van den Brand Judith M A, Smits Saskia L, Haagmans Bart L
Department of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands.
J Pathol. 2015 Jan;235(2):175-84. doi: 10.1002/path.4458.
Human coronaviruses (CoVs) mostly cause a common cold that is mild and self-limiting. Zoonotic transmission of CoVs such as the recently identified Middle East respiratory syndrome (MERS)-CoV and severe acute respiratory syndrome (SARS)-CoV, on the other hand, may be associated with severe lower respiratory tract infection. This article reviews the clinical and pathological data available on MERS and compares it to SARS. Most importantly, chest radiographs and imaging results of patients with MERS show features that resemble the findings of organizing pneumonia, different from the lesions in SARS patients, which show fibrocellular intra-alveolar organization with a bronchiolitis obliterans organizing pneumonia-like pattern. These findings are in line with differences in the induction of cytopathological changes, induction of host gene responses and sensitivity to the antiviral effect of interferons in vitro when comparing both MERS-CoV and SARS-CoV. The challenge will be to translate these findings into an integrated picture of MERS pathogenesis in humans and to develop intervention strategies that will eventually allow the effective control of this newly emerging infectious disease.
人类冠状病毒（CoVs）大多引起普通感冒，症状轻微且具有自限性。另一方面，冠状病毒的人畜共患传播，如最近发现的中东呼吸综合征（MERS）冠状病毒和严重急性呼吸综合征（SARS）冠状病毒，可能与严重的下呼吸道感染有关。本文综述了有关MERS的临床和病理数据，并将其与SARS进行比较。最重要的是，MERS患者的胸部X光片和影像学结果显示出类似于机化性肺炎的特征，这与SARS患者的病变不同，SARS患者的病变表现为纤维细胞性肺泡内组织，呈闭塞性细支气管炎机化性肺炎样模式。当比较MERS-CoV和SARS-CoV时，这些发现与细胞病理学变化的诱导、宿主基因反应诱导以及体外对干扰素抗病毒作用的敏感性差异一致。挑战将是把这些发现转化为人类MERS发病机制的综合图景，并制定最终能够有效控制这种新出现传染病的干预策略。
