MERS
Study Assiri et al (2013)N = 47, confirmed casesRetrospective study Corman et al (2015)N = 37, confirmed casesClinicopathologic study Alenazi et al (2017)N = 130, confirmed casesClinicopathologic study Zhou et al (2017)Human intestinal epithelial cell culture, hDDP4 transgenic miceClinicopathologic Al-Abdley et al (2019)N = 33, confirmed casesClinicopathologic study
Clinical features • Diarrhea (26%)
• Nausea (21%)
• Vomiting (21%)
• Abdominal pain (17%)
(at presentation) N/A GI symptoms in• Community acquired infection: 46.2%
• Healthcare associated infection: 46.6%
• HAI in healthcare workers: 16% N/A • Vomiting (31%)
• Diarrhea (15%)
Key findings on investigations N/A • 14.6% stool yielded viral RNA N/A N/A RNA positive stool (57%) did not correlate with presence of GI symptoms
Key study findings and message GI symptoms are frequent at presentation • Viral load in stool is significantly lower than in lower respiratory tract
• Virus not cultivable from stool MERS-CoV high in healthcare environment • GI symptoms among the commonest extrapulmonary symptoms
• Intestinal epithelial cells could support viral replication
• Primary gastric infection can lead to respiratory symptoms via hematogenous or lymphatic spread Diarrhea may be associated with prolonged viral detection (p 0.069)