Recent Middle East Respiratory Syndrome Research Articles

A Comprehensive Review of COVID-19 Pathogenesis, Diagnosis, and Management

SARS-CoV-2 has been found to be the leading cause of the outbreak of coronavirus disease 2019 (COVID-19) globally. The disease is triggered by a new form of coronavirus and is characterized by acute respiratory distress syndrome (ARDS) or some primary chills. It was originated from a wet market in Wuhan, China and has engulfed 6.39 million lives globally uptillseptember-2022. Historically, the world has witnessed many noticeable epidemics in the form of, SARS-CoV (2002 to 2003), H1N1 influenza in 2009, and the most recent Middle East Respiratory Syndrome coronavirus (MERS-CoV), which erupted in Saudi Arabia in 2012. Different people get this disease with different symptoms including mild to severe illness. The molecular and cellular basis of SARS-CoV-2 pathogenesis gives us in-depth mechanisms involved. Experimental investigations have elaborated bats as the primary host for viral the transmission behind COVID-19. Moreover, the anatomy of the virus revealed its RNA based on the genome, which makes its therapeutic interventions more challenging. By the involvement of pre-analytic, analytic, and post-analytical strategies, patients with acute or chronic pneumonia can be distinguished as infected or not. Artificial intelligence has embarked significant importance in the course of viral detection based on computer algorithms. Furthermore, chemical or immune-based therapies were examined for finding a permanent solution to this epidemic issue. This review would cover every emerging aspect of pathogenesis, diagnosis, management, and the latest therapeutic interventions in the course of COVID-19 treatment. By giving rapidly evolving knowledge about this virus, readers are urged to update themselves regularly.

Serological Screening for Middle East Respiratory Syndrome Coronavirus and Hepatitis E Virus in Camels in Kazakhstan.

After the recent Middle East Respiratory Syndrome coronavirus (MERS-CoV) pandemic in 2013, more attention has been paid to the camel as an important source of zoonotic viral infections. Almost simultaneously, in 2013, new genotypes 7 and 8 of the hepatitis E virus (HEV) were discovered in dromedary and Bactrian camels, respectively. HEV 7 was further shown to be associated with chronic viral hepatitis in a transplant recipient. In this study, serological screening for antibodies to MERS-CoV and hepatitis E virus was carried out on large camel farms in the south and west of Kazakhstan. 6.42% of the tested camels were found to be positive for antibodies to the hepatitis E virus, which indicates its circulation in local camel population. For the first time, antibodies to the hepatitis E virus were found in Bactrians, which have been little studied to date. Antibodies to MERS-CoV were not found in the camel sera.

Convalescent Plasma Therapy for COVID-19: Current Status and Future Directions

AbstractThe ongoing pandemic of coronavirus disease 2019 (COVID-19) has triggered a global health crisis probably due to a lack of a reliable cure till date. Several clinical trials are ongoing, but initial results have not been overly promising. Convalescent plasma (CP), which refers to plasma collected from individuals recovered from an illness and developed antibodies against the pathogen, is also being proposed as a therapeutic option for COVID-19 treatment in severe cases to achieve short-term immunity against the virus. Use of CP is not new, and it has been used in various outbreaks over the past century, ranging from the Spanish influenza outbreak in 1918 to the recent Middle East respiratory syndrome (MERS). However, data available on its use in COVID-19 patients is limited. Use of CP so far is restricted to a “rescue therapy” and needs further trials to assess its possible use in other situations (prevention, postexposure prophylaxis) and patient populations (considering age and comorbid illnesses). In this review, we will try to summarize the current status of use of CP for COVID-19 and ongoing trials in India and elsewhere and will discuss the possible avenues for its use in future.

The Antiviral, Anti-Inflammatory Effects of Natural Medicinal Herbs and Mushrooms and SARS-CoV-2 Infection.

