MERS: What You Need to Know

In 2012, a new strain of coronavirus was identified and brought into the spotlight: Middle East Respiratory Syndrome (MERS). MERS originated in the Middle East, primarily in Saudi Arabia, causing severe respiratory illness and recording a high mortality rate. Since then, MERS has affected thousands of people globally, necessitating a better understanding of this infectious disease. This article is dedicated to educating patients about MERS, shedding light on its risk factors, symptoms, diagnostic tests, medications, procedures used for treatment, and home care practices.

Introduction to MERS

MERS, short for Middle East Respiratory Syndrome, is a viral respiratory illness caused by the MERS-CoV (Middle East Respiratory Syndrome Coronavirus). MERS-CoV is a type of coronavirus, a family of viruses that can cause illnesses ranging from the common cold to more severe diseases. The first case of MERS was reported in Saudi Arabia in 2012. Since then, the virus has spread to various parts of the world, though the majority of cases remain in the Middle East.

The progression of MERS can vary widely among individuals, with some showing mild symptoms or none at all, while others experience severe respiratory distress. As per the World Health Organization, approximately 35% of reported patients with MERS have died, mostly due to underlying medical conditions.

Risk Factors for MERS

Lifestyle Risk Factors

Several lifestyle factors can increase your susceptibility to MERS. Traveling to or residing in the Arabian Peninsula, particularly in countries such as Saudi Arabia, increases the risk due to the prevalence of MERS-CoV in this region. Moreover, direct or indirect contact with camels, known carriers of the virus, can put you at risk. Additionally, consuming raw camel products, like milk or meat, or not following proper hygiene practices, can elevate the chances of MERS infection.

Medical Risk Factors

Individuals with pre-existing chronic medical conditions are at a higher risk of developing severe symptoms if they contract MERS-CoV. These conditions include heart disease, diabetes, kidney disease, respiratory disease, and a weakened immune system due to illnesses like HIV/AIDS. Hospital-associated infections are also a risk factor, as MERS can spread in healthcare settings from infected patients to other individuals.

Genetic and Age-Related Risk Factors

Though research is still ongoing, certain genetic factors might influence the susceptibility to MERS. Additionally, older age, particularly those above 60 years, poses a significant risk factor due to weakened immune responses and the likelihood of existing comorbidities. Both these factors can lead to a more severe progression of the disease, increasing the potential for complications or even mortality.

Clinical Manifestations of MERS

Fever

Fever is a common symptom of MERS, occurring in about 98% of cases. It is often one of the earliest indications of the disease, typically appearing within the first week of infection. Fever in MERS patients is a response to the body fighting off the viral infection, as the immune system triggers an increase in body temperature to aid in killing off the virus.

Cough

Around 83% of MERS patients report a cough. This respiratory symptom generally appears in the early stages of the illness, resulting from the virus attacking the cells in the respiratory tract, leading to inflammation and irritation that triggers a cough reflex. A persistent dry cough is common, though some patients may produce sputum.

Shortness of Breath

Shortness of breath, also known as dyspnea, is a severe symptom experienced by about 72% of MERS patients. It typically arises as the disease progresses and the virus causes significant damage to lung tissues. This impairment can lead to a decrease in oxygen levels in the blood, causing feelings of breathlessness.

Diarrhea

Approximately 26% of MERS patients experience gastrointestinal symptoms, such as diarrhea. Though MERS is primarily a respiratory disease, the virus can infect cells in the gastrointestinal tract, leading to symptoms like diarrhea. This symptom can arise at various stages of the illness.

Nausea/Vomiting

Nausea and vomiting are reported in about 21% of MERS cases. These symptoms can result from the virus’s impact on the gastrointestinal system, often coupled with diarrhea. It can occur at any time during the disease progression, depending on the individual’s response to the virus.

Diagnostic Evaluation of MERS

Diagnosing MERS involves several steps to confirm the presence of the MERS-CoV virus. The diagnosis process is typically initiated based on the patient’s symptoms, travel history, and possible exposure to the virus. However, definitive diagnosis requires specific laboratory tests to detect the virus.

RT-PCR (Reverse Transcription Polymerase Chain Reaction)

The RT-PCR test is a molecular diagnostic tool that detects the genetic material of the MERS-CoV virus in respiratory specimens, such as from the nose or throat. The test involves extracting the viral RNA, converting it into DNA (the reverse transcription part), and then amplifying it (the polymerase chain reaction part) to enable detection. The importance of this test lies in its ability to confirm a MERS diagnosis by directly identifying the virus.

A positive RT-PCR result, indicating the presence of MERS-CoV, confirms a MERS diagnosis. However, a negative result doesn’t necessarily rule out MERS, especially if the test is done early in the infection or if the sample was not collected properly. If MERS is still suspected despite a negative result, retesting with new specimens or using additional tests is often recommended.

Chest X-ray

A chest X-ray is a non-invasive imaging test that can reveal abnormalities in the lungs, such as pneumonia, often seen in MERS patients. The X-ray, which uses a small amount of radiation to produce images of the chest, can show if the patient has fluid or inflammation in the lungs, indicative of severe MERS infection.

Typically, a chest X-ray of a MERS patient would show signs of pneumonia or acute respiratory distress syndrome. However, not all patients with MERS will have abnormal X-ray results, particularly in the early stages of the disease. A normal chest X-ray does not rule out MERS if other symptoms and risk factors are present.

Blood Test

Blood tests in MERS patients are used to assess the overall health of the patient and to look for signs of infection. The blood sample is analyzed for white blood cell count, liver and kidney function, and other factors that might indicate how the body is responding to the infection.

