affiliation wicri:level="3"><inist:fA14 i1="12"><s1>Conservatoire National des Arts et Métiers</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="13"><s1>Institut Pasteur, Emerging Diseases Epidemiology Unit</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Der Werf, Sylvie Van" sort="Der Werf, Sylvie Van" uniqKey="Der Werf S" first="Sylvie Van" last="Der Werf">Sylvie Van Der Werf</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Institut Pasteur, National Reference Center for Influenza Viruses and Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Université Paris Diderot Sorbonne Paris Cité, Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Centre National de la Recherche Scientifique UMR3569</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">Lancet : (British edition)</title><title level="j" type="abbreviated">Lancet : (Br. ed.)</title><idno type="ISSN">0140-6736</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Lancet : (British edition)</title><title level="j" type="abbreviated">Lancet : (Br. ed.)</title><idno type="ISSN">0140-6736</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Clinical form</term><term>Coronavirus</term><term>Diagnosis</term><term>Medicine</term><term>Middle east</term><term>Nosocomial infection</term><term>Report</term><term>Respiratory system</term><term>Respiratory tract</term><term>Symptomatology</term><term>Syndrome</term><term>Transmission</term><term>Viral disease</term><term>Virus</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Symptomatologie</term><term>Forme clinique</term><term>Virose</term><term>Virus</term><term>Diagnostic</term><term>Infection nosocomiale</term><term>Moyen Orient</term><term>Appareil respiratoire</term><term>Voie respiratoire</term><term>Syndrome</term><term>Coronavirus</term><term>Compte rendu</term><term>Transmission</term><term>Médecine</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Médecine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital. Methods Patient 1 visited Dubai in April, 2013; patient 2 lives in France and did not travel abroad. Both patients had underlying immunosuppressive disorders. We tested specimens from the upper (nasopharyngeal swabs) or the lower (bronchoalveolar lavage, sputum) respiratory tract and whole blood, plasma, and serum specimens for MERS-CoV by real-time RT-PCR targeting the upE and Orf1A genes of MERS-CoV. Findings Initial clinical presentation included fever, chills, and myalgia in both patients, and for patient 1, diarrhoea. Respiratory symptoms rapidly became predominant with acute respiratory failure leading to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Both patients developed acute renal failure. MERS-CoV was detected in lower respiratory tract specimens with high viral load (eg, cycle threshold [Ct] values of 22.9 for upE and 24 for Orf1a for a bronchoalveolar lavage sample from patient 1; Ct values of 22.5 for upE and 23.9 for Orf1a for an induced sputum sample from patient 2), whereas nasopharyngeal specimens were weakly positive or inconclusive. The two patients shared the same room for 3 days. The incubation period was estimated at 9-12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure. Interpretation Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor. Funding French Institute for Public Health Surveillance, ANR grant Labex Integrative Biology of Emerging Infectious Diseases, and the European Community's Seventh Framework Programme projects EMPERIE and PREDEMICS.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0140-6736</s0></fA01><fA02 i1="01"><s0>LANCAO</s0></fA02><fA03 i2="1"><s0>Lancet : (Br. ed.)