Middle East Respiratory Syndrome (MERS) Infection in Hematological and Oncological Patients: A Case Series from a Tertiary Care Center in Saudi Arabia

Abstract

We present the largest to date of a case series of nine patients with hematological and oncological malignancies who were infected with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV is a novel beta-coronavirus with a high fatality rate in comorbid patients. The majority of MERS cases globally were reported from Saudi Arabia (1983 cases, including 745 related deaths with a case-fatality rate of 37.5%) according to the WHO update of February 2019. All were clinically stable before acquiring the virus. Most of the cases had an active disease as relapse or refractory with three cases being neutropenic. The clinical presentation and radiological features of the patients were variable and inconsistent (Table 1). Diagnosis was confirmed with RT-PCR assays targeting upstream of the E gene and the open-reading frame gene 1a which had to be done repeatedly and required an average of 3 (with max. of 7) samples for a test to be positive (Table 2). All the patients developed respiratory failure, were admitted to the critical care unit (ICU) and required mechanical ventilation. The length of hospital stay ranged from 15 - 48, with an average of 24 days. Unfortunately, all nine patients died within days after admission to the ICU. In addition, the time from diagnosis to death has an average of 9 days ranging from 2-24 days, respectively. In conclusion, MERS CoV infection in hematology/oncology patients has a very poor prognosis regardless of the status of the underlying disease. The clinical presentation is not distinctive and confirming the diagnosis requires numerous respiratory samples. Measures to prevent nosocomial outbreaks should include proper compliance with personal protection equipment by health-care workers when managing patients with suspected and confirmed MERS-CoV infection and prompt isolation of infected patients. Future research is required to enhance our understanding of the disease and to evaluate superior diagnostic and therapeutic options. Disclosures No relevant conflicts of interest to declare.

Managing patients with hematological malignancies during COVID-19 pandemic

“…Despite a lower-case fatality rate, the total number of deaths due to COVID-19 has outweighed that due to MERS and SARS due to the greater number of cases. Referring to oncology, cancer patients had a dismal outcome during the previous viral outbreaks [11][12][13]. As a group, cancer patients are vulnerable and have compromised overall health, and on anticancer drugs that also suppress the immune system.…”

“…As a group, cancer patients are vulnerable and have compromised overall health, and on anticancer drugs that also suppress the immune system. For instance, Alaskar et al reported a 100% mortality upon acquiring MERS in their case series of nine patients with cancer [11].…”

Coronavirus Spectrum Infections (COVID-19, MERS, SARS) in Cancer Patients: A Systematic Review of the Literature

“…Four of the six studies of MERS examined patients with cancer in Saudi Arabia (21)(22)(23)(24), and one case report from Germany described a case of a patient from the United Arab Emirates (25). Only one study examined the 2015 Korean MERS outbreak (26).…”

Quasispecies pattern in coronavirus along with new concern of recurrence, relapse and re-infection of SARS-CoV-2

“…Also, the two refractory cases had evidence of co infection with enterococcus and gram negative bacteremia. 18…”