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Middle East respiratory syndrome coronavirus infection differential diagnosis

Introduction

Overview

Overview

MERS-CoV must be differentiated from other respiratory tract infections that cause flu-like symptoms, such as influenza virus, respiratory syncytial virus (RSV), and other coronaravirus infections.

Differential Diagnosis

Differential Diagnosis

The differential diagnosis of MERS-CoV include the following:[1][2]

Life threatening infection with 2019-nCoV, MERS-CoV and SARS-CoV should be differentiated from each other. The following table differentiates infection from these coronaviruses:[3][4][5][6]_Home_|_CDC-7|[7][8][9][10][11][12][13][14]

Type of Coronavirus Origins Family (Lineage) Receptor Incubation Period Genome size Clinical Features Transmission Epidemiology Cytokine Profile Imaging Findings Serological Testing
Fever Dry cough Dyspnea Rhinorrhea Sneezing Sore throat Diarrhea
2019-nCoV
  • Huanan seafood market, Wuhan, Hubei China (December 2019)
  • Betacoronaviridea, subgenus: Sarbecovirus (Lineage B)
  • ACE1/2
  • 1-14 days
  • 29.8 kB (> 80% nucleotide identity with SARS-CoV)
 ++ ++ ++ + + + –
  • Human to human transmission through close contact
  • 14380 confirmed cases
  • 17 deaths
  • Males > females
  • Mortality rate 2.7%
  • IL1B, IFNγ, IP10, and MCP1
  • GCSF, IP10, MCP1, MIP1A, and TNFα (ICU-admitted)
  • IL4 and IL10
  • On CT scan:
    • Bilateral ground-glass opacities
    • Peripheral localization and subpleural sparing
MERS-CoV
  • Saudi Arabia (September 2012)
  • Betacoronaviridea (Lineage C)
  • DPP4 (CD26)
  • 2-14 days
  • 29.9 kB
 ++ ++ ++ ++ ++ ++ +
  • Limited human to human trasnmission
  • Reservoirs:
    • Bats
    • Civets
    • Camels
  • 2494 confirmed cases
  • 858 deaths
  • Mortality rate of 34%
  • IFNγ, TNFα, IL15, and IL17
  • On CT scan:
    • Bilateral, subpleural and basilar infiltrates
    • Ground glass opacities
    • Organizing pneumonia-like pattern (subpleural and peribroncho-vascular)
SARS-CoV
  • Guangdong, Southern China (November 2002)
  • Betacoronaviridea (Lineage B)
  • ACE2
  • 2-7 days
  • 29.3 kB
 ++ ++ ++ ++ ++ ++ +
  • Human to human transmission through close contact
  • Reservoirs:
    • Bats
    • Civets
    • Camels
  • 8098 cases
  • 774 deaths
  • Mortality rate of about 10%
  • IL1B, IL6, IL12, IFNγ, IP10, and MCP1
  • On CT scan:
    • Airspace consolidation
    • Focal or multi-focal opacities
References

