Middle East Respiratory Syndrome Coronavirus Infection Dynamics and Antibody Responses among Clinically Diverse Patients, Saudi Arabia

Abstract

Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, particularly in relation to underlying medical conditions, clinical manifestations, and mortality. We enrolled MERS-CoV–positive patients at a hospital in Saudi Arabia and periodically collected specimens from multiple sites for real-time reverse transcription PCR and serologic testing. We conducted interviews and chart abstractions to collect clinical, epidemiologic, and laboratory information. We found that diabetes mellitus among survivors was associated with prolonged MERS-CoV RNA detection in the respiratory tract. Among case-patients who died, development of robust neutralizing serum antibody responses during the second and third week of illness was not sufficient for patient recovery or virus clearance. Fever and cough among mildly ill patients typically aligned with RNA detection in the upper respiratory tract; RNA levels peaked during the first week of illness. These findings should be considered in the development of infection control policies, vaccines, and antibody therapeutics.

Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection

“…A drug that inhibits virus replication may be of little use once virus replication has reached its peak, as was shown in vitro (9). However, in a considerable number of severe cases of MERS, viral RNA and infectious virus can still be detected in respiratory tract samples several weeks after the onset of symptoms (18,19), with this prolonged virus replication most likely due to the presence of underlying conditions such as diabetes mellitus (18). Likewise, an increase in virus replication over a longer period of time was observed in immunocompromised rhesus macaques (20).…”

Diabetes Mellitus, Hypertension, and Death among 32 Patients with MERS-CoV Infection, Saudi Arabia

“…We further explored this relationship among MERS patients admitted to a referral hospital in Riyadh, Saudi Arabia, during August 1, 2015-August 31, 2016. Enrollment criteria and data collection methods have been described (4).…”

“…We isolated a new IDV strain from diseased cattle in Japan; this strain is phylogenetically and antigenically distinguished from the previously described IDVs. (1)(2)(3)(4). In addition, both IDV RNAs and specific antibodies have been detected in many animal species (1,5,6).…”

Viral Kinetics and Antibody Responses in Patients with COVID-19

“…Our data provide important findings for this newly discovered virus infection in human. First, unlike SARS-CoV 14 and MERS-CoV infection15 , SARS-CoV-2 viral shedding in the nasopharyngeal swabs, sputum and stools appeared in the early phase (3-5 days from symptom onset), peaked in the first week, decreased in the second week, and persisted up to 38 days from illness onset. The viral load was highest in sputum, higher in nasopharyngeal and lower in stools.…”