Neurological Complications of Middle East Respiratory Syndrome Coronavirus: A Report of Two Cases and Review of the Literature

Hussein Algahtani, Ahmad Subahi, Bader Shirah, Hussein Algahtani, Ahmad Subahi, Bader Shirah

Abstract

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first discovered in September 2012 in Saudi Arabia. Since then, it caused more than 1600 laboratory-confirmed cases and more than 580 deaths among them. The clinical course of the disease ranges from asymptomatic infection to severe lower respiratory tract illness with multiorgan involvement and death. The disease can cause pulmonary, renal, hematological, and gastrointestinal complications. In this paper, we report neurological complications of MERS-CoV in two adult patients, and we hypothesize the pathophysiology. The first patient had an intracerebral hemorrhage as a result of thrombocytopenia, disseminated intravascular coagulation, and platelet dysfunction. The second case was a case of critical illness polyneuropathy complicating a long ICU stay. In these cases, the neurological complications were secondary to systemic complications and long ICU stay. Autopsy studies are needed to further understand the pathological mechanism.

Figures

Figure 1
Figure 1
CT of the brain showing right frontal lobe intracerebral hemorrhage with massive brain edema, midline shift, and intraventricular extension.

References

    1. Zaki A. M., Van Boheemen S., Bestebroer T. M., Osterhaus A. D. M. E., Fouchier R. A. M. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. The New England Journal of Medicine. 2012;367(19):1814–1820. doi: 10.1056/nejmoa1211721.
    1. World Health Organization. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Genève, Switzerland: World Health Organization; 2016.
    1. Mackay I. M., Arden K. E. MERS coronavirus: diagnostics, epidemiology and transmission. Virology Journal. 2015;12(1, article 222) doi: 10.1186/s12985-015-0439-5.
    1. Arabi Y. M., Harthi A., Hussein J., et al. Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV) Infection. 2015;43(4):495–501. doi: 10.1007/s15010-015-0720-y.
    1. Saad M., Omrani A. S., Baig K., et al. Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection: a single-center experience in Saudi Arabia. International Journal of Infectious Diseases. 2014;29:301–306. doi: 10.1016/j.ijid.2014.09.003.
    1. Gralinski L. E., Baric R. S. Molecular pathology of emerging coronavirus infections. The Journal of Pathology. 2015;235(2):185–195. doi: 10.1002/path.4454.
    1. Hu B., Ge X., Wang L. F., Shi Z. Bat origin of human coronaviruses. Virology Journal. 2015;12, article 221 doi: 10.1186/s12985-015-0422-1.
    1. Desforges M., Le Coupanec A., Brison É., Meessen-Pinard M., Talbot P. J. Neuroinvasive and neurotropic human respiratory coronaviruses: potential neurovirulent agents in humans. Advances in Experimental Medicine and Biology. 2014;807:75–96. doi: 10.1007/978-81-322-1777-0_6.
    1. Memish Z. A., Mishra N., Olival K. J., et al. Middle East respiratory syndrome coronavirus in bats, Saudi Arabia. Emerging Infectious Diseases. 2013;19(11):1819–1823. doi: 10.3201/eid1911.131172.
    1. Saudi Ministry of Health. Command & Control Center, 2016, .
    1. Sampathkumar P. Middle east respiratory syndrome: what clinicians need to know. Mayo Clinic Proceedings. 2014;89(8):1153–1158. doi: 10.1016/j.mayocp.2014.06.008.
    1. Du L., Jiang S. Middle East respiratory syndrome: current status and future prospects for vaccine development. Expert Opinion on Biological Therapy. 2015;15(11):1647–1651. doi: 10.1517/14712598.2015.1092518.
    1. Berth S. H., Leopold P. L., Morfini G. Virus-induced neuronal dysfunction and degeneration. Frontiers in Bioscience. 2009;14(14):5239–5259. doi: 10.2741/3595.
    1. Leland D. S., Ginocchio C. C. Role of cell culture for virus detection in the age of technology. Clinical Microbiology Reviews. 2007;20(1):49–78. doi: 10.1128/CMR.00002-06.
    1. Joob B., Wiwanitkit V. Neurologic syndrome due to MERS: is there a possibility that the virus can cross the blood-brain barrier to cause a neurological problem? Annals of Tropical Medicine and Public Health. 2015;8(5):p. 231. doi: 10.4103/1755-6783.162654.
    1. Talbot P. J., Arnold D., Antel J. P. Virus-induced autoimmune reactions in the CNS. Current Topics in Microbiology and Immunology. 2001;253:247–271.
    1. Algahtani H., Shirah B., Alkhashan S., Ahmad R. Neurological complications of novel influenza A (H1N1) pdm09 infection: report of two cases and a systematic review of the literature. Journal of Neuroinfectious Diseases. 2016;7, article 201 doi: 10.4172/2314-7326.1000201.
    1. Stockman L. J., Bellamy R., Garner P. SARS: systematic review of treatment effects. PLoS Medicine. 2006;3(9):1525–1531. doi: 10.1371/journal.pmed.0030343.
    1. Zumla A., Hui D. S., Perlman S. Middle East respiratory syndrome. The Lancet. 2015;386(9997):995–1007. doi: 10.1016/s0140-6736(15)60454-8.

Source: PubMed

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