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/Corpus ); 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 ; Julien Poissy ; Loubna El Mansouf ; Caroline Sejourne ; Nicolas Ettahar ; Xavier Lemaire ; Fanny Vuotto ; Anne Goffard ; Sylvie Behillil ; Vincent Enouf ; Valérie Caro ; Alexandra Mailles ; Didier Che ; Jean-Claude Manuguerra ; Daniel Mathieu ; Arnaud Fontanet ; Sylvie Van Der WerfSource :
- Lancet : (British edition) [ 0140-6736 ] ; 2013.
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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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| NO : | PASCAL 13-0220381 INIST |
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| ET : | Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission |
| AU : | GUERY (Benoit); POISSY (Julien); EL MANSOUF (Loubna); SEJOURNE (Caroline); ETTAHAR (Nicolas); LEMAIRE (Xavier); VUOTTO (Fanny); GOFFARD (Anne); BEHILLIL (Sylvie); ENOUF (Vincent); CARO (Valérie); MAILLES (Alexandra); CHE (Didier); MANUGUERRA (Jean-Claude); MATHIEU (Daniel); FONTANET (Arnaud); DER WERF (Sylvie Van) |
| AF : | 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/Lille/France (1 aut., 7 aut.); Pôle de Reanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2/Lille/France (2 aut., 15 aut.); Service de Maladies Infectieuses, Centre Hospitalier de Douai/Douai/France (3 aut., 6 aut.); Service de Reanimation, Centre Hospitalier de Douai/Douai/France (4 aut.); Unité de Maladies Infectieuses, Centre Hospitalier de Valenciennes/Valenciennes/France (5 aut.); Laboratoire de Virologie, Centre de Biologie Pathologie, Centre Hospitalier Regional et Universitaire de Lille, Université de Lille 2/Lille/France (8 aut.); Institut Pasteur, National Reference Center for Influenza Viruses and Unit of Molecular Genetics of RNA Viruses/Paris/France (9 aut., 10 aut., 17 aut.); Université Paris Diderot Sorbonne Paris Cité, Unit of Molecular Genetics of RNA Viruses/Paris/France (9 aut., 10 aut., 17 aut.); Centre National de la Recherche Scientifique UMR3569/Paris/France (9 aut., 10 aut., 17 aut.); Institut Pasteur, Cellule d'Intervention Biologique d'Urgence/Paris/France (11 aut., 14 aut.); Institut de veille Sanitaire/Saint-Maurice/France (12 aut., 13 aut.); Conservatoire National des Arts et Métiers/Paris/France (16 aut.); Institut Pasteur, Emerging Diseases Epidemiology Unit/Paris/France (16 aut.) |
| DT : | Publication en série; Niveau analytique |
| SO : | Lancet : (British edition); ISSN 0140-6736; Coden LANCAO; Royaume-Uni; Da. 2013; Vol. 381; No. 9885; Pp. 2265-2272; Bibl. 26 ref. |
| LA : | Anglais |
| EA : | 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. |
| CC : | 002B01; 002B05C; 002B05A03 |
| FD : | Symptomatologie; Forme clinique; Virose; Virus; Diagnostic; Infection nosocomiale; Moyen Orient; Appareil respiratoire; Voie respiratoire; Syndrome; Coronavirus; Compte rendu; Transmission; Médecine |
| FG : | Infection; Asie; Coronaviridae; Nidovirales |
| ED : | Symptomatology; Clinical form; Viral disease; Virus; Diagnosis; Nosocomial infection; Middle east; Respiratory system; Respiratory tract; Syndrome; Coronavirus; Report; Transmission; Medicine |
| EG : | Infection; Asia; Coronaviridae; Nidovirales |
| SD : | Sintomatología; Forma clínica; Virosis; Virus; Diagnóstico; Infección nosocomial; Oriente Medio; Aparato respiratorio; Vía respiratoria; Síndrome; Coronavirus; Informe; Transmisión; Medicina |
| LO : | INIST-5004.354000509082440140 |
| ID : | 13-0220381 |
