Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
Lancet Infect Dis. 2013 Sep;13(9):752-61. doi: 10.1016/S1473-3099(13)70204-4. Epub 2013 Jul 26.
Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities.
We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR.
47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]).
Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition.
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中东呼吸综合征（MERS）是一种由新型冠状病毒（CoV）引起的新发人类疾病。关于 MERS-CoV 感染的临床数据很少。我们报告了 47 例 MERS-CoV 感染的流行病学、人口统计学、临床和实验室特征，确定了知识空白，并确定了研究重点。
我们从 2012 年 9 月 1 日至 2013 年 6 月 15 日期间沙特阿拉伯报告的散发性、家庭、社区和医疗机构相关的 MERS-CoV 感染确诊病例中提取和分析了流行病学、人口统计学、临床和实验室数据。病例通过实时 RT-PCR 确认为 MERS-CoV 感染。
共发现 47 例实验室确诊的 MERS-CoV 疾病患者（46 例成人，1 例儿童）；36 例（77%）为男性（男：女比例 3.3:1）。28 例患者死亡，病死率为 60%。病死率随年龄增长而升高。47 例病例中仅有 2 例为既往健康者；大多数患者（45 [96%]）存在潜在的合并症，包括糖尿病（32 [68%]）、高血压（16 [34%]）、慢性心脏疾病（13 [28%]）和慢性肾脏疾病（23 [49%]）。就诊时常见的症状有发热（46 [98%]）、发热伴寒战或肌痛（41 [87%]）、咳嗽（39 [83%]）、呼吸急促（34 [72%]）和肌痛（15 [32%]）。胃肠道症状也很常见，包括腹泻（12 [26%]）、呕吐（10 [21%]）和腹痛（8 [17%]）。所有患者的胸部 X 线检查均有异常，范围从单侧和双侧细微到广泛的异常。实验室分析显示乳酸脱氢酶升高（23 [49%]）、天冬氨酸转氨酶升高（7 [15%]）、血小板减少（17 [36%]）和淋巴细胞减少（16 [34%]）。
由 MERS-CoV 引起的疾病临床表现广泛，住院患者合并症死亡率高。我们对感染和疾病的流行病学、社区流行率和临床谱的知识存在重大差距，需要紧急确定。
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