Serveur d'exploration MERS

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Respiratory Tract Samples, Viral Load, and Genome Fraction Yield in Patients With Middle East Respiratory Syndrome

Identifieur interne : 000F81 ( Pmc/Checkpoint ); précédent : 000F80; suivant : 000F82

Respiratory Tract Samples, Viral Load, and Genome Fraction Yield in Patients With Middle East Respiratory Syndrome

Auteurs : Ziad A. Memish ; Jaffar A. Al-Tawfiq ; Hatem Q. Makhdoom ; Abdullah Assiri ; Raafat F. Alhakeem ; Ali Albarrak ; Sarah Alsubaie ; Abdullah A. Al-Rabeeah ; Waleed H. Hajomar ; Raheela Hussain ; Ali M. Kheyami ; Abdullah Almutairi ; Esam I. Azhar ; Christian Drosten [Allemagne] ; Simon J. Watson ; Paul Kellam ; Matthew Cotten ; Alimuddin Zumla [Royaume-Uni]

Source :

RBID : PMC:7107391

Abstract

Abstract

Background. Analysis of clinical samples from patients with new viral infections is critical to confirm the diagnosis, to specify the viral load, and to sequence data necessary for characterizing the viral kinetics, transmission, and evolution. We analyzed samples from 112 patients infected with the recently discovered Middle East respiratory syndrome coronavirus (MERS-CoV).

Methods. Respiratory tract samples from cases of MERS-CoV infection confirmed by polymerase chain reaction (PCR) were investigated to determine the MERS-CoV load and fraction of the MERS-CoV genome. These values were analyzed to determine associations with clinical sample type.

Results. Samples from 112 individuals in which MERS-CoV was detected by PCR were analyzed, of which 13 were sputum samples, 64 were nasopharyngeal swab specimens, 30 were tracheal aspirates, and 3 were bronchoalveolar lavage specimens; 2 samples were of unknown origin. Tracheal aspirates yielded significantly higher MERS-CoV loads, compared with nasopharyngeal swab specimens (P = .005) and sputum specimens (P = .0001). Tracheal aspirates had viral loads similar to those in bronchoalveolar lavage samples (P = .3079). Bronchoalveolar lavage samples and tracheal aspirates had significantly higher genome fraction than nasopharyngeal swab specimens (P = .0095 and P = .0002, respectively) and sputum samples (P = .0009 and P = .0001, respectively). The genome yield from tracheal aspirates and bronchoalveolar lavage samples were similar (P = .1174).

Conclusions. Lower respiratory tract samples yield significantly higher MERS-CoV loads and genome fractions than upper respiratory tract samples.


Url:
DOI: 10.1093/infdis/jiu292
PubMed: 24837403
PubMed Central: 7107391


Affiliations:


