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MERS: Causes, Symptoms, Diagnosis, Treatments and Prevention

Updated on July 6, 2017

MERS is a Viral Disease

MERS (Middle East Respiratory Syndrome) is a viral respiratory medical condition that was first reported in Saudi Arabia in the year 2012. In June 2012, a 60-year-old man with flu-like symptoms visited a private hospital in Jeddah.

First Known Victim of MERS

Two weeks later, he passed away due to multiple organ failure He was the first victim of a mysterious virus that came to be known as MERS. According to WHO, this severe pneumonia-like respiratory illness is a threat to the entire world.

MERS-CoV Is the Deadliest Coronavirus

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Causes of MERS

MERS is caused by a novel coronavirus MERS-CoV, a coronavirus variant that was discovered in 2012. It is a beta coronavirus. The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses decided on the name MERS-CoV for this virus.

Coronaviruses Cause Respiratory Medical Conditions in Mammals

Coronaviruses cause respiratory medical conditions in mammals. In fact they are responsible for one in every three cases of common cold. Corona in Latin means “crown”. MERS-CoV has crown-like projections on its surface. That is the reason why these organisms are called coronaviruses.

MERS-CoV Is Deadlier Than All the Other Coronaviruses Discovered till Date

According to experts, MERS-CoV is more deadly than all the other coronaviruses discovered till date. Cases of confirmed MERS infections have been reported in countries like Jordan, Kuwait, Oman, Qatar, Saudi Arabia, UAE, Yemen, France, Germany, Greece, Italy, UK, Egypt, Tunisia and the United States of America. Approximately 80 percent of human cases of MERS have been reported by the Kingdom of Saudi Arabia.

Between 1 and 10 June 2017, the National IHR Focal Point of Saudi Arabia Reported 35 Cases of MERS-CoV Infection

Between 1 and 10 June 2017, the national IHR focal point of Saudi Arabia reported 35 cases of MERS-CoV infection, including three fatal cases and one death among previously reported cases.

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MERS Spreads Through Contact With the Infected Person

As on today, how MERS spreads is not 100 percent clear. Research work is still on in this area; however, experts believe close contact with the infected person to be the main cause.

People who care for an infected person, or live with an infected person, or have direct contact with respiratory secretions and other body fluids of the infected person, are more likely to be affected by this medical condition. People who have been affected by this medical condition have all been in a health care facility with other MERS patients, or among close family members affected by this illness.

Two staff members of Dr. P. Phillips Hospital in Florida were affected by MERS after caring for a man with a confirmed case of this deadly medical condition. This has been confirmed by Orlando health officials.

Even today no one knows for certain where the virus came from. Some experts believe that it came from an animal source. This virus has been found in camels in Saudi Arabia, Qatar and Egypt; and in a bat in Saudi Arabia.

MERS-CoV Has Been Found in Camels in Saudi Arabia, Qatar and Egypt; And in a Bat in Saudi Arabia

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Symptoms of MERS

Not all people carrying the MERS-CoV display symptoms of MERS. Usually infected people display symptoms like coughing, malaise, mucous, shortness of breath, chest pain, diarrhea, fever and kidney failure.

Experts describe MERS as flu-like disease with signs and symptoms of pneumonia. Some people describe symptoms as similar to those identified in SARS-CoV (severe acute respiratory syndrome) cases. However, SARS infection does not cause kidney failure, unlike MERS-CoV. More than 60 percent of the people affected by MERS die.

Patients with chronic medical conditions (like diabetes), organ transplant recipients who are on immunosuppressive medicines, and people in general with poor immunity are more likely to be affected by MERS. According to some experts, men may be more vulnerable than women.

If you develop coughing, fever or shortness of breath within 14 days of traveling to a nation in or near the Middle East (like Saudi Arabia, Qatar, UAE and Jordan), you must consult a certified physician without delay.

MERS Diagnosis

In order to diagnose MERS, doctors perform physical examination. They check for fever and swollen glands. Using a stethoscope, they examine the lungs. Fluid buildup in the lungs can be observed with the help of a chest X-ray, CT scan or MRI scan.

Samples from the upper and lower respiratory tract are taken. These are tested using PCR (polymerase chain reaction) technique. According to experts, virus detection is most successful with material from the lower respiratory tract. Feces are also a relevant sample for direct virus detection. However, it is advisable to test samples from respiratory tract.

MERS Treatment

According to WHO, there are no specific treatment for patients affected by MERS. Physicians provide supportive medical care in an endeavor to relieve the symptoms. Effort during treatment is to prevent, control or relieve complications and side effects.

Doctors try their best to increase the affected persons’ comfort and to enhance their quality of life. Though vaccines prepared from the convalescent plasma extracted from the blood of MERS-CoV survivors, they are not yielding positive results.

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Anti-Viral Tool

Research scientists at the University of Toronto have invented an anti-viral tool. Writing about it in the journal PLoS Pathogens, the team headed by professor Sachdev Sidhu of the Donnelly Centre for Cellular and Biomolecular Research and Department of Molecular Genetics explain how they turned ubiquitin, a staple protein in human cell into a medicine capable of thwarting MERS in cultured human cells.

This technology can be applied to many range of pathogens. It could become a game-changer in anti-viral therapeutics with implications for human health and the farming industry.

"Vaccines are important for prevention, but there is a great need for anti-viral medicines to treat people who have become infected," said Dr. Wei Zhang, a postdoctoral research fellow in Sidhu's laboratory who worked on the study.

MERS is similar to SARS, a virus which killed around 800 people in a 2002 global epidemic. Both kill more than a third of people infected; both emerged from animals.

MERS emerged from camels and bats after mutating into a form capable of infecting human cells.