The 2019 novel coronavirus, SARS-CoV-2, producing the disease COVID-19 is a pathogenic virus that targets mostly the human respiratory system and also other organs. SARS-CoV-2 is a new strain that has not been previously identified in humans, however there have been previous outbreaks of different versions of the beta coronavirus including severe acute respiratory syndrome (SARS-CoV1) from 2002 to 2003 and the most recent Middle East respiratory syndrome (MERS-CoV) which was first identified in 2012. All of the above have been recognised as major pathogens that are a great threat to public health and global economies. Currently, no specific treatment for SARS-CoV-2 infection has been identified; however, certain drugs have shown apparent efficacy in viral inhibition of the disease. Natural substances such as herbs and mushrooms have previously demonstrated both great antiviral and anti-inflammatory activity. Thus, the possibilities of natural substances as effective treatments against COVID-19 may seem promising. One of the potential candidates against the SARS-CoV-2 virus may be Inonotus obliquus (IO), also known as chaga mushroom. IO commonly grows in Asia, Europe and North America and is widely used as a raw material in various medical conditions. In this review, we have evaluated the most effective herbs and mushrooms, in terms of the antiviral and anti-inflammatory effects which have been assessed in laboratory conditions.

Use of SARS-CoV-2-infected deceased organ donors: Should we always "just say no?"

In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS‐CoV‐2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS‐CoV‐2 through organ transplantation. The isolation of SARS‐CoV‐2 from nonlung clinical specimens, the detection of SARS‐CoV‐2 in autopsy specimens, previous experience with the related coronaviruses SARS‐CoV and MERS‐CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS‐CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS‐CoV‐2 infection.

Assessment of fever in the returning traveller.

Evaluation of people returning from trips abroad with fever is an important skill for all general physicians given the increasing trend in foreign travel. This evaluation should comprise a detailed travel history, thorough clinical examination, appropriate initial tests and a knowledge of when to ask for further advice. An understanding of the incubation periods of common imported infections and a syndromic approach to patients' symptoms is helpful in order to narrow down the likely diagnosis. The need to implement relevant infection control precautions has been highlighted by the recent Middle East respiratory syndrome coronavirus and Ebola virus disease outbreaks.

Implications for Poor Public Healthcare System of South Korea Revealed in MERS Outbreak

This article aims to prevent the possible recurrence of the Middle East Respiratory Syndrome (MERS) by understanding the status of South Korea's public healthcare system through a literature review. In addition, it presents measures to reinforce the public health system by analyzing the roles and limitations of the health authority, which plays a key role in preventing the spread of this infectious disease, through their response to the recent MERS outbreak in the country. Based on the analysis, the results showed the following implications: (1) Community health centers need to expand and reinforce their functions. It is important to publish response manuals at the national level and regularly educate and train medical service providers on infectious disease control, especially against diseases such as MERS. Accordingly, manpower and facilities must be developed. (2) Public hospitals located in regional hubs must expand to establish a public healthcare system. Public healthcare and emergency healthcare systems should be established by connecting community health centers, regional hub hospitals, and national university hospitals. The improvements in the facility must to be supported to help increase the efficiency of public health system. (3) Awareness among people must increase with respect to the prevention of infectious diseases and managing direct contact with infected patients. Most importantly, education and training on infectious disease prevention must be regularly provided to the public, and social support systems and programs must be organized for the infected people who are in self-isolation.

Potent and selective inhibition of pathogenic viruses by engineered ubiquitin variants.

