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  • 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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