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last="Manuguerra">Jean-Claude Manuguerra</name><affiliation><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></affiliation></author><author><name sortKey="Mathieu, Daniel" sort="Mathieu, Daniel" uniqKey="Mathieu D" first="Daniel" last="Mathieu">Daniel Mathieu</name><affiliation><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></affiliation></author><author><name sortKey="Fontanet, Arnaud" sort="Fontanet, Arnaud" uniqKey="Fontanet A" first="Arnaud" last="Fontanet">Arnaud Fontanet</name><affiliation><inist:fA14 i1="12"><s1>Conservatoire National des Arts et Métiers</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14></affiliation><affiliation><inist:fA14 i1="13"><s1>Institut Pasteur, Emerging Diseases Epidemiology Unit</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14></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><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></affiliation><affiliation><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></affiliation><affiliation><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></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0220381</idno><date when="2013">2013</date><idno type="stanalyst">PASCAL 13-0220381 INIST</idno><idno type="RBID">Pascal:13-0220381</idno><idno type="wicri:Area/PascalFrancis/Corpus">000059</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission</title><author><name sortKey="Guery, Benoit" sort="Guery, Benoit" uniqKey="Guery B" first="Benoit" last="Guery">Benoit Guery</name><affiliation><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></affiliation></author><author><name sortKey="Poissy, Julien" sort="Poissy, Julien" uniqKey="Poissy J" first="Julien" last="Poissy">Julien Poissy</name><affiliation><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></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><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></affiliation></author><author><name sortKey="Sejourne, Caroline" sort="Sejourne, Caroline" uniqKey="Sejourne C" first="Caroline" last="Sejourne">Caroline Sejourne</name><affiliation><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></affiliation></author><author><name sortKey="Ettahar, Nicolas" sort="Ettahar, Nicolas" uniqKey="Ettahar N" first="Nicolas" last="Ettahar">Nicolas Ettahar</name><affiliation><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></affiliation></author><author><name sortKey="Lemaire, Xavier" sort="Lemaire, Xavier" uniqKey="Lemaire X" first="Xavier" last="Lemaire">Xavier Lemaire</name><affiliation><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></affiliation></author><author><name sortKey="Vuotto, Fanny" sort="Vuotto, Fanny" uniqKey="Vuotto F" first="Fanny" last="Vuotto">Fanny Vuotto</name><affiliation><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></affiliation></author><author><name sortKey="Goffard, Anne" sort="Goffard, Anne" uniqKey="Goffard A" first="Anne" last="Goffard">Anne Goffard</name><affiliation><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></affiliation></author><author><name sortKey="Behillil, Sylvie" sort="Behillil, Sylvie" uniqKey="Behillil S" first="Sylvie" last="Behillil">Sylvie Behillil</name><affiliation><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></affiliation><affiliation><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></affiliation><affiliation><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></affiliation></author><author><name sortKey="Enouf, Vincent" sort="Enouf, Vincent" uniqKey="Enouf V" first="Vincent" last="Enouf">Vincent Enouf</name><affiliation><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></affiliation><affiliation><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></affiliation><affiliation><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></affiliation></author><author><name sortKey="Caro, Valerie" sort="Caro, Valerie" uniqKey="Caro V" first="Valérie" last="Caro">Valérie Caro</name><affiliation><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></affiliation></author><author><name sortKey="Mailles, Alexandra" sort="Mailles, Alexandra" uniqKey="Mailles A" first="Alexandra" last="Mailles">Alexandra Mailles</name><affiliation><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></affiliation></author><author><name sortKey="Che, Didier" sort="Che, Didier" uniqKey="Che D" first="Didier" last="Che">Didier Che</name><affiliation><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></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><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></affiliation></author><author><name