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PMC:7107391

Le document en format XML

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<name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name>
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<name sortKey="Albarrak, Ali" sort="Albarrak, Ali" uniqKey="Albarrak A" first="Ali" last="Albarrak">Ali Albarrak</name>
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<name sortKey="Alsubaie, Sarah" sort="Alsubaie, Sarah" uniqKey="Alsubaie S" first="Sarah" last="Alsubaie">Sarah Alsubaie</name>
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<institution>King Saud University</institution>
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<addr-line>Riyadh</addr-line>
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<name sortKey="Al Rabeeah, Abdullah A" sort="Al Rabeeah, Abdullah A" uniqKey="Al Rabeeah A" first="Abdullah A." last="Al-Rabeeah">Abdullah A. Al-Rabeeah</name>
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<nlm:aff id="af1">
<institution>Global Centre for Mass Gatherings Medicine and Ministry of Health, Riyadh, Kingdom of Saudi Arabia and College of Medicine, Alfaisal University,</institution>
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<name sortKey="Hajomar, Waleed H" sort="Hajomar, Waleed H" uniqKey="Hajomar W" first="Waleed H." last="Hajomar">Waleed H. Hajomar</name>
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<institution>Ministry of Health</institution>
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<addr-line>Regional Laboratory</addr-line>
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<institution>Ministry of Health</institution>
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<institution>Ministry of Health</institution>
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<addr-line>Regional Laboratory</addr-line>
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<institution>Ministry of Health</institution>
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<country>Kingdom of Saudi Arabia</country>
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<name sortKey="Hussain, Raheela" sort="Hussain, Raheela" uniqKey="Hussain R" first="Raheela" last="Hussain">Raheela Hussain</name>
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<addr-line>Regional Laboratory</addr-line>
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<institution>Ministry of Health</institution>
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<addr-line>Regional Laboratory</addr-line>
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<institution>Ministry of Health</institution>
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<addr-line>Regional Laboratory</addr-line>
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<institution>Ministry of Health</institution>
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<addr-line>Madinah</addr-line>
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</affiliation>
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<nlm:aff id="af9">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Dammam</addr-line>
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<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
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<name sortKey="Kheyami, Ali M" sort="Kheyami, Ali M" uniqKey="Kheyami A" first="Ali M." last="Kheyami">Ali M. Kheyami</name>
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<nlm:aff id="af2">
<addr-line>Regional Laboratory</addr-line>
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<institution>Ministry of Health</institution>
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<addr-line>Regional Laboratory</addr-line>
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<institution>Ministry of Health</institution>
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<addr-line>Regional Laboratory</addr-line>
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<institution>Ministry of Health</institution>
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<addr-line>Madinah</addr-line>
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</affiliation>
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<nlm:aff id="af9">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
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<addr-line>Dammam</addr-line>
,
<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
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<name sortKey="Almutairi, Abdullah" sort="Almutairi, Abdullah" uniqKey="Almutairi A" first="Abdullah" last="Almutairi">Abdullah Almutairi</name>
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<nlm:aff id="af2">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
