Understanding Middle East Respiratory Syndrome (MERS)

The Middle East Respiratory Syndrome (MERS) is a viral respiratory illness that first surfaced in 2012 in Saudi Arabia. The disease is relatively new, but it has already caused significant concern due to its high mortality rate and lack of a definitive cure. This article is designed to equip you with essential information about MERS, helping you understand its risk factors, symptoms, diagnostic tests, medications, procedures, and self-care strategies at home.

What is Middle East Respiratory Syndrome (MERS)?

MERS is a respiratory illness caused by a coronavirus known as MERS-CoV. While coronaviruses are common and usually cause mild-to-moderate upper-respiratory tract illnesses, MERS-CoV can lead to severe respiratory symptoms and has a relatively high fatality rate. The progression of MERS is typically rapid, with patients often requiring hospitalization and intensive care.

As per the World Health Organization, since 2012, MERS has affected over 2,500 people, causing approximately 850 fatalities across 27 countries. The majority of these cases have been in the Middle East, predominantly Saudi Arabia. However, isolated cases and clusters have also occurred in countries outside this region.

Risk Factors for Middle East Respiratory Syndrome (MERS)

Lifestyle Risk Factors

Exposure to camels, which are known carriers of MERS-CoV, significantly increases the risk of contracting MERS. This includes consuming raw camel products, such as milk and meat. Close contact with infected people, especially without the use of protective equipment, can also lead to transmission.

Medical Risk Factors

Individuals with chronic illnesses such as diabetes, kidney disease, or respiratory conditions are at higher risk of developing severe symptoms if they contract MERS-CoV. Furthermore, immunocompromised individuals, such as those undergoing cancer treatment, are more susceptible to the virus.

Genetic and Age-Related Risk Factors

While anyone can contract MERS, people above 50 years of age have a higher risk of severe disease and complications. In addition, certain genetic factors may make some individuals more susceptible to MERS, but research in this area is ongoing.

In the next part of this series, we will delve deeper into the symptoms of MERS, the tests used for diagnosing it, and the medications and procedures that form part of its treatment strategy.

Clinical Manifestations of MERS

In understanding any disease, a key aspect is recognizing its clinical manifestations. Here, we explore the common symptoms associated with MERS and explain how these symptoms occur in patients affected by the virus.

Fever

Occurring in approximately 98% of MERS patients, fever is one of the most common symptoms. This rise in body temperature is a typical response of the immune system fighting off an infection. MERS-CoV triggers this reaction as the body attempts to inhibit viral replication.

Cough

As a respiratory virus, MERS-CoV often leads to a persistent dry cough in about 83% of cases. This is caused by the inflammation and damage in the respiratory tract due to the viral invasion, triggering a cough reflex as a protective mechanism to clear the airways.

Shortness of Breath

Approximately 72% of patients experience shortness of breath or dyspnea. As MERS-CoV primarily affects the lungs, it can lead to difficulties in breathing due to the infection and inflammation of the air sacs, which hinders oxygen exchange.

Diarrhea

MERS-CoV can also affect the gastrointestinal system, causing symptoms like diarrhea in about 26% of cases. This is a result of the virus infecting cells in the digestive tract, disrupting its normal functioning.

Nausea and Vomiting

Nausea and vomiting are seen in approximately 21% of MERS patients. The exact mechanism isn’t completely understood, but it is believed that these symptoms could be due to the body’s systemic response to the infection or the direct impact of the virus on the stomach and intestines.

Diagnostic Evaluation for MERS

Diagnosing MERS involves a series of tests aimed at detecting the presence of the virus in the body. Let’s take a closer look at these tests and how they contribute to a definitive diagnosis of MERS.

Real-Time Reverse Transcription Polymerase Chain Reaction (rRT-PCR)

This is the primary test used for diagnosing MERS. The rRT-PCR test detects the viral RNA in respiratory samples, which could be from a throat swab or sputum sample. A positive rRT-PCR result signifies an active MERS-CoV infection, which requires immediate isolation and treatment. If the result is negative but symptoms persist, the test might be repeated, or additional tests may be done.

Serology

Serology tests detect antibodies produced by the body in response to a MERS-CoV infection. These tests help determine whether a person has been previously infected with the virus. They are usually used for epidemiological studies or for diagnosing cases where initial rRT-PCR testing was negative, but clinical suspicion remains high.

Chest X-ray

A chest X-ray is commonly used in patients showing symptoms of respiratory infection. In the case of MERS, it can reveal signs of pneumonia such as patchy infiltrates or consolidation. However, while these findings support the diagnosis, they are not exclusive to MERS and further testing is needed to confirm the disease.

Complete Blood Count (CBC)

This is a basic blood test that measures different components of the blood. In MERS patients, the CBC might show certain abnormalities

such as lymphopenia (low lymphocyte count), which is commonly observed in severe cases. However, these changes are not specific to MERS and should be interpreted in conjunction with other test results.

Remember, testing negative on all these tests does not necessarily mean you are free from disease, especially if symptoms persist. If you continue experiencing symptoms, it is important to consult your healthcare provider to explore other possible causes of your illness and devise a suitable management plan.

In the next part of this series, we will cover medications and procedures used in treating MERS, along with self-care strategies you can implement at home.

Given the wide range of symptoms associated with Middle East Respiratory Syndrome (MERS), it can often be confused with other health conditions. In this section, we will explore these conditions and explain how they can be differentiated from MERS.

Influenza (Flu)

Influenza, commonly known as the flu, is a highly contagious viral infection affecting the respiratory system. Symptoms can range from mild to severe and may include fever, cough, and body aches.