Bats have been suspects in the emergence of outbreaks of Ebola, SARS and MERS-Cov. A research study published in Nature settles the question about whether bats are special in this regard.

“Unfortunately they are special. They do have a higher proportion of viruses that are able to infect people than any other mammal group,” said Peter Daszack, a disease ecologist and a senior author of the new study.

Unfortunately they are special. They do have a higher proportion of viruses that are able to infect people than any other mammal group.

— Peter Daszack, a disease ecologist

Although MERS has so far been detected in around 27 nations since the first case emerged in 2012, the outbreak has largely been contained within Saudi Arabia, according to the WHO.

MERS works by hijacking the ubiquitin system in human cells, which are made of hundreds of proteins that depend on ubiquitin to keep the cells alive. Upon infection, viral enzymes alter ubiquitin pathways in a way that enables the virus to evade the immune defense while multiplying and destroying the host tissue as it spreads in the body.

"Viruses have evolved proteins that allow them to hijack host proteins. We can now devise strategies to prevent this from happening," says Zhang.

Zhang and colleagues engineered the human ubiquitin protein into a new form that paralyses a key MERS enzyme, thereby stopping the virus from replicating. These synthetic ubiquitin variants act quickly, completely removing MERS from cells in a dish within 24 hours.

This invention is designed to target only the virus -- this should minimize side effects in any future medicine. Before these engineered proteins can be developed into a drug, research scientists need to find a way to deliver them into the right part of the body.

In order to achieve this endeavor, Zhang and Sidhu are working with Dr. Roman Melnyk, a biochemist in the Hospital for Sick Children and an expert in protein delivery.

Research scientists are also investigating the possibility of finding medicines that function in a similar manner, but can already cross the cell membrane. Proteins may be tested first in plants and animals where regulatory approvals are less strict than they are for human medicines.

In the meantime, Zhang will continue to improve delivery of his designer proteins to human cells that target not only MERS but also other viruses. He hopes others will follow suit.

MERS Prevention

If you are located in an area with cases of MERS, it is advisable to take measures currently recommended for any kind of respiratory illness. It is very important to avoid contact with people who would have displayed symptoms of this medical condition.

Always maintain good hand hygiene. Wash your hands often with soap and water for 20 seconds. It is important to train your children to do the same. If soap and water are unavailable, you may use an alcohol-based hand sanitizer.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection.

These people should avoid close contact with animals, particularly camels, while visiting farms, markets, or barn areas where the virus is known to be potentially circulating.

Adhere to general hygiene measures, like regular hand washing before and after touching animals. Avoid contact with sick animals. Avoid drinking raw camel milk or camel urine. Do not eat meat that has not been cooked properly.

Do not touch your eyes, nose and mouth with unwashed hands. Wash vegetables and fruits thoroughly. Consume pure water only. Ensure that it is sterilized before drinking. Clean and disinfect touched surfaces like toys and doorknobs frequently.

People who are infected should behave with great responsibility. They should avoid close contact with people around them. It is advisable to wear a face mask. While sneezing, they should use a tissue, and ensure that it is disposed properly. Or they can sneeze into a sleeve or flexed elbow. According to experts at WHO, unless you are looking after a person affected by MERS, your risk of contracting the medical condition is small.

The Most Effective Way to Prevent MERS

According to some experts, natural remedies, and not vaccines, can protect people from deadly medical conditions like MERS. The best way to prevent this medical condition is to increase immunity. Here are some proven ways of boosting immunity.

Avoid smoking. Exercise regularly. Consume healthy and balanced diet. Your diet should include whole grain, vegetables and fruits. Reduce intake of foods high in saturated fat. Avoid consuming too much sugar. Yogurt, oats, barley, garlic, green tea, sweet potatoes and mushrooms are known to boost immunity.

Mushrooms especially supercharge your immune system by enhancing the number of WBC in the bloodstream. It is easy to increase mushroom intake. You may just add it to your vegetable soup.

Prevent obesity. Your body mass index should ideally be between 18.5 and 24.9. It is definitely advisable to control your blood pressure. Avoid excessive consumption of alcohol. Sleep well.

Yoga is a proven and natural way to boost your immune system. Heart-opening asanas (yoga postures) like Bhujangasana (Cobra Pose), Matsyasana (Fish Pose) and Setu Bandha Sarvangasana (Bridge Pose) go a long way in preventing colds and flu.

“Doing all three poses only takes five minutes and may make the difference between staying well and getting sick…” says Hema Sundaram, an integrative physician in Washington, D. C.

However it is important to practice these asanas under the guidance of certified yoga instructor. Do not practice yoga on your own, by reading a book or watching on TV. It can be risky.

WHO has set minimum acceptable standards for three vaccines currently under development: one vaccine intends to prevent transmission of this virus from dromedary camels to people; and two vaccines for use in outbreaks of this disease and for longer-term protection of people at high risk.

MERS has become the talk of the healthcare and pharmaceutical industry. Members of the medical community worldwide are stumped and helpless in front of this super bug. Efforts are on to find a treatment to this dreadful medical condition.

Summary

  • MERS is a viral respiratory medical condition.
  • Fever, cough, shortness of breath and chest pain are some common symptoms of MERS.
  • There is no specific treatment for MERS.
  • It is advisable to stay away from people affected by MERS.
  • It is a good idea to do everything to boost your immunity.

MERS and SARS: A Comparison

MERS
SARS
Caused by MERS-CoV
Caused by SARS-CoV
Emerged in Saudi Arabia in 2012
Emerged in Southern China in late 2002
Incubation period: 5.2 days
Incubation period: 4.6 days
Can cause rapid kidney failure
Acute renal failure is not common

For a virus to go pandemic, it must be able to spread easily between people... but MERS-CoV is primarily an animal virus,

— Declan Butler

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