WHO, Saudi Arabia update MERS case information

The World Health Organization (WHO) recently recognized the Middle East respiratory syndrome coronavirus (MERS-CoV) case reported recently in the United Arab Emirates (UAE), while the latest sketchy reports from Saudi Arabia describe five recent cases there, including three in healthcare workers.

In a Dec 22 statement, the WHO confirmed a MERS case in a 68-year-old UAE man, previously reported by the media. The man had a cough when he was hospitalized Dec 14 for joint replacement surgery, and he was moved to an intensive care unit (ICU) Dec 16 because of rapid deterioration, the agency said. His MERS-CoV infection was confirmed Dec 19.

The patient, who has underlying medical conditions, has no recent history of travel or of contact with animals or other MERS patients, the WHO reported. Investigation of his family and healthcare contacts was continuing.

The UAE case raised the WHO's MERS-CoV count to 166 cases and 71 deaths.

A recent English-language statement from the Saudi Ministry of Health (MOH) reported four MERS cases, including one death, and appeared to match up with an earlier machine-translated statement that surfaced Dec 20. An Agence France-Presse (AFP) story published today cites five Saudi cases, at least three of which appear to be those cited in the English-language MOH statement.

The latter statement, officially dated Dec 20, reports cases in:

  • A 73-year-old Saudi man who succumbed to the illness
  • A 53-year-old Saudi man who has chronic illnesses and was in an ICU
  • Two "female residents"—foreign nationals—who work in healthcare and had contact with a MERS patient; the statement gives no ages or other details

Today's AFP story cited a statement on the Saudi MOH Web site as the source of its information on the five cases, all of which were reported in Riyadh. They involve:

  • A 73-year-old Saudi man who died of the illness
  • A 57-year-old Saudi who has chronic illnesses and is being treated in an ICU
  • A 27-year-old Saudi health worker
  • Two foreign health workers: a 43-year-old woman and a 35-year-old man

The story, and the MOH coronavirus page, say Saudi Arabia's MERS-CoV count has reached 141 cases with 57 deaths.

Meanwhile, a machine translation of the latest Saudi MOH statement, posted yesterday by Crawford Killian on his H5N1 blog, matches the information in the AFP story, but it adds that none of the three infected health workers had any symptoms.

MERS-CoV in kidney cells

In other developments, German researchers reported in Virology Journal that MERS-CoV seems to have a special affinity for human kidney cells, which may explain why acute renal failure has been reported in some MERS-CoV cases. Christian Drosten, MD, of the Insitute of Virology, University of Bonn, was the study's senior author.

In the study, published Dec 23, the researchers compared the effects of MERS-CoV and the SARS-CoV (severe acute respiratory syndrome coronavirus) on cultures of primary human bronchial epithelial and primary human kidney cells. They found that pathogenic infection occurred only with MERS-CoV in the kidney cells and that kidney cells produced almost 1,000-fold more MERS-CoV copies than bronchial cells did.

The authors recommended that epidemiologic studies analyze kidney impairment in MERS-CoV. "Virus replication in the kidney with potential shedding in urine might constitute a way of transmission, and could explain untraceable transmission chains leading to new cases," they wrote. "Individual patients might benefit from early induction of renoprotective treatment."

See also:

Dec 22 WHO statement on UAE case

Dec 20 Saudi MOH statement on four cases

Dec 26 AFP story

H5N1 blog with Dec 25 machine translation of Saudi MOH statement

Saudi MOH coronavirus page with case count

Dec 23 Virology Journal abstract

 

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