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Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia October 17, 2012DOI: 10.1056/NEJMoa1211721 A 60-year-old Saudi man was admitted to a private hospital in Jeddah, Saudi Arabia, on June 13, 2012, with a 7-day history of fever, cough, expectoration, and shortness of breath. He had no history of cardiopulmonary or renal disease, was receiving no long-term medications, and did not smoke. The physical examination revealed a body-mass index (the weight in kilograms divided by the square of the height in meters) of 35.1, a blood pressure of 140/80 mm Hg, a pulse of 117 beats per minute, a temperature of 38.3°C, and a respiratory rate of 20 breaths per minute. The patient's findings on chest radiography together with the clinical symptoms indicated acute respiratory distress syndrome (ARDS) with multiorgan dysfunction syndrome (MODS), similar to what has been described in severe cases of influenza and SARS.19-21 These pneumonic changes did not respond to antibacterial treatment.22 The patient was treated with oseltamivir for the possibility of infection with the H1N1 swine flu virus. Hematologic changes were evident in this patient in the form of lymphopenia, neutrophilia, and late thrombocytopenia. Abnormal hematologic variables were also quite common among patients with SARS. Lymphopenia was the most common finding in a cohort of 157 patients with SARS. In those patients, postmortem findings showed lymphopenia in various lymphoid organs with no features of bone marrow failure or reactive hemophagocytic syndrome.23 The patient also had progressive impairment of renal function, similar to what had been described in some patients with SARS and possibly attributed to direct infection of renal tissue by the virus. The renal impairment in this case started on the 9th day of symptoms and progressed over the course of the patient's illness No symptoms were observed in the hospital among doctors and nurses caring for the patient, which suggests that the disease did not spread readily. However, staff members were not tested for antibodies against the virus for confirmation. Now that the genome sequence of HCoV-EMC has become available and rapid diagnostic tests specific for HCoV-EMC have been developed,24 thorough epidemiologic investigations are warranted. Such studies should initially focus on identifying the original source of the virus (including bats and other animal species) and potential transmission events between the infected patient and direct contacts. The development of serologic assays for surveillance studies is important. Three months after the hospitalization of the patient in Jeddah, it was reported that a second patient with a history of travel to Saudi Arabia who had been transferred from a hospital in Qatar to a hospital in London was infected with the same virus.25 At present, links between the two infected patients or a potential common source of infection have not been identified. No additional cases have been identified, although several are still under investigation. Epidemiologic investigations, active case findings with the use of updated case definitions,25 and syndrome surveillance in combination with sensitive diagnostic tests will be key to monitoring the present situation and — if necessary — to intervene in a potential outbreak. It will be equally important to test whether HCoV-EMC fulfills Koch's postulates as the causative agent of severe respiratory disease. This case is a reminder that although most infections with human coronaviruses are mild and associated with common colds, certain animal and human coronaviruses may cause severe and sometimes fatal infections in humans. Although HCoV-EMC does not have many of the worrisome characteristics of SARS-CoV, we should take notice of the valuable lessons learned during the 2003 SARS outbreak with respect to outbreak investigations and management. http://www.nejm.org/doi/full/10.1056/NEJMoa1211721#t=article May Allah keep all our Hijjaj healthy and safe
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