Snapshot A 34-year-old woman presents to a local hospital in the United States with a week history of fevers, headaches, myalgias, and nonproductive cough. She stated she started having a nonproductive cough yesterday. Two weeks ago, she traveled to Hong Kong to visit relatives. She visited a nursing home a couple of times but did not have any sick contacts. On physical exam, she is diaphoretic and her oxygen saturation is 93% on room air. A chest radiograph reveals bilateral pulmonary infiltrates. A rapid influenza antigen test is negative. She is admitted for further management. Introduction Classification coronavirus (CoV) an enveloped, linear, positive, single-stranded RNA virus with a helical capsid causes the “common cold” as well as severe acute respiratory syndrome (SARS) and Middle Eastern respiratory syndrome (MERS) SARS-CoV MERS-CoV transmission via respiratory secretions Epidemiology incidence worldwide MERS-CoV countries around the Arabian Peninsula SARS-COV Asia demographics all ages risk factors recent travel to the Arabian Peninsula or Asia sick contacts immunosuppression healthcare workers Pathogenesis replication in tracheobronchial epithelium Prognosis worse prognosis higher respiratory virus titer older age underlying comorbidities Presentation Symptoms MERS/SARS presents more acutely and severely than the common cold, often requiring hospitalization prodrome fever and chills malaise myalgias nausea and vomiting headache respiratory phase nonproductive cough shortness of breath sore throat Imaging Chest radiography indication MERS/SARS findings bilateral pulmonary infiltrates Studies Labs detection of viral RNA on reverse-transcriptase polymerase chain reaction serum antibody on enzyme-linked immunosorbent assay may have increased lactate dehydrogenase Making the diagnosis based on clinical presentation and confirmed with laboratory evaluation Differential Influenza distinguishing factors systemic symptoms predominate rapid antigen detection test for influenza is positive Treatment Management approach treatment is typically supportive Conservative supportive indication all patients modalities supplemental oxygen hydration Complications Hypoxemic respiratory failure
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