sortKey="Mathieu, Daniel" sort="Mathieu, Daniel" uniqKey="Mathieu D" first="Daniel" last="Mathieu">Daniel Mathieu</name><affiliation><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></affiliation></author><author><name sortKey="Fontanet, Arnaud" sort="Fontanet, Arnaud" uniqKey="Fontanet A" first="Arnaud" last="Fontanet">Arnaud Fontanet</name><affiliation><inist:fA14 i1="12"><s1>Conservatoire National des Arts et Métiers</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14></affiliation><affiliation><inist:fA14 i1="13"><s1>Institut Pasteur, Emerging Diseases Epidemiology Unit</s1><s2>Paris</s2><s3>FRA</s3><sZ>16 aut.</sZ></inist:fA14></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><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></affiliation><affiliation><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></affiliation><affiliation><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></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></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><server><NO>PASCAL 13-0220381 INIST</NO><ET>Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission</ET><AU>GUERY (Benoit); POISSY (Julien); EL MANSOUF (Loubna); SEJOURNE (Caroline); ETTAHAR (Nicolas); LEMAIRE (Xavier); VUOTTO (Fanny); GOFFARD (Anne); BEHILLIL (Sylvie); ENOUF (Vincent); CARO (Valérie); MAILLES (Alexandra); CHE (Didier); MANUGUERRA (Jean-Claude); MATHIEU (Daniel); FONTANET (Arnaud); DER WERF (Sylvie Van)</AU><AF>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/Lille/France (1 aut., 7 aut.); Pôle de Reanimation, Hôpital Roger Salengro, Centre Hospitalier Régional et Universitaire de Lille, Université de Lille 2/Lille/France (2 aut., 15 aut.); Service de Maladies Infectieuses, Centre Hospitalier de Douai/Douai/France (3 aut., 6 aut.); Service de Reanimation, Centre Hospitalier de Douai/Douai/France (4 aut.); Unité de Maladies Infectieuses, Centre Hospitalier de Valenciennes/Valenciennes/France (5 aut.); Laboratoire de Virologie, Centre de Biologie Pathologie, Centre Hospitalier Regional et Universitaire de Lille, Université de Lille 2/Lille/France (8 aut.); Institut Pasteur, National Reference Center for Influenza Viruses and Unit of Molecular Genetics of RNA Viruses/Paris/France (9 aut., 10 aut., 17 aut.); Université Paris Diderot Sorbonne Paris Cité, Unit of Molecular Genetics of RNA Viruses/Paris/France (9 aut., 10 aut., 17 aut.); Centre National de la Recherche Scientifique UMR3569/Paris/France (9 aut., 10 aut., 17 aut.); Institut Pasteur, Cellule d'Intervention Biologique d'Urgence/Paris/France (11 aut., 14 aut.); Institut de veille Sanitaire/Saint-Maurice/France (12 aut., 13 aut.); Conservatoire National des Arts et Métiers/Paris/France (16 aut.); Institut Pasteur, Emerging Diseases Epidemiology Unit/Paris/France (16 aut.)</AF><DT>Publication en série; Niveau analytique</DT><SO>Lancet : (British edition); ISSN 0140-6736; Coden LANCAO; Royaume-Uni; Da. 2013; Vol. 381; No. 9885; Pp. 2265-2272; Bibl. 26 ref.</SO><LA>Anglais</LA><EA>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.</EA><CC>002B01; 002B05C; 002B05A03</CC><FD>Symptomatologie; Forme clinique; Virose; Virus; Diagnostic; Infection nosocomiale; Moyen Orient; Appareil respiratoire; Voie respiratoire; Syndrome; Coronavirus; Compte rendu; Transmission; Médecine</FD><FG>Infection; Asie; Coronaviridae; Nidovirales</FG><ED>Symptomatology; Clinical form; Viral disease; Virus; Diagnosis; Nosocomial infection; Middle east; Respiratory system; Respiratory tract; Syndrome; Coronavirus; Report; Transmission; Medicine</ED><EG>Infection; Asia; Coronaviridae; Nidovirales</EG><SD>Sintomatología; Forma clínica; Virosis; Virus; Diagnóstico; Infección nosocomial; Oriente Medio; Aparato respiratorio; Vía respiratoria; Síndrome; Coronavirus; Informe; Transmisión; Medicina</SD><LO>INIST-5004.354000509082440140</LO><ID>13-0220381</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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