Case report: Detection of the Middle East respiratory syndrome corona virus (MERS-CoV) in nasal secretions of a dead human

Mahallawi, Waleed H.

The Middle East respiratory syndrome (MERS) is a novel disease that first appeared in 2012 in KSA. 1 The disease is caused by a single strand RNA virus that belongs to the genus Beta coronavirus and named MERS-corona virus (MERS-CoV). 2 It is assumed that the virus enters the cells via fusing with the plasma membrane by the binding of the envelope protein of the virus (S protein) to the dipeptidyl peptidase 4 (DPP4) as the host receptor, which is profusely expressed in a mammal's lung. 3 The World Health Organization (WHO) has reported that as of the 13th of July 2017, there have been 2040 MERS CoV confirmed cases, with 712 deaths among 27 countries worldwide (http://www.who.int/emergencies/mers-cov/en/, accessed on 13/07/2017). This specifies a mortality rate of approximately 39%, which was found to be linked with patients who have medical comorbidities. 4 Both birds and mammals are prone to infection by a family of viruses called coronaviruses. To date, it is unknown how an animal source infects humans. Moreover, the mode of transmission of the MERS-CoV in humans is not fully understood. Knowing the mode of transmission is essential to reducing the threat of transmission and to developing effective control measures. Upon the initial appearance of the severe acute respiratory syndrome, during the coronavirus (SARS-CoV) endemic between 2002 and 2003, the phylogenetic analysis of the SARS-CoV from the patients from several terrestrial areas was vital for understanding the viral development and the level of the disease. 5 Molecular analysis supported the proposition that the SARS-CoV perhaps initiated in bats and was then transmitted to humans. The results from linking the genetic relationship between the SARS-CoV in humans and in civets has shown a cross-host evolution. 6 The majority of patients present with fever (98%), fever with cough (83%), and shortness of breath (72%) due to a MERS-CoV infection. 7 Most of the cases were reported in Middle East countries including the KSA, Oman, Kuwait, Qatar, United Arab Emirates, Jordan and Yemen. 2,4 A few cases have also been documented in Asian countries (such as Iran, Bangladesh and Malaysia), North African countries (such as Egypt, Tunisia, and Algeria), European countries (for example United Kingdom, France and Germany) and the United States. 8 A study conducted in KSA showed that the whole genome sequence of human-and camel-obtained virus from nasal swabs are almost identical. 9 This direct evidence along with other studies suggests that the virus is transmitted to humans via direct contact with animals, especially dromedary camels in the Middle East. 10 Human-to-human transmission is usually via direct contact with affected individuals and is higher among household and healthcare settings. 11 In this case, report, I will introduce the first reported case of detecting the presence of the MERS-CoV by RT-PCR assay in the nasal swab of a human cadaver.