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Symptom overlap makes MERS tests crucial for diffe

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    Posted: August 10 2017 at 9:05am

Symptom overlap makes MERS tests crucial for differential diagnosis

Patients critically ill with MERS-CoV infections have symptoms and risk factors similar to those of people severely ill with other types of respiratory infections, a research team from Saudi Arabia recently reported in an early online edition of Critical Care Medicine. The study is the largest to date to compare critically sick Middle East respiratory syndrome coronavirus (MERS-CoV) patients with a large cohort of patients similarly ill from a variety of different causes.

For their analysis, the authors looked at patients admitted to intensive care units (ICUs) at 14 hospitals in Saudi Arabia. They compared clinical information from 330 patients who had lab-confirmed MERS-CoV infections between Sep 2012 and Oct 2015 with data from 222 people who were critically ill with other types of community-acquired respiratory infections.

Though patients who were sick with MERS-CoV tended to be younger, their clinical pictures and underlying health conditions overlapped substantially with people had other types of severe respiratory infections. Those with MERS-CoV had severe hypoxemic respiratory failure and experienced nonrespiratory organ failure more often, which prompted more frequent mechanical ventilation, extracorporeal membrane oxygenation (ECMO), vasopressor support, and renal replacement therapy.

The researchers also found that initial negative results on reverse transcription polymerase chain reaction (RT-PCR) testing does not rule out MERS-CoV; the initial test was positive in only 76.2% of patients who were ultimately diagnosed with the infection, and specimens from the upper respiratory tract were more likely to initially test negative.

After adjusting for confounding factors, the clinicians found that MERS-CoV illness was independently associated with death—a five- to six-fold increase—compared with other types of severe respiratory infections.

Though they found key differences in clinical findings and outcomes between the two groups of patients, given the overlap in findings, a high index of suspicion and timely diagnostic testing are essential for investigating severe respiratory infections in at-risk patients, the team concluded. "This overlap has important implications for practice, as a MERS diagnosis based on clinical, radiologic, and standard laboratory data alone is not possible," they wrote.
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