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<nlm:aff id="af6">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af8">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Madinah</addr-line>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af9">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Dammam</addr-line>
,
<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Azhar, Esam I" sort="Azhar, Esam I" uniqKey="Azhar E" first="Esam I." last="Azhar">Esam I. Azhar</name>
<affiliation>
<nlm:aff id="af7">
<addr-line>Special Infectious Diseases Agents Unit, King Fahad Medical Research Center</addr-line>
,
<institution>King Abdualziz University</institution>
,
<addr-line>Jeddah</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Drosten, Christian" sort="Drosten, Christian" uniqKey="Drosten C" first="Christian" last="Drosten">Christian Drosten</name>
<affiliation wicri:level="1">
<nlm:aff id="af11">
<institution>Institute of Virology, University of Bonn Medical Center</institution>
,
<country>Germany</country>
</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Watson, Simon J" sort="Watson, Simon J" uniqKey="Watson S" first="Simon J." last="Watson">Simon J. Watson</name>
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<nlm:aff id="af12">
<institution>Wellcome Trust Sanger Institute</institution>
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<addr-line>Hinxton</addr-line>
,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kellam, Paul" sort="Kellam, Paul" uniqKey="Kellam P" first="Paul" last="Kellam">Paul Kellam</name>
<affiliation>
<nlm:aff id="af12">
<institution>Wellcome Trust Sanger Institute</institution>
,
<addr-line>Hinxton</addr-line>
,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Cotten, Matthew" sort="Cotten, Matthew" uniqKey="Cotten M" first="Matthew" last="Cotten">Matthew Cotten</name>
<affiliation>
<nlm:aff id="af12">
<institution>Wellcome Trust Sanger Institute</institution>
,
<addr-line>Hinxton</addr-line>
,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name>
<affiliation>
<nlm:aff id="af1">
<institution>Global Centre for Mass Gatherings Medicine and Ministry of Health, Riyadh, Kingdom of Saudi Arabia and College of Medicine, Alfaisal University,</institution>
</nlm:aff>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="af13">
<addr-line>Division of Infection and Immunity</addr-line>
,
<institution>University College London (UCL), and UCL Hospitals National Health Service Foundation Trust</institution>
,
<country>United Kingdom</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
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<idno type="wicri:source">PMC</idno>
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<idno type="doi">10.1093/infdis/jiu292</idno>
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<title xml:lang="en" level="a" type="main">Respiratory Tract Samples, Viral Load, and Genome Fraction Yield in Patients With Middle East Respiratory Syndrome</title>
<author>
<name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. Memish</name>
<affiliation>
<nlm:aff id="af1">
<institution>Global Centre for Mass Gatherings Medicine and Ministry of Health, Riyadh, Kingdom of Saudi Arabia and College of Medicine, Alfaisal University,</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A." last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name>
<affiliation>
<nlm:aff id="af5">
<addr-line>Saudi Aramco Medical Services Organization</addr-line>
,
<country>Dhahran</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Dhahran</wicri:noCountry>
</affiliation>
<affiliation>
<nlm:aff id="af10">
<institution>Indiana University School of Medicine</institution>
,
<addr-line>Indianapolis</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Makhdoom, Hatem Q" sort="Makhdoom, Hatem Q" uniqKey="Makhdoom H" first="Hatem Q." last="Makhdoom">Hatem Q. Makhdoom</name>
<affiliation>
<nlm:aff id="af2">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af6">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af8">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Madinah</addr-line>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af9">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Dammam</addr-line>
,
<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Assiri, Abdullah" sort="Assiri, Abdullah" uniqKey="Assiri A" first="Abdullah" last="Assiri">Abdullah Assiri</name>
<affiliation>
<nlm:aff id="af1">
<institution>Global Centre for Mass Gatherings Medicine and Ministry of Health, Riyadh, Kingdom of Saudi Arabia and College of Medicine, Alfaisal University,</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name>
<affiliation>
<nlm:aff id="af1">
<institution>Global Centre for Mass Gatherings Medicine and Ministry of Health, Riyadh, Kingdom of Saudi Arabia and College of Medicine, Alfaisal University,</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Albarrak, Ali" sort="Albarrak, Ali" uniqKey="Albarrak A" first="Ali" last="Albarrak">Ali Albarrak</name>