Flu shares many symptoms with MERS such as fever, cough, and fatigue. However, flu symptoms typically appear suddenly and may also include sore throat and muscle aches, which are less common in MERS. Flu can be confirmed through rapid flu tests, which detect influenza viruses in respiratory samples, whereas MERS is confirmed via rRT-PCR testing for MERS-CoV.

Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs, causing them to fill with fluid or pus. This condition can cause difficulty breathing, chest pain, fever, and cough.

Both pneumonia and MERS can lead to severe respiratory symptoms and chest X-rays for both conditions may show signs of pneumonia. However, symptoms such as nausea and diarrhea, seen in some MERS cases, are less common in pneumonia. Further, the causative organism, identified through sputum or blood cultures, helps distinguish pneumonia from MERS.

Severe Acute Respiratory Syndrome (SARS)

SARS is a viral respiratory illness caused by a coronavirus, SARS-CoV. It is characterized by symptoms such as fever, chills, and body aches, often progressing to pneumonia.

Given that SARS and MERS are caused by similar viruses, their symptoms overlap significantly. However, SARS tends to be more associated with chills and body aches compared to MERS. Similar to MERS, SARS diagnosis involves detecting the virus through rRT-PCR or serology tests.

COVID-19

COVID-19 is a disease caused by the SARS-CoV-2 virus. It primarily spreads between people during close contact, often through small droplets from coughing or sneezing.

COVID-19 and MERS share common symptoms like fever, cough, and shortness of breath. However, loss of taste or smell is a distinguishing symptom for COVID-19, not typically seen in MERS. Confirmatory testing for each disease involves detection of their respective viruses.

Tuberculosis

Tuberculosis (TB) is a potentially serious infectious disease that mainly affects the lungs. The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes.

Both TB and MERS can cause long-lasting cough, fever, and weight loss. However, night sweats and blood in sputum are more suggestive of TB. TB is diagnosed through skin tests, blood tests, or sputum smears and cultures, which are distinct from the rRT-PCR test used for MERS.

Understanding these conditions and how they differ from MERS helps healthcare professionals make a correct diagnosis. If you are experiencing persistent symptoms, please consult a healthcare provider for a thorough evaluation.

Treatment Options

The management of MERS involves various treatment strategies. They can range from symptom management to experimental treatments.

Medications

• Antipyretics: These are drugs used to reduce fever, a common symptom in MERS. They are typically first-line treatments to provide symptom relief.

Antipyretics work by resetting the body’s thermostat to a lower temperature, effectively reducing fever. The expected outcome is relief from discomfort and fever within a few hours of administration.

• Antiviral medications: Currently, there are no specific antivirals for MERS. However, some are under experimental use in clinical trials, aimed at inhibiting the MERS coronavirus.

These medications are typically used in more severe cases. The intended outcome is to slow down viral replication, potentially reducing disease severity and duration.

• Antibiotics: These are used to treat secondary bacterial infections that can occur in patients with MERS, not the MERS virus itself.

Antibiotics are prescribed based on the suspected or confirmed type of bacteria. They can improve symptoms and outcomes over a course of treatment, typically a few days to weeks.

Procedures

• Oxygen therapy: This involves providing supplemental oxygen to patients with breathing difficulties or low oxygen levels in the blood, common in severe MERS cases.

Oxygen therapy can be a first-line treatment in hospital settings for severe respiratory distress. It can significantly improve symptoms and may be necessary until the patient’s condition stabilizes.

• Mechanical ventilation: This is a life-support treatment where a machine helps a person breathe when they can’t do so on their own, used in severe MERS cases.

Mechanical ventilation is usually reserved for critical cases where other treatments are not effective. This can significantly improve survival rates in these patients.

• Kidney dialysis: This is a procedure to remove waste and excess water from the blood when the kidneys stop working properly, used in MERS patients with kidney failure.

Kidney dialysis is typically used for patients with acute kidney injury or failure, a possible complication of severe MERS. This treatment can help maintain the patient’s health status until their kidneys recover.

• Extracorporeal membrane oxygenation (ECMO): ECMO is a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream, providing heart-lung bypass support.

ECMO is typically used as a last resort when other treatments fail to improve a patient’s condition. It can improve oxygen levels and survival chances in critically ill patients.

Improving MERS and Seeking Medical Help

In addition to professional medical care, certain practices at home can help manage symptoms and prevent the spread of MERS.

• Regular hand hygiene: Regular and proper handwashing can help prevent the spread of the virus.
• Wearing masks and practicing respiratory hygiene: This can help prevent the spread of respiratory droplets that may contain the virus.
• Isolation (quarantine): Staying isolated can help avoid spreading the virus to others.
• Rest and hydration: Adequate rest and staying hydrated can support recovery.
• Balanced nutrition: A balanced diet can support the immune system in fighting off the infection.

If your symptoms worsen or don’t improve, seeking immediate medical help is essential. The convenience of telemedicine means you can consult healthcare providers without leaving your home, reducing the risk of spreading the virus.

Living with Middle East Respiratory Syndrome (MERS)

Living with MERS can be challenging, but with appropriate medical care and self-management, you can achieve a better quality of life. This includes following your treatment plan, practicing good hygiene, and caring for your overall health.

Conclusion

Middle East Respiratory Syndrome (MERS) is a significant respiratory illness with potential severe complications. Understanding this disease, its symptoms, and similar conditions, along with potential treatment options, is essential in managing this disease effectively. Remember, early diagnosis and treatment can significantly impact the disease outcome, and with the convenience of telemedicine, timely medical consultation is at your fingertips. Always seek professional medical advice if you suspect you have MERS or if your condition worsens.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.