Association of Higher MERS-CoV Virus Load with Severe Disease and Death, Saudi Arabia, 2014

Overview

Journal Emerg Infect Dis

Specialty Infectious Diseases

Date 2015 Oct 22

PMID 26488195

Citations 61

Authors

Daniel R Feikin

Basem Alraddadi

Mohammed Qutub

Omaima Shabouni

Aaron Curns

Ikwo K Oboho

Sara M Tomczyk

Bernard Wolff

John T Watson

Tariq A Madani

Affiliations

Soon will be listed here.

Abstract

Middle East respiratory syndrome coronavirus (MERS-CoV) causes a spectrum of illness. We evaluated whether cycle threshold (Ct) values (which are inversely related to virus load) were associated with clinical severity in patients from Saudi Arabia whose nasopharyngeal specimens tested positive for this virus by real-time reverse transcription PCR. Among 102 patients, median Ct of 31.0 for the upstream of the E gene target for 41 (40%) patients who died was significantly lower than the median of 33.0 for 61 survivors (p=0.0087). In multivariable regression analyses, risk factors for death were age>60 years), underlying illness, and decreasing Ct for each 1-point decrease in Ct). Results were similar for a composite severe outcome (death and/or intensive care unit admission). More data are needed to determine whether modulation of virus load by therapeutic agents affects clinical outcomes.

Citing Articles

Low-Level Zoonotic Transmission of Clade C MERS-CoV in Africa: Insights from Scoping Review and Cohort Studies in Hospital and Community Settings.

Karani A, Ombok C, Situma S, Breiman R, Mureithi M, Jaoko W Viruses. 2025; 17(1.

PMID: 39861917 PMC: 11768526. DOI: 10.3390/v17010125.

Evaluation and comparison of one-step real-time PCR and one-step RT-LAMP methods for detection of SARS-CoV-2.

Hanifehpour H, Ashrafi F, Siasi E, Fallahi S BMC Infect Dis. 2024; 24(1):679.

PMID: 38982392 PMC: 11232332. DOI: 10.1186/s12879-024-09574-9.

Impact of TRIM5α and TRIM22 Genes Expression on the Clinical Course of Coronavirus Disease 2019.

Tavakoli R, Rahimi P, Hamidi-Fard M, Eybpoosh S, Doroud D, Sadeghi S Arch Med Res. 2023; 54(2):105-112.

PMID: 36621405 PMC: 9794484. DOI: 10.1016/j.arcmed.2022.12.010.

COVID-19 environmental and operational impact for public transport in Kuwait.

AlKheder S Environ Sci Pollut Res Int. 2022; 30(6):16539-16564.

PMID: 36190634 PMC: 9528885. DOI: 10.1007/s11356-022-23264-6.

Biological Properties of SARS-CoV-2 Variants: Epidemiological Impact and Clinical Consequences.

Hoteit R, Yassine H Vaccines (Basel). 2022; 10(6).

PMID: 35746526 PMC: 9230982. DOI: 10.3390/vaccines10060919.

References

Lee N, Chan P, Hui D, Rainer T, Wong E, Choi K . Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis. 2009; 200(4):492-500. PMC: 7110250. DOI: 10.1086/600383. View

Jansen R, Schinkel J, Dek I, Koekkoek S, Visser C, de Jong M . Quantitation of respiratory viruses in relation to clinical course in children with acute respiratory tract infections. Pediatr Infect Dis J. 2009; 29(1):82-4. DOI: 10.1097/INF.0b013e3181b6de8a. View

Franz A, Adams O, Willems R, Bonzel L, Neuhausen N, Schweizer-Krantz S . Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection. J Clin Virol. 2010; 48(4):239-45. PMC: 7185496. DOI: 10.1016/j.jcv.2010.05.007. View

Utokaparch S, Marchant D, Gosselink J, McDonough J, Thomas E, Hogg J . The relationship between respiratory viral loads and diagnosis in children presenting to a pediatric hospital emergency department. Pediatr Infect Dis J. 2010; 30(2):e18-23. DOI: 10.1097/INF.0b013e3181ff2fac. View

Jansen R, Wieringa J, Koekkoek S, Visser C, Pajkrt D, Molenkamp R . Frequent detection of respiratory viruses without symptoms: toward defining clinically relevant cutoff values. J Clin Microbiol. 2011; 49(7):2631-6. PMC: 3147826. DOI: 10.1128/JCM.02094-10. View