</s0></fA03><fA05><s2>381</s2></fA05><fA06><s2>9885</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission</s1></fA08><fA11 i1="01" i2="1"><s1>GUERY (Benoit)</s1></fA11><fA11 i1="02" i2="1"><s1>POISSY (Julien)</s1></fA11><fA11 i1="03" i2="1"><s1>EL MANSOUF (Loubna)</s1></fA11><fA11 i1="04" i2="1"><s1>SEJOURNE (Caroline)</s1></fA11><fA11 i1="05" i2="1"><s1>ETTAHAR (Nicolas)</s1></fA11><fA11 i1="06" i2="1"><s1>LEMAIRE (Xavier)</s1></fA11><fA11 i1="07" i2="1"><s1>VUOTTO (Fanny)</s1></fA11><fA11 i1="08" i2="1"><s1>GOFFARD (Anne)</s1></fA11><fA11 i1="09" i2="1"><s1>BEHILLIL (Sylvie)</s1></fA11><fA11 i1="10" i2="1"><s1>ENOUF (Vincent)</s1></fA11><fA11 i1="11" i2="1"><s1>CARO (Valérie)</s1></fA11><fA11 i1="12" i2="1"><s1>MAILLES (Alexandra)</s1></fA11><fA11 i1="13" i2="1"><s1>CHE (Didier)</s1></fA11><fA11 i1="14" i2="1"><s1>MANUGUERRA (Jean-Claude)</s1></fA11><fA11 i1="15" i2="1"><s1>MATHIEU (Daniel)</s1></fA11><fA11 i1="16" i2="1"><s1>FONTANET (Arnaud)</s1></fA11><fA11 i1="17" i2="1"><s1>DER WERF (Sylvie Van)</s1></fA11><fA14 i1="01"><s1>Members listed at end of paper Service de Gestion du Risque Infectieux, Vigilances et Infectiologie, Hopital Huriez, Pavilion Fourrier, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ></fA14><fA14 i1="02"><s1>Pôle de Reanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>15 aut.</sZ></fA14><fA14 i1="03"><s1>Service de Maladies Infectieuses, Centre Hospitalier de Douai</s1><s2>Douai</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ></fA14><fA14 i1="04"><s1>Service de Reanimation, Centre Hospitalier de Douai</s1><s2>Douai</s2><s3>FRA</s3><sZ>4 aut.</sZ></fA14><fA14 i1="05"><s1>Unité de Maladies Infectieuses, Centre Hospitalier de Valenciennes</s1><s2>Valenciennes</s2><s3>FRA</s3><sZ>5 aut.</sZ></fA14><fA14 i1="06"><s1>Laboratoire de Virologie, Centre de Biologie Pathologie, Centre Hospitalier Regional et Universitaire de Lille, Université de Lille 2</s1><s2>Lille</s2><s3>FRA</s3><sZ>8 aut.</sZ></fA14><fA14 i1="07"><s1>Institut Pasteur, National Reference Center for Influenza Viruses and Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></fA14><fA14 i1="08"><s1>Université Paris Diderot Sorbonne Paris Cité, Unit of Molecular Genetics of RNA Viruses</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></fA14><fA14 i1="09"><s1>Centre National de la Recherche Scientifique UMR3569</s1><s2>Paris</s2><s3>FRA</s3><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>17 aut.</sZ></fA14><fA14 i1="10"><s1>Institut Pasteur, Cellule d'Intervention Biologique d'Urgence</s1><s2>Paris</s2><s3>FRA</s3><sZ>11 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="11"><s1>Institut de veille Sanitaire</s1><s2>Saint-Maurice</s2><s3>FRA</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ></fA14><fA14 i1="12"><s1>Conservatoire National des Arts et Métiers</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></fA14><fA14 i1="13"><s1>Institut Pasteur, Emerging Diseases Epidemiology Unit</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></fA14><fA17 i1="01" i2="1"><s1>MERS-CoV study group</s1><s3>INC</s3></fA17><fA20><s1>2265-2272</s1></fA20><fA21><s1>2013</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>5004</s2><s5>354000509082440140</s5></fA43><fA44><s0>0000</s0><s1>© 2013 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>26 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>13-0220381</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Lancet : (British edition)</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>Background Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital. Methods Patient 1 visited Dubai in April, 2013; patient 2 lives in France and did not travel abroad. Both patients had underlying immunosuppressive disorders. We tested specimens from the upper (nasopharyngeal swabs) or the lower (bronchoalveolar lavage, sputum) respiratory tract and whole blood, plasma, and serum specimens for MERS-CoV by real-time RT-PCR targeting the upE and Orf1A genes of MERS-CoV. Findings Initial clinical presentation included fever, chills, and myalgia in both patients, and for patient 1, diarrhoea. Respiratory symptoms rapidly became predominant with acute respiratory failure leading to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Both patients developed acute renal failure. MERS-CoV was detected in lower respiratory tract specimens with high viral load (eg, cycle threshold [Ct] values of 22.9 for upE and 24 for Orf1a for a bronchoalveolar lavage sample from patient 1; Ct values of 22.5 for upE and 23.9 for Orf1a for an induced sputum sample from patient 2), whereas nasopharyngeal specimens were weakly positive or inconclusive. The two patients shared the same room for 3 days. The incubation period was estimated at 9-12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure. Interpretation Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor. Funding French Institute for Public Health Surveillance, ANR grant Labex Integrative Biology of Emerging Infectious Diseases, and the European Community's Seventh Framework Programme projects EMPERIE and PREDEMICS.