Abnormal blood test results, such as a high white blood cell count, could indicate an infection, including MERS. However, these results are nonspecific and cannot confirm MERS on their own. Further specific tests like RT-PCR are needed for confirmation.

Sputum Test

A sputum test involves analysis of the mucus that’s coughed up from the lungs to look for signs of infection. The test can detect the presence of the MERS-CoV virus and thus plays a crucial role in diagnosing MERS.

Positive results from a sputum test can confirm a MERS diagnosis, but a negative result does not definitively rule out the disease, especially if other symptoms persist. If MERS is still suspected, retesting or other diagnostic tests may be required.

If all tests come back negative but symptoms persist, it’s important not to dismiss the symptoms. Communicate openly with your healthcare provider, as you may need to be re-tested or undergo additional tests to rule out other potential causes. Remember, your health and wellbeing are the priority, and it’s crucial to get a proper diagnosis to receive appropriate care.

Health Conditions with Similar Symptoms to MERS

Influenza

Influenza, commonly known as the flu, is a viral infection that affects the respiratory system. This condition is characterized by symptoms such as fever, cough, body aches, and fatigue, which can be similar to the initial symptoms of MERS.

However, influenza generally doesn’t cause shortness of breath unless it progresses to pneumonia, a distinguishing symptom seen in MERS. Also, influenza typically presents with sudden onset of symptoms and rapid improvement over a week. On the other hand, tests for influenza involve a simple nasal or throat swab, and positive results would suggest influenza rather than MERS.

SARS (Severe Acute Respiratory Syndrome)

SARS is another type of coronavirus disease that affects the respiratory system. Similar to MERS, SARS often begins with a high fever and can progress to cough and shortness of breath.

The differences lie in the specifics of these symptoms and their progression. For example, SARS often presents with chills and body aches, which are less common in MERS. Additionally, specific laboratory tests, like RT-PCR, can differentiate between the viruses causing MERS and SARS, helping doctors make an accurate diagnosis.

COVID-19

COVID-19, caused by the SARS-CoV-2 virus, shares many symptoms with MERS, including fever, cough, and shortness of breath. However, unique symptoms like loss of taste or smell often occur in COVID-19 but not in MERS.

Diagnostic testing for COVID-19 usually involves a nasal or throat swab test, similar to MERS, but the test looks for the specific SARS-CoV-2 virus. A positive result would suggest COVID-19 rather than MERS.

Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs, causing symptoms like cough with phlegm or pus, fever, and difficulty breathing, which are also seen in MERS.

However, pneumonia often involves chest pain and is typically accompanied by rapid breathing and increased heart rate, which aren’t as common in MERS. Chest imaging and blood tests can help distinguish between pneumonia and MERS.

Tuberculosis

Tuberculosis (TB) is a bacterial infection that primarily affects the lungs, causing symptoms like cough, fever, night sweats, and weight loss, which could be confused with MERS.

But TB tends to progress more slowly than MERS, with symptoms worsening over weeks to months rather than days. A skin or blood test for TB, showing a positive result, would suggest TB rather than MERS.

Treatment Options for MERS

Medications

Currently, there are no specific antiviral medications approved for the treatment of MERS. However, symptomatic and supportive care is provided to manage symptoms and improve the patient’s condition. This approach involves relieving symptoms, preventing complications, and supporting vital organ functions.

This kind of care is essential in all stages of MERS, particularly in severe cases. While it may not directly fight the MERS coronavirus, it can significantly improve patient outcomes by managing the symptoms and complications that arise.

Procedures

Mechanical Ventilation: This is a treatment where a machine called a ventilator supports or takes over the function of breathing for a patient who is unable to breathe adequately on their own. This is often used for MERS patients with severe respiratory distress or failure.

Dialysis: This is a treatment that performs the function of the kidneys when they are failing. Dialysis may be needed in severe MERS cases that result in kidney failure.

Improving MERS and Seeking Medical Help

In addition to medical treatments, there are steps individuals can take at home to help manage symptoms and prevent the spread of MERS:

• Isolation: Isolating at home prevents the spread of the virus to others.
• Hydration: Keeping the body hydrated helps support the immune system and aids in recovery.
• Rest: Proper rest allows the body to focus on fighting the virus.
• Balanced Diet: Eating a balanced diet provides essential nutrients to strengthen the immune system.
• Use of a Humidifier: A humidifier can help soothe a cough and a sore throat, common symptoms of MERS.
• Regular Handwashing: Frequent handwashing with soap can prevent the spread of the virus.
• Wearing a Mask: Wearing a mask, particularly if sick or caring for someone with MERS, helps prevent transmission of the virus.

Prevention and Management of MERS: When to Seek Medical Help and the Convenience of Telemedicine

Prevention is paramount in managing MERS, as there is currently no vaccine available. It’s crucial to seek medical help if symptoms persist or worsen, or if there’s been exposure to someone with MERS. Given our increasingly digital world, telemedicine is an effective way to consult healthcare professionals while minimizing potential exposure.

Living with MERS: Tips for Better Quality of Life

Living with MERS can be challenging, but with adequate medical care and self-management, individuals can maintain a good quality of life. It’s important to follow medical advice, manage symptoms at home, and make necessary lifestyle changes.

Conclusion

Middle East Respiratory Syndrome (MERS) is a serious and sometimes fatal respiratory illness. Early diagnosis and treatment, as well as symptomatic and supportive care, can significantly improve outcomes. If you’re feeling unwell or if you’ve been exposed to MERS, don’t hesitate to reach out to our primary care practice via telemedicine. You’ll receive the care you need in a safe, convenient, and compassionate manner.

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.