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The Lancet Infect Dis. Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection

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  • The Lancet Infect Dis. Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection

    [Source: The Lancet Infectious Diseases, full text: (LINK). Abstract, edited.]
    The Lancet Infectious Diseases, Early Online Publication, 17 June 2013


    Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection

    Original Text

    Prof Christian Drosten MD a, Michael Seilmaier MD b, Victor M Corman MD a, Wulf Hartmann MD b, Gregor Scheible MD b, Prof Stefan Sack MD b, Wolfgang Guggemos MD b, Rene Kallies PhD a, Doreen Muth PhD a, Sandra Junglen PhD a, Marcel A M?ller PhD a, Walter Haas MD c, Hana Guberina MD d, Tim R?hnisch MD f, Prof Monika Schmid-Wendtner MD f, Souhaib Aldabbagh DVM a, Prof Ulf Dittmer PhD e, Hermann Gold MD g, Petra Graf MD g, Frank Bonin MD h, Andrew Rambaut DPhil i j, Prof Clemens-Martin Wendtner MD b



    The Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging virus involved in cases and case clusters of severe acute respiratory infection in the Arabian Peninsula, Tunisia, Morocco, France, Italy, Germany, and the UK. We provide a full description of a fatal case of MERS-CoV infection and associated phylogenetic analyses.


    We report data for a patient who was admitted to the Klinikum Schwabing (Munich, Germany) for severe acute respiratory infection. We did diagnostic RT-PCR and indirect immunofluorescence. From time of diagnosis, respiratory, faecal, and urine samples were obtained for virus quantification. We constructed a maximum likelihood tree of the five available complete MERS-CoV genomes.


    A 73-year-old man from Abu Dhabi, United Arab Emirates, was transferred to Klinikum Schwabing on March 19, 2013, on day 11 of illness. He had been diagnosed with multiple myeloma in 2008, and had received several lines of treatment. The patient died on day 18, due to septic shock. MERS-CoV was detected in two samples of bronchoalveolar fluid. Viral loads were highest in samples from the lower respiratory tract (up to 1?2 ? 106 copies per mL). Maximum virus concentration in urine samples was 2691 RNA copies per mL on day 13; the virus was not present in the urine after renal failure on day 14. Stool samples obtained on days 12 and 16 contained the virus, with up to 1031 RNA copies per g (close to the lowest detection limit of the assay). One of two oronasal swabs obtained on day 16 were positive, but yielded little viral RNA (5370 copies per mL). No virus was detected in blood. The full virus genome was combined with four other available full genome sequences in a maximum likelihood phylogeny, correlating branch lengths with dates of isolation. The time of the common ancestor was halfway through 2011. Addition of novel genome data from an unlinked case treated 6 months previously in Essen, Germany, showed a clustering of viruses derived from Qatar and the United Arab Emirates.


    We have provided the first complete viral load profile in a case of MERS-CoV infection. MERS-CoV might have shedding patterns that are different from those of severe acute respiratory syndrome and so might need alternative diagnostic approaches.


    European Union; German Centre for Infection Research; German Research Council; and German Ministry for Education and Research.
    a Institute of Virology, University of Bonn Medical Centre, Bonn, Germany; b Klinikum Schwabing, Munich, Germany; c Department of Infection Epidemiology, Robert Koch Institute, Berlin, Germany; d Department of Internal Medicine, University of Duisburg-Essen, Essen, Germany; e Institute of Virology, University of Duisburg-Essen, Essen, Germany; f Interdisziplin?res Onkologisches Zentrum, Munich, Germany; g Department of Health and the Environment, Munich, Germany; h Department of Intensive Care, Ruhrlandklinik, Essen, Germany; i Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK; j Forgarty International Center, National Institutes of Health, Bethesda, MD, USA

    Correspondence to: Prof Christian Drosten, Institute of Virology, University of Bonn Medical Centre, 53105 Bonn, Germany

    Prof Clemens-Martin Wendtner, Department of Hematology, Klinikum Schwabing, Koelner Platz 1, 80804 Munich, Germany