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Indian Pediatr 2016;53: 745 |
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Middle East Respiratory Syndrome Coronavirus
in Children
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*Karuna M Das and #Edward Y Lee
*Department of Radiology, College of Medicine and
Health Sciences, United Arab Emirates. University, Al-Ain, UAE, and
#Departments of Radiology and Medicine, Pulmonary Division, Boston
Children’s Hospital and
Harvard Medical School, Boston, USA.
Email: [email protected]
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Middle East respiratory syndrome coronavirus (MERS-CoV) is one of the
recently encountered viral diseases causing pulmonary infection in
children. Till date, about 16 pediatric cases are reported in the
literature [1,2]. This new coronavirus belongs to lineage C of the genus
Beta coronavirus and is genetically closely related to coronaviruses
from various bat species in Africa, Middle East and Eurasia [3]. In
2012, the novel human coronavirus was identified in two adult patients
with severe respiratory disease in Saudi Arabia.
MERS-Cov usually spreads by droplet inhalation, and
the case fatality is very high in adults. In contrast, the disease is
usually mild in children [4]. Fever with cough the predominant clinical
symptom in the majority of affected children, with occasional rapid
deterioration and increasing oxygen requirements, requiring mechanical
ventilation and ECMO (Extracorporeal Membrane oxygenation). Acute
respiratory illness has been noted in only four cases with a fatal
outcome following multi-organ failure [1,2,4]. All these four cases
involving pediatric patients were associated with comorbidities such as
nephrotic syndrome, Down syndrome, craniopharyngioma and right
ventricular tumor. The diagnosis of MERS-Cov is currently established by
positive real-time reverse-transcriptase polymerase chain reaction (rRT-PCR)
in deep nasopharyngeal secrations.
On imaging studies, the MERS- CoV pneumonia has a
radiographic appearance that mimics other more common pulmonary viral
infections. Ground-glass opacity (66%) was the most commonly encountered
abnormality in adults followed by consolidation (18%) [2]. In children,
fine reticular pattern interstitial inflammation may be seen [4]. In
acute respiratory illness, the milder lung disease may rapidly progress
into diffuse bilateral ground glass opacities mixed with air space
consolidation. Pleural effusion or chest X-ray was noted in only
one of these cases [5]. Although, the extent of lung involvement can be
better estimated with computed tomography, sequential chest radiographs
have an additional advantage of estimation of the chest radiographic
score and the chest radiographic deterioration score with an acceptable
dose of radiation exposure to the individuals [2]. Due to its
nonspecific clinical symptoms, the accurate and timely diagnosis of
MERS-CoV in children can be challenging. However, heightened clinical
suspicion in children with underlying risk factors living in endemic
areas in conjunction with improved understanding of imaging findings
have a great potential for optimal pediatric patient care.
References
1. Thabet F, Chehab M, Bafaqih H, Al Mohaimeed S.
Middle East respiratory syndrome coronavirus in children. Saudi Med J.
2015;36:484-6.
2. Das KM, Lee EY, Al Jawder SE, Enani MA, Singh R,
Skakni L, et al. Acute Middle East respiratory syndrome
coronavirus: Temporal lung changes observed on the chest radiographs of
55 patients. Am J Roentgenol. 2015;205:W267-74.
3. WHO. Novel coronavirus infection—update May 22,
2013. Available from:
http://www.who.int/csr/don/2013_05_22_ncov/en/index.html.Accessed
May 27, 2013.
4. Memish ZA, Al-Tawfiq JA, Assiri A, AlRabiah FA, Al
Hajjar S, Albarrak A, et al. Middle East respiratory syndrome
coronavirus disease in children. Pediatr Infect Dis J. 2014;33:904-6.
5. Das KM, Lee EY, Enani MA, Enani MA, AlJawder SE,
Singh R, et al. CT correlation with outcomes in 15 patients with
acute Middle East respiratory syndrome coronavirus. AJR Am J Roentgenol.
2015;204:736-42.
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