</s0></fC01><fC02 i1="01" i2="X"><s0>002B01</s0></fC02><fC02 i1="02" i2="X"><s0>002B05C</s0></fC02><fC02 i1="03" i2="X"><s0>002B05A03</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Symptomatologie</s0><s5>02</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Symptomatology</s0><s5>02</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Sintomatología</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Forme clinique</s0><s5>03</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Clinical form</s0><s5>03</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Forma clínica</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Virose</s0><s5>05</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Viral disease</s0><s5>05</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Virosis</s0><s5>05</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Virus</s0><s2>NW</s2><s5>06</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Virus</s0><s2>NW</s2><s5>06</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Virus</s0><s2>NW</s2><s5>06</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Diagnostic</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Diagnosis</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Diagnóstico</s0><s5>08</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Infection nosocomiale</s0><s2>NM</s2><s5>09</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Nosocomial infection</s0><s2>NM</s2><s5>09</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Infección nosocomial</s0><s2>NM</s2><s5>09</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Moyen Orient</s0><s2>NG</s2><s5>11</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Middle east</s0><s2>NG</s2><s5>11</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Oriente Medio</s0><s2>NG</s2><s5>11</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Appareil respiratoire</s0><s5>12</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Respiratory system</s0><s5>12</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Aparato respiratorio</s0><s5>12</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Voie respiratoire</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Respiratory tract</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Vía respiratoria</s0><s5>17</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Syndrome</s0><s5>18</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Syndrome</s0><s5>18</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Síndrome</s0><s5>18</s5></fC03><fC03 i1="11" i2="X" l="FRE"><s0>Coronavirus</s0><s2>NW</s2><s5>19</s5></fC03><fC03 i1="11" i2="X" l="ENG"><s0>Coronavirus</s0><s2>NW</s2><s5>19</s5></fC03><fC03 i1="11" i2="X" l="SPA"><s0>Coronavirus</s0><s2>NW</s2><s5>19</s5></fC03><fC03 i1="12" i2="X" l="FRE"><s0>Compte rendu</s0><s5>20</s5></fC03><fC03 i1="12" i2="X" l="ENG"><s0>Report</s0><s5>20</s5></fC03><fC03 i1="12" i2="X" l="SPA"><s0>Informe</s0><s5>20</s5></fC03><fC03 i1="13" i2="X" l="FRE"><s0>Transmission</s0><s5>21</s5></fC03><fC03 i1="13" i2="X" l="ENG"><s0>Transmission</s0><s5>21</s5></fC03><fC03 i1="13" i2="X" l="SPA"><s0>Transmisión</s0><s5>21</s5></fC03><fC03 i1="14" i2="X" l="FRE"><s0>Médecine</s0><s5>22</s5></fC03><fC03 i1="14" i2="X" l="ENG"><s0>Medicine</s0><s5>22</s5></fC03><fC03 