Middle East respiratory syndrome coronavirus infection diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
MERS-CoV infection is suspected when patients with a recent travel to the Arabian peninsula, exposure to infected patients, or exposure to healthcare settings develop fever, pneumonia, or ARDS. Once suspected, patients should undergo lab testing to confirm or rule out MERS-CoV infection.
Diagnostic Criteria for MERS-CoV Infection
MERS-CoV infection is suspected when patients with a recent travel to endemic regions, exposure to infected patients, or exposure to healthcare settings develop fever, pneumonia, or ARDS. Once suspected, patients should undergo lab testing to confirm or rule out MERS-CoV infection.
Suspected Case
Patients with the following findings (either A or B) are suspected to have MERS-CoV :[1]
A. Fever and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence)
- AND EITHER
- History of travel from countries in or near endemic regions within 14 days before symptom onset
- History of travel from countries in or near endemic regions within 14 days before symptom onset
- OR
- Close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near endemic regions
- Close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near endemic regions
- OR
- Member of a cluster of patients with severe acute respiratory illness (e.g.fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments
- Member of a cluster of patients with severe acute respiratory illness (e.g.fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments
OR
B. Fever
- AND
- Symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath)
- Symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath)
- AND
- Being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country or territory in or near endemic regions in which recent healthcare-associated cases of MERS have been identified
Probable Case
According to the CDC, a probable case of MERS-CoV infection is defined as an individual under investigation who has missing or inconclusive laboratory test results for the infection and who has been in close contact with another individual with a "laboratory-confirmed case" of MERS-CoV infection.[1]
Confirmed Case
According to the CDC, a confirmed case of MERS-CoV infection is defined as an individual who demonstrates laboratory confirmation of infection by MERS-CoV.[1]
CDC Guidelines
According to CDC guidelines:[1]
- Investigations of MERS-CoV and other respiratory pathogens may be conducted simultaneously and additionally, positive results for another respiratory pathogen should not hinder testing for MERS-CoV.
- Health-care providers in the United States should continue to evaluate patients for MERS-CoV infection if they develop fever and pneumonia or acute respiratory distress syndrome within 14 days after traveling from countries in or near the Arabian Peninsula.
- Providers should also evaluate patients for MERS-CoV infection, in the presence of ARDS, fever or pneumonia and if they have been in close contact with recent travelers from the Arabian Peninsula who have fever and acute respiratory illness.
- Clusters of patients with severe acute respiratory illness, such as fever and pneumonia that requires hospitalization, must be evaluated for common respiratory pathogens and reported to local and state public health departments. In case a diagnosis isn't reached, particularly if the cluster includes health-care providers, testing for MERS-CoV should be considered, in consultation with state and local health departments. In this situation, all patients should be tested, even if they haven't had travel-related exposure.
- If symptoms have started more than 14 days prior, CDC guidelines recommend additional testing of a serum specimen via the CDC MERS-CoV serologic assay
- Laboratory confirmation of infection by MERS-CoV now requires a positive PCR test of ≥2 specific genomic targets or, a single positive target followed by successful sequencing of a second.
- Laboratory tests, such as the PCR for MERS-CoV are available at state health departments, CDC and some international laboratories. Otherwise, MERS-CoV tests are not routinely available, despite the existence of a limited number of non-FDA-approved commercial tests.