<affiliation>
<nlm:aff id="af3">
<institution>Prince Sultan Military Medical City</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Alsubaie, Sarah" sort="Alsubaie, Sarah" uniqKey="Alsubaie S" first="Sarah" last="Alsubaie">Sarah Alsubaie</name>
<affiliation>
<nlm:aff id="af4">
<addr-line>Pediatric Infectious Diseases</addr-line>
,
<institution>King Saud University</institution>
,
<addr-line>Riyadh</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Al Rabeeah, Abdullah A" sort="Al Rabeeah, Abdullah A" uniqKey="Al Rabeeah A" first="Abdullah A." last="Al-Rabeeah">Abdullah A. Al-Rabeeah</name>
<affiliation>
<nlm:aff id="af1">
<institution>Global Centre for Mass Gatherings Medicine and Ministry of Health, Riyadh, Kingdom of Saudi Arabia and College of Medicine, Alfaisal University,</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Hajomar, Waleed H" sort="Hajomar, Waleed H" uniqKey="Hajomar W" first="Waleed H." last="Hajomar">Waleed H. Hajomar</name>
<affiliation>
<nlm:aff id="af2">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af6">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af8">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Madinah</addr-line>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af9">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Dammam</addr-line>
,
<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Hussain, Raheela" sort="Hussain, Raheela" uniqKey="Hussain R" first="Raheela" last="Hussain">Raheela Hussain</name>
<affiliation>
<nlm:aff id="af2">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af6">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af8">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Madinah</addr-line>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af9">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Dammam</addr-line>
,
<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Kheyami, Ali M" sort="Kheyami, Ali M" uniqKey="Kheyami A" first="Ali M." last="Kheyami">Ali M. Kheyami</name>
<affiliation>
<nlm:aff id="af2">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af6">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af8">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Madinah</addr-line>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af9">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Dammam</addr-line>
,
<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Almutairi, Abdullah" sort="Almutairi, Abdullah" uniqKey="Almutairi A" first="Abdullah" last="Almutairi">Abdullah Almutairi</name>
<affiliation>
<nlm:aff id="af2">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af6">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af8">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Madinah</addr-line>
</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="af9">
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Dammam</addr-line>
,
<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Azhar, Esam I" sort="Azhar, Esam I" uniqKey="Azhar E" first="Esam I." last="Azhar">Esam I. Azhar</name>
<affiliation>
<nlm:aff id="af7">
<addr-line>Special Infectious Diseases Agents Unit, King Fahad Medical Research Center</addr-line>
,
<institution>King Abdualziz University</institution>
,
<addr-line>Jeddah</addr-line>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Drosten, Christian" sort="Drosten, Christian" uniqKey="Drosten C" first="Christian" last="Drosten">Christian Drosten</name>
<affiliation wicri:level="1">
<nlm:aff id="af11">
<institution>Institute of Virology, University of Bonn Medical Center</institution>
,
<country>Germany</country>
</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Watson, Simon J" sort="Watson, Simon J" uniqKey="Watson S" first="Simon J." last="Watson">Simon J. Watson</name>
<affiliation>
<nlm:aff id="af12">
<institution>Wellcome Trust Sanger Institute</institution>
,
<addr-line>Hinxton</addr-line>
,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kellam, Paul" sort="Kellam, Paul" uniqKey="Kellam P" first="Paul" last="Kellam">Paul Kellam</name>
<affiliation>
<nlm:aff id="af12">
<institution>Wellcome Trust Sanger Institute</institution>
,
<addr-line>Hinxton</addr-line>
,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Cotten, Matthew" sort="Cotten, Matthew" uniqKey="Cotten M" first="Matthew" last="Cotten">Matthew Cotten</name>
<affiliation>
<nlm:aff id="af12">
<institution>Wellcome Trust Sanger Institute</institution>
,
<addr-line>Hinxton</addr-line>
,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name>
<affiliation>
<nlm:aff id="af1">
<institution>Global Centre for Mass Gatherings Medicine and Ministry of Health, Riyadh, Kingdom of Saudi Arabia and College of Medicine, Alfaisal University,</institution>
</nlm:aff>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="af13">
<addr-line>Division of Infection and Immunity</addr-line>