References

  1. ↑ Paulino, Renato de Souza; Benega, Margarete Aparecida; Santos, Katia Correa de Oliveira; Silva, Daniela Bernardes Borges da; Pereira, Juliana Cristina; Sasaki, Norio Augusto; Silva, Patricia Evelin; Curti, Suely Pires; Oliveira, Maria Isabel; R.M.P. Carvalhanas, Telma; Peret, Teresa; Erdman, Dean; Paiva, Terezinha Maria de (2013). “DIFFERENTIAL DIAGNOSIS OF RESPIRATORY VIRUSES BY USING REAL TIME RT-PCR METHODOLOGY”. Revista do Instituto de Medicina Tropical de São Paulo. 55 (6): 432–432. doi:10.1590/S0036-46652013000600012. ISSN 0036-4665.
  2. ↑ “Eurosurveillance: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) July 2013” (PDF).
  3. ↑ Chan, Jasper Fuk-Woo; Kok, Kin-Hang; Zhu, Zheng; Chu, Hin; To, Kelvin Kai-Wang; Yuan, Shuofeng; Yuen, Kwok-Yung (2020). “Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan”. Emerging Microbes & Infections. 9 (1): 221–236. doi:10.1080/22221751.2020.1719902. ISSN 2222-1751.
  4. ↑ Lu, Roujian; Zhao, Xiang; Li, Juan; Niu, Peihua; Yang, Bo; Wu, Honglong; Wang, Wenling; Song, Hao; Huang, Baoying; Zhu, Na; Bi, Yuhai; Ma, Xuejun; Zhan, Faxian; Wang, Liang; Hu, Tao; Zhou, Hong; Hu, Zhenhong; Zhou, Weimin; Zhao, Li; Chen, Jing; Meng, Yao; Wang, Ji; Lin, Yang; Yuan, Jianying; Xie, Zhihao; Ma, Jinmin; Liu, William J; Wang, Dayan; Xu, Wenbo; Holmes, Edward C; Gao, George F; Wu, Guizhen; Chen, Weijun; Shi, Weifeng; Tan, Wenjie (2020). “Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding”. The Lancet. doi:10.1016/S0140-6736(20)30251-8. ISSN 0140-6736.
  5. ↑ Ajlan, Amr M.; Ahyad, Rayan A.; Jamjoom, Lamia Ghazi; Alharthy, Ahmed; Madani, Tariq A. (2014). “Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings”. American Journal of Roentgenology. 203 (4): 782–787. doi:10.2214/AJR.14.13021. ISSN 0361-803X.
  6. ↑ Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. The Lancet. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.
  7. _Home_|_CDC_7-0|↑ “Coronavirus | Home | CDC”.
  8. ↑ Nassar MS, Bakhrebah MA, Meo SA, Alsuabeyl MS, Zaher WA (August 2018). “Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics”. Eur Rev Med Pharmacol Sci. 22 (15): 4956–4961. doi:10.26355/eurrev_201808_15635. PMID 30070331.
  9. ↑ Xia S, Liu Q, Wang Q, Sun Z, Su S, Du L, Ying T, Lu L, Jiang S (December 2014). “Middle East respiratory syndrome coronavirus (MERS-CoV) entry inhibitors targeting spike protein”. Virus Res. 194: 200–10. doi:10.1016/j.virusres.2014.10.007. PMID 25451066.
  10. ↑ Hajjar SA, Memish ZA, McIntosh K (2013). “Middle East Respiratory Syndrome Coronavirus (MERS-CoV): a perpetual challenge”. Ann Saudi Med. 33 (5): 427–36. doi:10.5144/0256-4947.2013.427. PMC 6074883. PMID 24188935.
  11. ↑ Memish ZA, Assiri AM, Al-Tawfiq JA (December 2014). “Middle East respiratory syndrome coronavirus (MERS-CoV) viral shedding in the respiratory tract: an observational analysis with infection control implications”. Int. J. Infect. Dis. 29: 307–8. doi:10.1016/j.ijid.2014.10.002. PMID 25448335.
  12. ↑ Satija N, Lal SK (April 2007). “The molecular biology of SARS coronavirus”. Ann. N. Y. Acad. Sci. 1102: 26–38. doi:10.1196/annals.1408.002. PMID 17470909.
  13. ↑ Bolles M, Donaldson E, Baric R (December 2011). “SARS-CoV and emergent coronaviruses: viral determinants of interspecies transmission”. Curr Opin Virol. 1 (6): 624–34. doi:10.1016/j.coviro.2011.10.012. PMC 3237677. PMID 22180768.
  14. ↑ Fehr AR, Perlman S (2015). “Coronaviruses: an overview of their replication and pathogenesis”. Methods Mol. Biol. 1282: 1–23. doi:10.1007/978-1-4939-2438-7_1. PMC 4369385. PMID 25720466.

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