MIDDLE EAST RESPIRATORY SYNDROME (MERS): A SYSTEMATIC REVIEW

The first case of middle east respiratory syndrome (MERS) was identified in a mid-aged Saudi Arabian resident in 2012. The syndrome is analogous to severe acute respiratory syndrome (SARS) in its clinical course, with a male predominance in incidence. MERS virus is disseminated as a result of close proximity of people to camels, person to person transmission being uncommon and confined to hospital settings. The incubation period usually lasts for 2 - 14 days. MERS-CoV appears to be an enzootic virus, tracing its origin to bats, whereas camels may act as intermediate hosts. Typical flu-like symptoms are observed, which include pyrexia, myalgia, apnoea and cough. Symptoms advance over time leading to multiple organ failure, septic shock and eventually death. Diagnosis can be done with the aid of recombinant IgA and IgG ELISAs, and other specific assays such as upE and real-time Reverse Transcription (rt-RT) PCR assay. Currently, neither an authorized vaccine nor a definitive treatment is available for human use. However, adenosine deaminase, mycophenolic acid (MPA), cyclosporine A, nelfinavir, lopinavir, combination of IFN-alpha 2b and ribavirin are underway to attain recognition as specific therapies. The following review summarizes the pharmacotherapy and management options for healthcare workers and preventive strategies for susceptible groups. Our review demonstrates that there exists some relation of the virus with seasonal variability, peculiarly in months from May to September.