,
<institution>University College London (UCL), and UCL Hospitals National Health Service Foundation Trust</institution>
,
<country>United Kingdom</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series>
<title level="j">The Journal of Infectious Diseases</title>
<idno type="ISSN">0022-1899</idno>
<idno type="eISSN">1537-6613</idno>
<imprint>
<date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass></textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<title>Abstract</title>
<p>
<bold>
<italic>Background.</italic>
</bold>
 Analysis of clinical samples from patients with new viral infections is critical to confirm the diagnosis, to specify the viral load, and to sequence data necessary for characterizing the viral kinetics, transmission, and evolution. We analyzed samples from 112 patients infected with the recently discovered Middle East respiratory syndrome coronavirus (MERS-CoV).</p>
<p>
<bold>
<italic>Methods.</italic>
</bold>
 Respiratory tract samples from cases of MERS-CoV infection confirmed by polymerase chain reaction (PCR) were investigated to determine the MERS-CoV load and fraction of the MERS-CoV genome. These values were analyzed to determine associations with clinical sample type.</p>
<p>
<bold>
<italic>Results.</italic>
</bold>
 Samples from 112 individuals in which MERS-CoV was detected by PCR were analyzed, of which 13 were sputum samples, 64 were nasopharyngeal swab specimens, 30 were tracheal aspirates, and 3 were bronchoalveolar lavage specimens; 2 samples were of unknown origin. Tracheal aspirates yielded significantly higher MERS-CoV loads, compared with nasopharyngeal swab specimens (
<italic>P</italic>
= .005) and sputum specimens (
<italic>P</italic>
= .0001). Tracheal aspirates had viral loads similar to those in bronchoalveolar lavage samples (
<italic>P</italic>
= .3079). Bronchoalveolar lavage samples and tracheal aspirates had significantly higher genome fraction than nasopharyngeal swab specimens (
<italic>P</italic>
= .0095 and
<italic>P</italic>
= .0002, respectively) and sputum samples (
<italic>P</italic>
= .0009 and
<italic>P</italic>
= .0001, respectively). The genome yield from tracheal aspirates and bronchoalveolar lavage samples were similar (
<italic>P</italic>
= .1174).</p>
<p>
<bold>
<italic>Conclusions.</italic>
</bold>
 Lower respiratory tract samples yield significantly higher MERS-CoV loads and genome fractions than upper respiratory tract samples.</p>
</div>
</front>
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</TEI>
<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">J Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Infect. Dis</journal-id>
<journal-id journal-id-type="publisher-id">jid</journal-id>
<journal-id journal-id-type="hwp">jinfdis</journal-id>
<journal-title-group>
<journal-title>The Journal of Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="ppub">0022-1899</issn>
<issn pub-type="epub">1537-6613</issn>
<publisher>
<publisher-name>Oxford University Press</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">24837403</article-id>
<article-id pub-id-type="pmc">7107391</article-id>
<article-id pub-id-type="doi">10.1093/infdis/jiu292</article-id>
<article-id pub-id-type="publisher-id">jiu292</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Major Articles and Brief Reports</subject>
<subj-group subj-group-type="category-toc-heading">
<subject>Viruses</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Respiratory Tract Samples, Viral Load, and Genome Fraction Yield in Patients With Middle East Respiratory Syndrome</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Memish</surname>
<given-names>Ziad A.</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<pmc-comment>zmemish@yahoo.com</pmc-comment>
<xref ref-type="corresp" rid="d808894e450"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Al-Tawfiq</surname>
<given-names>Jaffar A.</given-names>
</name>
<xref ref-type="aff" rid="af5">5</xref>
<xref ref-type="aff" rid="af10">10</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Makhdoom</surname>
<given-names>Hatem Q.</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
<xref ref-type="aff" rid="af6">6</xref>
<xref ref-type="aff" rid="af8">8</xref>
<xref ref-type="aff" rid="af9">9</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Assiri</surname>
<given-names>Abdullah</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alhakeem</surname>
<given-names>Raafat F.</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Albarrak</surname>
<given-names>Ali</given-names>
</name>
<xref ref-type="aff" rid="af3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alsubaie</surname>
<given-names>Sarah</given-names>
</name>
<xref ref-type="aff" rid="af4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Al-Rabeeah</surname>
<given-names>Abdullah A.</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hajomar</surname>