The recent Middle East respiratory syndrome coronavirus (MERS-CoV), Ebola and Zika virus outbreaks exemplify the continued threat of (re-)emerging viruses to human health, and our inability to rapidly develop effective therapeutic countermeasures. Many viruses, including MERS-CoV and the Crimean-Congo hemorrhagic fever virus (CCHFV) encode deubiquitinating (DUB) enzymes that are critical for viral replication and pathogenicity. They bind and remove ubiquitin (Ub) and interferon stimulated gene 15 (ISG15) from cellular proteins to suppress host antiviral innate immune responses. A variety of viral DUBs (vDUBs), including the MERS-CoV papain-like protease, are responsible for cleaving the viral replicase polyproteins during replication, and are thereby critical components of the viral replication cycle. Together, this makes vDUBs highly attractive antiviral drug targets. However, structural similarity between the catalytic cores of vDUBs and human DUBs complicates the development of selective small molecule vDUB inhibitors. We have thus developed an alternative strategy to target the vDUB activity through a rational protein design approach. Here, we report the use of phage-displayed ubiquitin variant (UbV) libraries to rapidly identify potent and highly selective protein-based inhibitors targeting the DUB domains of MERS-CoV and CCHFV. UbVs bound the vDUBs with high affinity and specificity to inhibit deubiquitination, deISGylation and in the case of MERS-CoV also viral replicative polyprotein processing. Co-crystallization studies further revealed critical molecular interactions between UbVs and MERS-CoV or CCHFV vDUBs, accounting for the observed binding specificity and high affinity. Finally, expression of UbVs during MERS-CoV infection reduced infectious progeny titers by more than four orders of magnitude, demonstrating the remarkable potency of UbVs as antiviral agents. Our results thereby establish a strategy to produce protein-based inhibitors that could protect against a diverse range of viruses by providing UbVs via mRNA or protein delivery technologies or through transgenic techniques.

Sex-Based Differences in Susceptibility to Severe Acute Respiratory Syndrome Coronavirus Infection

Pathogenic human coronaviruses (CoVs), such as the severe acute respiratory syndrome (SARS)-CoV and the Middle East respiratory syndrome-CoV, cause acute respiratory illness. Epidemiological data from the 2002-2003 SARS epidemic and recent Middle East respiratory syndrome outbreak indicate that there may be sex-dependent differences in disease outcomes. To investigate these differences, we infected male and female mice of different age groups with SARS-CoV and analyzed their susceptibility to the infection. Our results showed that male mice were more susceptible to SARS-CoV infection compared with age-matched females. The degree of sex bias to SARS-CoV infection increased with advancing age, such that middle-aged mice showed much more pronounced differences compared with young mice. Enhanced susceptibility of male mice to SARS-CoV was associated with elevated virus titers, enhanced vascular leakage, and alveolar edema. These changes were accompanied by increased accumulation of inflammatory monocyte macrophages and neutrophils in the lungs of male mice, and depletion of inflammatory monocyte macrophages partially protected these mice from lethal SARS. Moreover, the sex-specific differences were independent of T and B cell responses. Furthermore, ovariectomy or treating female mice with an estrogen receptor antagonist increased mortality, indicating a protective effect for estrogen receptor signaling in mice infected with SARS-CoV. Together, these data suggest that sex differences in the susceptibility to SARS-CoV in mice parallel those observed in patients and also identify estrogen receptor signaling as critical for protection in females.

Communicating the Changing Role of a Nurse in an Epidemic: The Example of the MERS-CoV Outbreak in Saudi Arabia

Context: In the event of outbreaks of infectious diseases, the role of the nurse changes to adapt to the needs of the patient, their families, and the hospital. Articulating the changes in the nurses’ role is helpful for communicating a plan to decrease the spread of disease and for implementing improved policies, procedures, and supplies. Objective: This article outlines the reflections made by a team of nurses on how roles changed during the recent Middle East Respiratory Syndrome Corona Virus (MERS-CoV) epidemic. Design: A survey was used to ask nurses about their roles and how they changed asthey worked with MERS-CoV patients during the height of the epidemic in Saudi Arabia. Participants: The nurse researchers interviewed 9 critical care nurses about their past experiences with MERS-CoV patients. Main outcome: The nurses identified areas that need to be improved in preparation for future epidemics. Conclusion: The importance of communication during these complex outbreaks is considered. Much of the experience gleaned from this incident can be used to guide future practice in epidemics of MERS-CoV and other infectious diseases.

