Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study
Open accessAbstract
Background Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities.Methods We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR.Findings 47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]).Interpretation Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition.Funding None.
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There is evidence that co-infections do not occur in patients infected with MERS-CoV and occur rarely in patients infected with SARS-CoV-1.
“there is evidence that co-infections do not occur in patients infected with MERS-CoV8 and occur rarely in patients infected with SARS-CoV-1.9”
From Co-infections in people with COVID-19: a systematic review and meta-analysis. (2020) · cites this paper as [8]
Our findings are similar to studies reporting the bacteria implicated in secondary infections in patients with MERS-CoV and SARS-CoV.
“Our findings are similar to studies reporting the bacteria implicated in secondary infections in patients with MERS-CoV and SARS-CoV.8 , 46 , 47”
From Co-infections in people with COVID-19: a systematic review and meta-analysis. (2020) · cites this paper as [8]
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- Authors
- Assiri, A., Al-Tawfiq, J. A., Al-Rabeeah, A. A., Al-Rabiah, F. A., Al-Hajjar, S., Al-Barrak, A., Flemban, H., Al-Nassir, W. N., Balkhy, H. H., Al-Hakeem, R. F., Makhdoom, H. Q., Zumla, A. I., & Memish, Z. A.
- Affiliations
- Ministry of Health (SA)
- Riyadh Armed Forces Hospital (SA)
- King Faisal Specialist Hospital & Research Centre (SA)
- King Abdulaziz Medical City (SA)
- Jeddah Regional Laboratory (SA)
- Corresponding author
- Memish, Ziad A
- ORCID
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 13
- Issue
- 9
- Pages
- 752-761
- ISSN
- 1473-3099 (ISSN-L)
- PMC
- PMC7185445
- OpenAlex
- W2006434809
- Cited by
- 1,435
- References
- 34
- Citations by year
- 2026: 7 · 2025: 27 · 2024: 23 · 2023: 76 · 2022: 111 · 2021: 271 · 2020: 470 · 2019: 44 · 2018: 44 · 2017: 63 · 2016: 97 · 2015: 84 · 2014: 90 · 2013: 26
- FWCI
- 72.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet Infectious Diseases (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- European Commission
- School of Pharmacy, University College London
- European and Developing Countries Clinical Trials Partnership
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- MERS, MERS-CoV, case fatality rate, comorbidities, diabetes mellitus, chronic kidney disease, clinical features, gastrointestinal symptoms, thrombocytopenia, lymphopenia, lactate dehydrogenase, household transmission, community transmission, Saudi Arabia, research priorities, mortality risk factors, age and mortality
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Aspartate Aminotransferases, Child, Cross Infection, Diarrhea, Female, Fever, Humans, L-Lactate Dehydrogenase, Male, Middle Aged, Saudi Arabia, Thrombocytopenia, Odds Ratio, Community-Acquired Infections, Coronavirus, Coronavirus Infections, Young Adult
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