<given-names>Waleed H.</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
<xref ref-type="aff" rid="af6">6</xref>
<xref ref-type="aff" rid="af8">8</xref>
<xref ref-type="aff" rid="af9">9</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hussain</surname>
<given-names>Raheela</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
<xref ref-type="aff" rid="af6">6</xref>
<xref ref-type="aff" rid="af8">8</xref>
<xref ref-type="aff" rid="af9">9</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kheyami</surname>
<given-names>Ali M.</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
<xref ref-type="aff" rid="af6">6</xref>
<xref ref-type="aff" rid="af8">8</xref>
<xref ref-type="aff" rid="af9">9</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Almutairi</surname>
<given-names>Abdullah</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
<xref ref-type="aff" rid="af6">6</xref>
<xref ref-type="aff" rid="af8">8</xref>
<xref ref-type="aff" rid="af9">9</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Azhar</surname>
<given-names>Esam I.</given-names>
</name>
<xref ref-type="aff" rid="af7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Drosten</surname>
<given-names>Christian</given-names>
</name>
<xref ref-type="aff" rid="af11">11</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Watson</surname>
<given-names>Simon J.</given-names>
</name>
<xref ref-type="aff" rid="af12">12</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kellam</surname>
<given-names>Paul</given-names>
</name>
<xref ref-type="aff" rid="af12">12</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cotten</surname>
<given-names>Matthew</given-names>
</name>
<xref ref-type="aff" rid="af12">12</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zumla</surname>
<given-names>Alimuddin</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af13">13</xref>
</contrib>
</contrib-group>
<aff id="af1">
<label>1</label>
<institution>Global Centre for Mass Gatherings Medicine and Ministry of Health, Riyadh, Kingdom of Saudi Arabia and College of Medicine, Alfaisal University,</institution>
</aff>
<aff id="af2">
<label>2</label>
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</aff>
<aff id="af3">
<label>3</label>
<institution>Prince Sultan Military Medical City</institution>
</aff>
<aff id="af4">
<label>4</label>
<addr-line>Pediatric Infectious Diseases</addr-line>
,
<institution>King Saud University</institution>
,
<addr-line>Riyadh</addr-line>
</aff>
<aff id="af5">
<label>5</label>
<addr-line>Saudi Aramco Medical Services Organization</addr-line>
,
<country>Dhahran</country>
</aff>
<aff id="af6">
<label>6</label>
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
</aff>
<aff id="af7">
<label>7</label>
<addr-line>Special Infectious Diseases Agents Unit, King Fahad Medical Research Center</addr-line>
,
<institution>King Abdualziz University</institution>
,
<addr-line>Jeddah</addr-line>
</aff>
<aff id="af8">
<label>8</label>
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Madinah</addr-line>
</aff>
<aff id="af9">
<label>9</label>
<addr-line>Regional Laboratory</addr-line>
,
<institution>Ministry of Health</institution>
,
<addr-line>Dammam</addr-line>
,
<country>Kingdom of Saudi Arabia</country>
</aff>
<aff id="af10">
<label>10</label>
<institution>Indiana University School of Medicine</institution>
,
<addr-line>Indianapolis</addr-line>
</aff>
<aff id="af11">
<label>11</label>
<institution>Institute of Virology, University of Bonn Medical Center</institution>
,
<country>Germany</country>
</aff>
<aff id="af12">
<label>12</label>
<institution>Wellcome Trust Sanger Institute</institution>
,
<addr-line>Hinxton</addr-line>
,</aff>
<aff id="af13">
<label>13</label>
<addr-line>Division of Infection and Immunity</addr-line>
,
<institution>University College London (UCL), and UCL Hospitals National Health Service Foundation Trust</institution>
,
<country>United Kingdom</country>
</aff>
<author-notes>
<corresp id="d808894e450">Correspondence: Ziad A. Memish, MD, FRCP(Can), FRCP(Edin), FRCP(Lond), FACP, WHO Collaborating Center for Mass Gathering Medicine, Ministry of Health, Riyadh 11176, Kingdom of Saudi Arabia (
<email>zmemish@yahoo.com</email>
).</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>15</day>
<month>11</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub">
<day>15</day>
<month>5</month>
<year>2014</year>
</pub-date>
<volume>210</volume>
<issue>10</issue>
<fpage>1590</fpage>
<lpage>1594</lpage>
<history>
<date date-type="received">
<day>28</day>
<month>3</month>
<year>2014</year>
</date>
<date date-type="accepted">
<day>6</day>
<month>5</month>
<year>2014</year>
</date>
</history>
<permissions>
<copyright-statement>© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail:
<email>journals.permissions@oup.com</email>
.</copyright-statement>
<copyright-year>2014</copyright-year>