Healthcare reform after MERS outbreak: progress to date and next steps

To avoid a future catastrophic event like the recent Middle East respiratory syndrome (MERS) outbreak, we must reform our health system based on an objective and thorough review of the outbreak. A little over a year after the outbreak, this paper aims to evaluate the current status of the government's effort to reform our health system across the three following areas: 1) infectious disease emergency preparedness and response; 2) an organized healthcare system for infectious diseases; and 3) hospital preparedness for healthcare-associated infections. In spite of the substantial organizational changes of the Korea Centers for Disease Control (CDC) responsible for infectious disease emergency preparedness and response, the Korea CDC has not shown significant improvement in its competence and organizational commitment in the face of recent infectious disease threats such as Zika virus and cholera. So far, the Korean government has not announced an implementation plan for establishing an organized healthcare system for infectious diseases. To reduce healthcare associated infections, the Korean government implemented major changes in the hospital infection control system, emergency medical service system, and enhanced nursing system. Because the most extensive reform occurred around reducing healthcare-associated infections in hospitals, we need to evaluate the impact of the entire reform effort in a near future. Because the effort to reform our health system remains ongoing, we also need to continue to observe the progress of reform to ensure the avoidance of a future catastrophic event like the recent MERS outbreak.

Structural Factors of the Middle East Respiratory Syndrome Coronavirus Outbreak as a Public Health Crisis in Korea and Future Response Strategies.

The recent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak has originated from a failure in the national quarantine system in the Republic of Korea as most basic role of protecting the safety and lives of its citizens. Furthermore, a number of the Korean healthcare system’s weaknesses seem to have been completely exposed. The MERS-CoV outbreak can be considered a typical public health crisis in that the public was not only greatly terrorized by the actual fear of the disease, but also experienced a great impact to their daily lives, all in a short period of time. Preparedness for and an appropriate response to a public health crisis require comprehensive systematic public healthcare measures to address risks comprehensively with an all-hazards approach. Consequently, discussion regarding establishment of post-MERS-CoV improvement measures must focus on the total reform of the national quarantine system and strengthening of the public health infrastructure. In addition, the Korea Centers for Disease Control and Prevention must implement specific strategies of action including taking on the role of “control tower” in a public health emergency, training of Field Epidemic Intelligence Service officers, establishment of collaborative governance between central and local governments for infection prevention and control, strengthening the roles and capabilities of community-based public hospitals, and development of nationwide crisis communication methods.

Development of human neutralizing monoclonal antibodies for prevention and therapy of MERS-CoV infections

The recent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak poses a serious threat to public health. Here, we summarize recent advances in identifying human neutralizing monoclonal antibodies (mAbs) against MERS-CoV, describe their mechanisms of action, and analyze their potential for treatment of MERS-CoV infections.

Virological and serological analysis of a recent Middle East respiratory syndrome coronavirus infection case on a triple combination antiviral regimen

Serological, molecular and phylogenetic analyses of a recently imported case of Middle East respiratory syndrome coronavirus (MERS-CoV) in Greece are reported. Although MERS-CoV remained detectable in the respiratory tract secretions of the patient until the fourth week of illness, viraemia was last detected 2 days after initiation of triple combination therapy with pegylated interferon, ribavirin and lopinavir/ritonavir, administered from Day 13 of illness. Phylogenetic analysis of the virus showed close similarity with other human MERS-CoVs from the recent Jeddah outbreak in Saudi Arabia. Immunoglobulin G (IgG) titres peaked 3 weeks after the onset of illness, whilst IgM levels remained constantly elevated during the follow-up period (second to fifth week of illness). Serological testing confirmed by virus neutralisation assay detected an additional case that was a close contact of the patient.

Alpha and lineage C betaCoV infections in Italian bats.

AlphaCoV and lineage C betaCoV, genetically similar to those identified in Spanish related bat species, have been detected in Italian Myotis blithii and Eptesicus serotinus, respectively, out of 75 anal swabs collected from Vespertilionidae between 2009 and 2012. Sequence analysis of the 816-bp obtained RdRp sequence fragment indicates a 96.9 % amino acid identity of the Italian lineage C betaCoV with the recent Middle East Respiratory Syndrome Coronavirus (MERS-CoV, Genbank accession number KF192507). This is the first documented occurrence of a lineage C betaCoV in the Italian bat population, notably in E. serotinus.