i1="14" i2="X" l="SPA"><s0>Medicina</s0><s5>22</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Infection</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Infection</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Infección</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Asie</s0><s2>NG</s2></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Asia</s0><s2>NG</s2></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Asia</s0><s2>NG</s2></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Coronaviridae</s0><s2>NW</s2></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Coronaviridae</s0><s2>NW</s2></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Coronaviridae</s0><s2>NW</s2></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Nidovirales</s0><s2>NW</s2></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Nidovirales</s0><s2>NW</s2></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Nidovirales</s0><s2>NW</s2></fC07><fN21><s1>203</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><affiliations><list><country><li>France</li></country><region><li>Hauts-de-France</li><li>Nord-Pas-de-Calais</li><li>Île-de-France</li></region><settlement><li>Douai</li><li>Lille</li><li>Paris</li><li>Valenciennes</li></settlement></list><tree><country name="France"><region name="Hauts-de-France"><name sortKey="Guery, Benoit" sort="Guery, Benoit" uniqKey="Guery B" first="Benoit" last="Guery">Benoit Guery</name></region><name sortKey="Behillil, Sylvie" sort="Behillil, Sylvie" uniqKey="Behillil S" first="Sylvie" last="Behillil">Sylvie Behillil</name><name sortKey="Behillil, Sylvie" sort="Behillil, Sylvie" uniqKey="Behillil S" first="Sylvie" last="Behillil">Sylvie Behillil</name><name sortKey="Behillil, Sylvie" sort="Behillil, Sylvie" uniqKey="Behillil S" first="Sylvie" last="Behillil">Sylvie Behillil</name><name sortKey="Caro, Valerie" sort="Caro, Valerie" uniqKey="Caro V" first="Valérie" last="Caro">Valérie Caro</name><name sortKey="Che, Didier" sort="Che, Didier" uniqKey="Che D" first="Didier" last="Che">Didier Che</name><name sortKey="Der Werf, Sylvie Van" sort="Der Werf, Sylvie Van" uniqKey="Der Werf S" first="Sylvie Van" last="Der Werf">Sylvie Van Der Werf</name><name sortKey="Der Werf, Sylvie Van" sort="Der Werf, Sylvie Van" uniqKey="Der Werf S" first="Sylvie Van" last="Der Werf">Sylvie Van Der Werf</name><name sortKey="Der Werf, Sylvie Van" sort="Der Werf, Sylvie Van" uniqKey="Der Werf S" first="Sylvie Van" last="Der Werf">Sylvie Van Der Werf</name><name sortKey="El Mansouf, Loubna" sort="El Mansouf, Loubna" uniqKey="El Mansouf L" first="Loubna" last="El Mansouf">Loubna El Mansouf</name><name sortKey="Enouf, Vincent" sort="Enouf, Vincent" uniqKey="Enouf V" first="Vincent" last="Enouf">Vincent Enouf</name><name sortKey="Enouf, Vincent" sort="Enouf, Vincent" uniqKey="Enouf V" first="Vincent" last="Enouf">Vincent Enouf</name><name sortKey="Enouf, Vincent" sort="Enouf, Vincent" uniqKey="Enouf V" first="Vincent" last="Enouf">Vincent Enouf</name><name sortKey="Ettahar, Nicolas" sort="Ettahar, Nicolas" uniqKey="Ettahar N" first="Nicolas" last="Ettahar">Nicolas Ettahar</name><name sortKey="Fontanet, Arnaud" sort="Fontanet, Arnaud" uniqKey="Fontanet A" first="Arnaud" last="Fontanet">Arnaud Fontanet</name><name sortKey="Fontanet, Arnaud" sort="Fontanet, Arnaud" uniqKey="Fontanet A" first="Arnaud" last="Fontanet">Arnaud Fontanet</name><name sortKey="Goffard, Anne" sort="Goffard, Anne" uniqKey="Goffard A" first="Anne" last="Goffard">Anne Goffard</name><name sortKey="Lemaire, Xavier" sort="Lemaire, Xavier" uniqKey="Lemaire X" first="Xavier" last="Lemaire">Xavier Lemaire</name><name sortKey="Mailles, Alexandra" sort="Mailles, Alexandra" uniqKey="Mailles A" first="Alexandra" last="Mailles">Alexandra Mailles</name><name sortKey="Manuguerra, Jean Claude" sort="Manuguerra, Jean Claude" uniqKey="Manuguerra J" first="Jean-Claude" last="Manuguerra">Jean-Claude Manuguerra</name><name sortKey="Mathieu, Daniel" sort="Mathieu, Daniel" uniqKey="Mathieu D" first="Daniel" last="Mathieu">Daniel Mathieu</name><name sortKey="Poissy, Julien" sort="Poissy, Julien" uniqKey="Poissy J" first="Julien" last="Poissy">Julien Poissy</name><name sortKey="Sejourne, Caroline" sort="Sejourne, Caroline" uniqKey="Sejourne C" first="Caroline" last="Sejourne">Caroline Sejourne</name><name sortKey="Vuotto, Fanny" sort="Vuotto, Fanny" uniqKey="Vuotto F" first="Fanny" last="Vuotto">Fanny Vuotto</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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|texte= Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission
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