Consultant Infectious Diseases Physician, Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Int J Infect Dis. 2013 Sep;17(9):e668-72. doi: 10.1016/j.ijid.2013.07.001. Epub 2013 Aug 2.
Ninety confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported to the World Health Organization. We report the details of a second family cluster of MERS-CoV infections from Riyadh, Saudi Arabia.
We present the clinical, laboratory and epidemiological details of 3 patients from a family cluster of MERS-CoV infections.
The first patient developed respiratory symptoms and fever 14 days after admission to hospital for an unrelated reason. He died 11 days later with multi-organ failure. Two of his brothers presented later to another hospital with respiratory symptoms and fever. MERS-CoV infection in the latter 2 patients was confirmed by reverse transcriptase polymerase chain reaction testing. All 3 patients had fever, cough, shortness of breath, bilateral infiltrates on chest x-ray, thrombocytopenia, lymphopenia and rises in serum creatinine kinase and alanine transaminase. No hospital or other social contacts are known to have acquired the infection. It appears that the index patient in this cluster acquired MERS-CoV infection whilst in hospital from an unrecognized mild or asymptomatic case.
MERS-CoV acquisition from unrecognized mild or asymptomatic cases may be a more important contributor to ongoing transmission than previously appreciated.
世界卫生组织报告了 90 例中东呼吸综合征冠状病毒（MERS-CoV）确诊病例。我们报告了沙特阿拉伯利雅得第二例家庭聚集性中东呼吸综合征冠状病毒感染的详细情况。
我们介绍了 3 例家庭聚集性中东呼吸综合征冠状病毒感染患者的临床、实验室和流行病学细节。
第一例患者因其他原因住院 14 天后出现呼吸道症状和发热，11 天后死于多器官衰竭。他的 2 个兄弟随后因呼吸道症状和发热到另一家医院就诊。通过逆转录聚合酶链反应检测证实后 2 例患者感染了中东呼吸综合征冠状病毒。所有 3 例患者均有发热、咳嗽、呼吸急促、胸部 X 线双侧浸润、血小板减少、淋巴细胞减少以及血清肌酸激酶和丙氨酸转氨酶升高。未发现该患者或其他医院或社会接触者获得感染。本聚集性病例中的指数患者似乎是在医院感染了中东呼吸综合征冠状病毒，而感染源是未被识别的轻症或无症状病例。
从中未被识别的轻症或无症状病例中获得中东呼吸综合征冠状病毒可能比以前认为的更为重要，是导致持续传播的原因之一。
