Assuntos
Infecções por Helicobacter , Helicobacter pylori , Humanos , Conduta Expectante , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Austrália/epidemiologia , Claritromicina , Farmacorresistência Bacteriana , Testes de Sensibilidade Microbiana , MetronidazolRESUMO
OBJECTIVES: Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with significant mortality. We examined the utility of plasma MERS-CoV PCR as a prognostic indicator and compared the efficacies of IFN-α2a and IFN-ß1a when combined with ribavirin in reducing MERS-CoV-related mortality rates. METHODS: We retrospectively analysed 32 patients with confirmed MERS-CoV infection, admitted between April 2014 and June 2014, by positive respiratory sample RT-PCR. Plasma MERS-CoV RT-PCR was performed at the time of diagnosis for 19 patients. RESULTS: The overall mortality rate was 69% (22/32). Ninety percent (9/10) of patients with positive plasma MERS-CoV PCR died compared with 44% (4/9) of those with negative plasma MERS-CoV PCR. Mortality rate in patients who received IFN-α2a was 85% (11/13) compared with 64% (7/11) in those who received IFN-ß1a (Pâ=â0.24). The mortality rate in patients with renal failure (14), including 8 on haemodialysis, was 100%. Age >50 years and diabetes mellitus were found to be significantly associated with mortality (ORâ=â26.1; 95% CI 3.58-190.76; Pâ=â0.001 and ORâ=â15.74; 95% CI 2.46-100.67; Pâ=â0.004, respectively). The median duration of viral shedding in patients who recovered was 11 days (range 6-38 days). Absence of fever was noted in 5/32 patients. CONCLUSIONS: Plasma MERS-CoV RT-PCR may serve as an effective tool to predict MERS-CoV-associated mortality. Older age and comorbid conditions may have contributed to the lack of efficacy of IFN-α2a or IFN-ß1a with ribavirin in treating MERS-CoV. Absence of fever should not exclude MERS-CoV.
Assuntos
Antivirais/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Interferon-alfa/administração & dosagem , Interferon beta/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Ribavirina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada/métodos , Feminino , Humanos , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Coronavírus da Síndrome Respiratória do Oriente Médio/isolamento & purificação , Plasma/virologia , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Resultado do Tratamento , Carga ViralRESUMO
Middle East Respiratory Syndrome Coronavirus (MERS CoV) may cause severe pneumonia with significant morbidity and mortality, particularly in patients with multiple comorbid condition. MERS CoV pneumonia has not been previously reported in patients with Human Immunodeficiency Virus (HIV). Herein, we report a case of MERS CoV pneumonia with a successful outcome in a patient recently diagnosed with HIV.
