Novel Coronavirus - Comment
Information covered in this presentation slides:
1. -The situation is dynamic and subject to new discoveries and changes.-Data are up to 15/May/2013.
2. - Coronaviruses are important human andanimal pathogens.- Up to 1/3 of community acquired upper respiratory tract infections in adults.- Play a role in severe respiratory tract infections in both adults and children.- They were first identified in the 1960s,and were named after the crown-like projections on the surface of the virus.
3. - Members of nidovirus family.- Replicate using a nested set of mRNAs.- Human coronaviruses are classified into 2genera:oAlpha: HCoV-229E and HCoV-NL63oBeta: HCoV-HKU1, HCoV-OC43, nCoV, andthe SARS coronavirus
4. - Coronaviruses are medium-sized, enveloped, positive-stranded RNAviruses.- Have the largest known viral RNAgenomes, with a length of 27 to 32 kb.- The genome encodes four or five structural proteins, S, M, N, HE, and E.
5. - Replication of viral RNA occurs in the host cytoplasm bya unique mechanism in which RNA polymerase binds to aleader sequence and then detaches and reattaches at multiple locations, allowing for the production of a nested set of mRNA moleculesProteins FunctionM (Membrane glycoprotein) Budding, envelope formationS (Spike glycoprotein) R. binding, cell fusion, as AgHE (Hemagglutinin-acetylesterase gp) Beta, adsorption to host cellN (Nucleocapsid phosphoprotein) RibonucleoproteinE (envelope) Unknown function
6. - The novel coronavirus (nCoV; also abbreviated as HCoV-EMC), has been classified through sequencing as a beta coronavirus.- Closely related to several bat coronaviruses.- Dipeptidyl peptidase 4 (DPP4; also known as CD26), which is present on the surfaces of human non-ciliated bronchialepithelial cells, is a functional receptor for nCoV.- nCoV appears to infect several other human celllines, including lower (but not upper)respiratory, kidney, intestinal, and liver cells, as well ashistiocytes.- nCoV can also infect non-human primate, porcine, bat, and rabbit cell lines
7. Epidemiology So far …
8. On 19 Apr 2012, Jordan: outbreak of pneumonia in the Zarqa PublicHospital’s ICU. 7 nurses, 1 doctor and 1 brother of a nurse were among the 11 affected. In Nov 2012, testing of stored samples from two died patients of this cluster confirmed novel coronavirus infection
9. 22/Sep/2012: UK: 49 yrs previously healthy Qatari male.Travel history to KSA
10. 23/Nov/2012: 3 cases in KSA, 2 died, 1 survived, 2 are family members1 case in Qatar.
11. 28/Nov/2012: 1 case in KSA, died.
12. Oct 2012: KSA: A family member of the 2 earlier cases in Nov.
13. 11/Feb/2013: UK: Critically ill male, with travel history to Pakistan and KSA.Later he died.
14. 13/Feb/2013: UK: Relative of the patient reported 2 days earlier, no travel history, no comorbidities.Later he died.
15. 16/Feb/2013: UK: Relative of the other 2 UK cases.Mild
16. 21/Feb/2013: KSA: Sporadic case, died.
17. 6/Mar/2013: KSA: Sporadic case, no contact with other reported cases, andno travel history.Died.
18. 12/Mar/2013: KSA: Sporadic case, no contact with other reported cases, and no travel history.Died.
19. 23/Mar/2013: KSA: Relative of the patient reported on 12/MarMild, Recovered.
20. 26/Mar/2013: Germany: 73 yrs Male, from Abu-Dhabi hospital.
21. 2/May/2013: KSA: 7 cases, no travel history, no animal contact, not relatives or cluster.
22. 3/May/2013: KSA: 3 cases, same region, 2 are family members, critical condition.
23. 6/May/2013: KSA: 3 cases, 2 died, 1 in critical condition.
24. 8/May/2013: France: immuno compromised, travel history to Dubai.
25. 9/May/2013: KSA: 2 cases, both with comorbidities, both recovered.Same cluster
26. 12/May/2013: France: 1 case, shared a room with the other French case
27. 14/May/2013: KSA: 4 cases, all with comorbidities, 1 died, 1 recovered, 2 in critical condition.
28. 15/May/2013: KSA: 2 cases, a male in critical condition, a female in stable condition.
29. - From September 2012 to 15/May/2013 WHO has been informed of 40 laboratory confirmed cases.- Of whom 20 died.30
30. - The incubation period is currently consideredto be up to ten days.
31. - The mode of transmission is currently unknown.Coronaviruses typically spread like other respiratory infections such as influenza.- The two clusters in Saudi Arabia and Jordan raise the possibility of limited human-to-human transmission, but could also be explained by exposure to a common source.- It is possible that some infections occur via intermittent zoonotic transmission or an environmental source.
32. - All patients presented generally as pneumonia with symptoms of fever, cough, shortness ofbreath and breathing difficulties.- Some cases have had acute kidney injury.- Other clinical manifestations that have been reported (in one patient each) are pericarditis and DIC.- Two cases presented with mild respiratory illness.
33. - Pulmonary parenchymal disease.- Evidence of consolidation.- Localized infiltrates and increased interstitial markings.
34. - Patient under investigation:
35. - Considered for evaluation:
36. - Probable case:
37. - Confirmed case:
38. - Testing for the novel coronavirus is undertaken only when there is clinical or epidemiological evidence that nCOV may be the cause in an individual or cluster of patients.- To avoid the inappropriate use of scarce resources,the generation of false positives and the risk of overwhelming the health system by unnecessary activation of hospital-based and public health response teams.
40. - Routine confirmation of of nCOV will be based on detection of unique sequences of viral RNA by real-time reverse-transcriptase polymerase chain reaction(RT-PCR) and sequencing.- Laboratories with the appropriate experience and containment facilities, may attempt to isolate the virus in cell culture, not routine.
41. - A number of RT-PCR assays that are specific for nCOV have been developed and published. Currently described tests include:o Upstream of the E protein gene (upE)o open reading frame 1b (ORF 1b) geneo open reading frame 1a (ORF 1a) gene.- The assay for the upE target is considered highly sensitive, with the ORF 1a assay considered of equal sensitivity.- The ORF 1b assay is considered less sensitive than the ORF 1aassay but may be more specific.- Other target sites on the nCOV genome suitable for sequencing to aid confirmation: RNA-dependent RNA polymerase (RdRp)and nucleocapsid (N) protein genes.
42. - As with other CoVs, no antiviral agents are recommended for the treatment of nCoV infection.- The WHO has issued recommendations for the management of severe respiratory infections suspected to be caused by nCoV.
43. - Patient under investigation for nCOV.- Severe pneumonia, ARDS.- Sepsis, septic shock.- Initiate infection prevention and control measures.- Collect specimens for laboratory testing.- Empiric anti microbials to treat suspected pathogens including community acquired pathogens.- Conservative fluid management if there is no evidence of shock
44. Permissive hypercapnia, PEEP, double triggering, deep sedation, prolonged inspiratory time.Neuro muscular block, prone, recruitment maneuvers.
45. Thank you…
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