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New MERS-CoV Cases In Italy Further Heighten Global Concern

Robert Glatter, MD, Emergency Medicine, 11:15AM Jun 3, 2013

The World Health Organization (WHO) has identified 3 additional laboratory- confirmed cases of MERS-CoV in Italy over the past 24 hours, according to a recent update by the WHO.

A 45 year old man who recently spent time in Jordan, and traveled back to Italy in late May developed fever and cough and progressive respiratory distress, according to the WHO. He was hospitalized on May 28th in Italy and is stable at this time, according to recent reports. Unfortunately, two close contacts--his 2 year old granddaughter and a 42 year old female co-worker--have also been infected. Both are in stable condition at this time based on early reports.

MERS-CoV belongs to the coronavirus family and is responsible for illnesses ranging from the common cold to Severe Acute Respiratory Syndrome (SARS). SARS, spreading from South China to Hong Kong, was responsible for over 775 deaths out of 8,273 cases worldwide between November, 2002 and July, 2003, according to the WHO. Within a few weeks, SARS spread from Hong Kong to infect individuals in 37 countries in early 2003.

While MERS-CoV is similar to SARS, it is not as easily as transmissible based upon clusters of patients evaluated to date. Thus far, out of 53 laboratory-confirmed cases of MERS-CoV since September of 2012, 30 have died.

Patients with Mers-CoV may develop either a mild  upper respiratory illness or a more severe course, marked by respiratory failure, with pneumonia progressing to acute respiratory distress syndrome (ARDS) and kidney failure.  Those with underlying diabetes, renal failure or coronary artery disease may be more at risk for severe illness, although there have already been a number of previously healthy patients affected as well.

Investigators have also noted that based on recently identified clusters, men seemed to predominate, with an unclear reason for the gender preference.  It appeared as though a large proportion of females were apparently exposed to infected males but did not seem to routinely develop symptoms. Based upon more recently identified cases, women who had close contact with infected males have tested positive for MERS-CoV, dispelling the idea that women were somehow less likely to be vectors or have the ability to develop infection.

Thus far, supportive care-intravenous fluids , oxygen and antibiotics [if suspected secondary infection]- are among the potential treatments once infected, as there is no vaccine or specific antiviral with known activity against MERS-CoV.

Although respiratory secretions or a droplet mechanism of spread are theorized, standard practice of so-called universal precautions for healthcare workers (gown gloves, and mask), as well as isolation or quarantine protocols for persons presenting to emergency departments or hospitals with fever and upper respiratory symptoms with recent travel to the Middle East are in place at this time.

According to Margaret Chan, Director-General of the WHO, we still do not have a defined mechanism for spread, which ultimately makes it difficult for scientists to prevent development of infections.

The virus is "a threat to the entire world," Chan said last week and emphasized that "is not a problem that any single affected country can keep to itself or manage all by itself.

Poll: Have you recently encountered any patients in your ED with fever and respiratory symptoms returning from the Middle East? Yes|No|
About This Blog

This medical blog focuses on relevant clinical issues and concerns for practicing emergency physicians. Our goal is to share interesting cases, clinical pearls of useful information, relevant journal articles, as well as touch on the psychosocial, legislative, and medico-legal aspects of emergency medicine. The blog encourages the exchange of information in an unbiased and open manner.

Robert Glatter, MD is the only active blogger

Poll: When do you recommend athletes return to play after suffering a concussion? a. 1 week|b. 2 weeks|c. 3 weeks|d. 4 weeks|e. defer decision to their PMD or referral|

  • Christopher Doty

    Christopher Doty is Assistant Professor of Emergency Medicine and the Emergency Medicine Residency Program Director at Kings County Hospital Center and SUNY Downstate Medical Center, Brooklyn, New York. Dr. Doty graduated from Jefferson Medical College in 1997 and completed his residency in emergency medicine at Kings County/SUNY Downstate. He joined the teaching faculty upon graduation and took a position as Assistant Program Director for the Categorical EM program in February 2002. Dr. Doty started the Combined EM/IM Residency in July 2002; since that time he has served as the program's Residency Co-Director. Dr. Doty transitioned formally to the Program Director position of the Categorical EM program in 2007. He is active in regional and national emergency medicine, serving in the leadership of the New York State AAEM and ACEP chapters and on several NY-ACEP committees. Dr. Doty also works extensively with national AAEM on several committees and is active in the Council of Residency Directors in emergency medicine. He has served as a reviewer for several emergency medicine journals and as an editor for several columns in Common Sense and the Emergency Medicine page on Medscape.

  • Joe Lex

    Dr. Joe Lex has been involved in emergency medicine for more than 42 years, initially as an Army medic with the 25th Infantry "Tropic Lightning" Division in Vietnam. He spent several years as an emergency medicine technician and certified emergency nurse before beginning medical school at age 35. After an emergency medicine residency, he was a community "pit doc" for 14 years before joining the staff at Temple University in Philadelphia. He was Chair of Education for the American Academy of Emergency Medicine for 5 years. The AAEM honored him by renaming the Educator of the Year award the Joe Lex Award. He has been an invited speaker at more than 250 conferences regionally, nationally, and internationally. He has been a featured speaker numerous times for Audio-Digest Emergency Medicine, Practical Reviews in Emergency Medicine, and Emergency Medicine Reviews and Perspectives (EM:RAP)

  • Mark Reiter

    Mark Reiter, MD, MBA, is Director of Medical Student Education at St. Luke's Hospital Emergency Medicine Residency in Bethlehem, Pennsylvania. Dr. Reiter graduated magna cum laude from Rutgers College where he also served as class president. He enrolled in an accelerated BA/MD program with UMDNJ-Robert Wood Johnson Medical School, where he was elected to the AOA Honor Society and served as President of the New Jersey Medical Student Association. During this time, he also earned an MBA from Rutgers Business School. Dr. Reiter completed his emergency medicine residency at the University of North Carolina-Chapel Hill. Dr. Reiter has been very active in organized medicine outside of emergency medicine, serving many roles within different organizations, such as on the Board of Directors for the American Academy of Emergency Medicine, the Council on Legislation for the American Medical Association, and the Board of Trustees for the Medical Society of New Jersey. Dr. Reiter is also the co-founder and CEO of Emergency Excellence (www.emergencyexcellence.com), a company dedicated to emergency department performance improvement.

  • Robert Glatter

    Robert Glatter, MD, FAAEM, is a member of the Editorial Board of Medscape Emergency Medicine and serves as Chair of the AAEM Society Page on Medscape Emergency Medicine. Dr. Glatter also serves as a clinical reviewer and author for AAEM's Ask the Expert series. He has also been a member of the Education and ACCME Committees of AAEM since 2004. Dr. Glatter is currently Attending Physician in the Department of Emergency Medicine at Lenox Hill Hospital in New York, NY, where he has been practicing emergency medicine since 2002. He completed his residency in emergency medicine at Kings County Hospital/SUNY Downstate after graduating from Emory University School of Medicine.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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