Zaki A, van Boheemen S, Bestebroer T, Osterhaus A, Fouchier R . Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012; 367(19):1814-20. DOI: 10.1056/NEJMoa1211721. View

Corman V, Muller M, Costabel U, Timm J, Binger T, Meyer B . Assays for laboratory confirmation of novel human coronavirus (hCoV-EMC) infections. Euro Surveill. 2012; 17(49). DOI: 10.2807/ese.17.49.20334-en. View

Fuller J, Njenga M, Bigogo G, Aura B, Ope M, Nderitu L . Association of the CT values of real-time PCR of viral upper respiratory tract infection with clinical severity, Kenya. J Med Virol. 2013; 85(5):924-32. DOI: 10.1002/jmv.23455. View

Zhao B, Yu X, Wang C, Teng Z, Wang C, Shen J . High human bocavirus viral load is associated with disease severity in children under five years of age. PLoS One. 2013; 8(4):e62318. PMC: 3640090. DOI: 10.1371/journal.pone.0062318. View

10.

Memish Z, Zumla A, Al-Hakeem R, Al-Rabeeah A, Stephens G . Family cluster of Middle East respiratory syndrome coronavirus infections. N Engl J Med. 2013; 368(26):2487-94. DOI: 10.1056/NEJMoa1303729. View

11.

Assiri A, McGeer A, Perl T, Price C, Al Rabeeah A, Cummings D . Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013; 369(5):407-16. PMC: 4029105. DOI: 10.1056/NEJMoa1306742. View

12.

Drosten C, Seilmaier M, Corman V, Hartmann W, Scheible G, Sack S . Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection. Lancet Infect Dis. 2013; 13(9):745-51. PMC: 7164791. DOI: 10.1016/S1473-3099(13)70154-3. View

13.

Assiri A, Al-Tawfiq J, Al-Rabeeah A, Al-Rabiah F, Al-Hajjar S, Al-Barrak A . Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis. 2013; 13(9):752-61. PMC: 7185445. DOI: 10.1016/S1473-3099(13)70204-4. View

14.

. Updated information on the epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) infection and guidance for the public, clinicians, and public health authorities, 2012-2013. MMWR Morb Mortal Wkly Rep. 2013; 62(38):793-6. PMC: 4585538. View

15.

Arabi Y, Arifi A, Balkhy H, Najm H, Aldawood A, Ghabashi A . Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection. Ann Intern Med. 2014; 160(6):389-97. DOI: 10.7326/M13-2486. View

16.

Memish Z, Cotten M, Watson S, Kellam P, Zumla A, Alhakeem R . Community case clusters of Middle East respiratory syndrome coronavirus in Hafr Al-Batin, Kingdom of Saudi Arabia: a descriptive genomic study. Int J Infect Dis. 2014; 23:63-8. PMC: 4441753. DOI: 10.1016/j.ijid.2014.03.1372. View

17.

Azhar E, El-Kafrawy S, Farraj S, Hassan A, Al-Saeed M, Hashem A . Evidence for camel-to-human transmission of MERS coronavirus. N Engl J Med. 2014; 370(26):2499-505. DOI: 10.1056/NEJMoa1401505. View

18.

Memish Z, Al-Tawfiq J, Makhdoom H, Assiri A, Alhakeem R, AlBarrak A . Respiratory tract samples, viral load, and genome fraction yield in patients with Middle East respiratory syndrome. J Infect Dis. 2014; 210(10):1590-4. PMC: 7107391. DOI: 10.1093/infdis/jiu292. View

19.

Welliver T, Garofalo R, Hosakote Y, Hintz K, Avendano L, Sanchez K . Severe human lower respiratory tract illness caused by respiratory syncytial virus and influenza virus is characterized by the absence of pulmonary cytotoxic lymphocyte responses. J Infect Dis. 2007; 195(8):1126-36. PMC: 7109876. DOI: 10.1086/512615. View

20.

Peiris J, Guan Y, Yuen K . Severe acute respiratory syndrome. Nat Med. 2004; 10(12 Suppl):S88-97. PMC: 7096017. DOI: 10.1038/nm1143. View