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Please use this identifier to cite or link to this item: http://hdl.handle.net/123456789/6724

Title: Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection
Authors: Drosten, Christian
Seilmaie, Michael
Corman, Victor M
Hartmann, Wulf
Scheible, Gregor
Sack, Stefan
Guggemos, Wolfgang
Kallies, Rene
Muth, Doreen
Junglen, Sandra
Müller, Marcel A
Haas, Walter
Guberina, Hana
Röhnisch, Tim
Schmid-Wendtner, Monika
Aldabbagh, Souhaib
Dittmer, Ulf
Gold, Hermann
Graf, Petra
Bonin, Frank
Rambaut, Andrew
Wendtner, Clemens-Martin
Issue Date: 2013
Publisher: The Lancet Infectious Diseases
Citation: The Lancet Infectious Diseases,Volume 13, Issue 9, September 2013, Pages 745–751
Abstract: Background The Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging virus involved in cases and case clusters of severe acute respiratory infection in the Arabian Peninsula, Tunisia, Morocco, France, Italy, Germany, and the UK. We provide a full description of a fatal case of MERS-CoV infection and associated phylogenetic analyses. Methods We report data for a patient who was admitted to the Klinikum Schwabing (Munich, Germany) for severe acute respiratory infection. We did diagnostic RT-PCR and indirect immunofluorescence. From time of diagnosis, respiratory, faecal, and urine samples were obtained for virus quantification. We constructed a maximum likelihood tree of the five available complete MERS-CoV genomes. Findings A 73-year-old man from Abu Dhabi, United Arab Emirates, was transferred to Klinikum Schwabing on March 19, 2013, on day 11 of illness. He had been diagnosed with multiple myeloma in 2008, and had received several lines of treatment. The patient died on day 18, due to septic shock. MERS-CoV was detected in two samples of bronchoalveolar fluid. Viral loads were highest in samples from the lower respiratory tract (up to 1•2 × 106 copies per mL). Maximum virus concentration in urine samples was 2691 RNA copies per mL on day 13; the virus was not present in the urine after renal failure on day 14. Stool samples obtained on days 12 and 16 contained the virus, with up to 1031 RNA copies per g (close to the lowest detection limit of the assay). One of two oronasal swabs obtained on day 16 were positive, but yielded little viral RNA (5370 copies per mL). No virus was detected in blood. The full virus genome was combined with four other available full genome sequences in a maximum likelihood phylogeny, correlating branch lengths with dates of isolation. The time of the common ancestor was halfway through 2011. Addition of novel genome data from an unlinked case treated 6 months previously in Essen, Germany, showed a clustering of viruses derived from Qatar and the United Arab Emirates. Interpretation We have provided the first complete viral load profile in a case of MERS-CoV infection. MERS-CoV might ......
Description: Article published in Lancet Infectious Diseases,Volume 13, Issue 9, September 2013, Pages 745–751. Also available at doi:10.1016/S1473-3099(13)70154-3
URI: http://hdl.handle.net/123456789/6724
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