<license>
<license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p>
</license>
</permissions>
<self-uri xlink:href="jiu292.pdf"></self-uri>
<abstract>
<title>Abstract</title>
<p>
<bold>
<italic>Background.</italic>
</bold>
 Analysis of clinical samples from patients with new viral infections is critical to confirm the diagnosis, to specify the viral load, and to sequence data necessary for characterizing the viral kinetics, transmission, and evolution. We analyzed samples from 112 patients infected with the recently discovered Middle East respiratory syndrome coronavirus (MERS-CoV).</p>
<p>
<bold>
<italic>Methods.</italic>
</bold>
 Respiratory tract samples from cases of MERS-CoV infection confirmed by polymerase chain reaction (PCR) were investigated to determine the MERS-CoV load and fraction of the MERS-CoV genome. These values were analyzed to determine associations with clinical sample type.</p>
<p>
<bold>
<italic>Results.</italic>
</bold>
 Samples from 112 individuals in which MERS-CoV was detected by PCR were analyzed, of which 13 were sputum samples, 64 were nasopharyngeal swab specimens, 30 were tracheal aspirates, and 3 were bronchoalveolar lavage specimens; 2 samples were of unknown origin. Tracheal aspirates yielded significantly higher MERS-CoV loads, compared with nasopharyngeal swab specimens (
<italic>P</italic>
= .005) and sputum specimens (
<italic>P</italic>
= .0001). Tracheal aspirates had viral loads similar to those in bronchoalveolar lavage samples (
<italic>P</italic>
= .3079). Bronchoalveolar lavage samples and tracheal aspirates had significantly higher genome fraction than nasopharyngeal swab specimens (
<italic>P</italic>
= .0095 and
<italic>P</italic>
= .0002, respectively) and sputum samples (
<italic>P</italic>
= .0009 and
<italic>P</italic>
= .0001, respectively). The genome yield from tracheal aspirates and bronchoalveolar lavage samples were similar (
<italic>P</italic>
= .1174).</p>
<p>
<bold>
<italic>Conclusions.</italic>
</bold>
 Lower respiratory tract samples yield significantly higher MERS-CoV loads and genome fractions than upper respiratory tract samples.</p>
</abstract>
<kwd-group>
<kwd>Middle East</kwd>
<kwd>MERS-CoV</kwd>
<kwd>RT-PCR</kwd>
<kwd>molecular</kwd>
<kwd>diagnosis</kwd>
<kwd>coronavirus</kwd>
<kwd>clinical</kwd>
<kwd>screening</kwd>
<kwd>viral load</kwd>
<kwd>Ct value</kwd>
<kwd>genome fraction</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations>
<list>
<country>
<li>Allemagne</li>
<li>Royaume-Uni</li>
</country>
</list>
<tree>
<noCountry>
<name sortKey="Al Rabeeah, Abdullah A" sort="Al Rabeeah, Abdullah A" uniqKey="Al Rabeeah A" first="Abdullah A." last="Al-Rabeeah">Abdullah A. Al-Rabeeah</name>
<name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A." last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name>
<name sortKey="Albarrak, Ali" sort="Albarrak, Ali" uniqKey="Albarrak A" first="Ali" last="Albarrak">Ali Albarrak</name>
<name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name>
<name sortKey="Almutairi, Abdullah" sort="Almutairi, Abdullah" uniqKey="Almutairi A" first="Abdullah" last="Almutairi">Abdullah Almutairi</name>
<name sortKey="Alsubaie, Sarah" sort="Alsubaie, Sarah" uniqKey="Alsubaie S" first="Sarah" last="Alsubaie">Sarah Alsubaie</name>
<name sortKey="Assiri, Abdullah" sort="Assiri, Abdullah" uniqKey="Assiri A" first="Abdullah" last="Assiri">Abdullah Assiri</name>
<name sortKey="Azhar, Esam I" sort="Azhar, Esam I" uniqKey="Azhar E" first="Esam I." last="Azhar">Esam I. Azhar</name>
<name sortKey="Cotten, Matthew" sort="Cotten, Matthew" uniqKey="Cotten M" first="Matthew" last="Cotten">Matthew Cotten</name>
<name sortKey="Hajomar, Waleed H" sort="Hajomar, Waleed H" uniqKey="Hajomar W" first="Waleed H." last="Hajomar">Waleed H. Hajomar</name>
<name sortKey="Hussain, Raheela" sort="Hussain, Raheela" uniqKey="Hussain R" first="Raheela" last="Hussain">Raheela Hussain</name>
<name sortKey="Kellam, Paul" sort="Kellam, Paul" uniqKey="Kellam P" first="Paul" last="Kellam">Paul Kellam</name>
<name sortKey="Kheyami, Ali M" sort="Kheyami, Ali M" uniqKey="Kheyami A" first="Ali M." last="Kheyami">Ali M. Kheyami</name>
<name sortKey="Makhdoom, Hatem Q" sort="Makhdoom, Hatem Q" uniqKey="Makhdoom H" first="Hatem Q." last="Makhdoom">Hatem Q. Makhdoom</name>
<name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. Memish</name>
<name sortKey="Watson, Simon J" sort="Watson, Simon J" uniqKey="Watson S" first="Simon J." last="Watson">Simon J. Watson</name>
</noCountry>
<country name="Allemagne">
<noRegion>
<name sortKey="Drosten, Christian" sort="Drosten, Christian" uniqKey="Drosten C" first="Christian" last="Drosten">Christian Drosten</name>
</noRegion>
</country>
<country name="Royaume-Uni">
<noRegion>
<name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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