Virological and serological analysis of a recent Middle East respiratory syndrome coronavirus infection case on a triple combination antiviral regimen

Nikolaos Spanakis, Sotirios Tsiodras, Bart L Haagmans, V Stalin Raj, Kostantinos Pontikis, Antonia Koutsoukou, Nikolaos G Koulouris, Albert D M E Osterhaus, Marion P G Koopmans, Athanassios Tsakris, Nikolaos Spanakis, Sotirios Tsiodras, Bart L Haagmans, V Stalin Raj, Kostantinos Pontikis, Antonia Koutsoukou, Nikolaos G Koulouris, Albert D M E Osterhaus, Marion P G Koopmans, Athanassios Tsakris

Abstract

Serological, molecular and phylogenetic analyses of a recently imported case of Middle East respiratory syndrome coronavirus (MERS-CoV) in Greece are reported. Although MERS-CoV remained detectable in the respiratory tract secretions of the patient until the fourth week of illness, viraemia was last detected 2 days after initiation of triple combination therapy with pegylated interferon, ribavirin and lopinavir/ritonavir, administered from Day 13 of illness. Phylogenetic analysis of the virus showed close similarity with other human MERS-CoVs from the recent Jeddah outbreak in Saudi Arabia. Immunoglobulin G (IgG) titres peaked 3 weeks after the onset of illness, whilst IgM levels remained constantly elevated during the follow-up period (second to fifth week of illness). Serological testing confirmed by virus neutralisation assay detected an additional case that was a close contact of the patient.

Keywords: Antiviral treatment; Coronavirus; MERS; MERS-CoV; Phylogeny; Serology.

Copyright © 2014. Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
Time course of symptoms, medication, and molecular and serological findings of the Middle East respiratory syndrome coronavirus (MERS-CoV)-infected patient. IIF, indirect immunofluorescence.
Fig. 2
Fig. 2
Phylogenetic tree of the Middle East respiratory syndrome coronavirus (MERS-CoV) from the Greek patient. Nucleotide sequences of 3-kb concatenated sequences of representative MERS-CoVs were analysed and a phylogenetic tree was constructed by the PhyML method. Values at the branches show the result of the approximate likelihood ratio, with values of

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Source: PubMed

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