(HealthDay News) — Patients with critical illness associated with Middle East respiratory syndrome coronavirus (MERS-CoV) present with acute severe hypoxemic respiratory failure and most have extrapulmonary manifestations, according to research published online January 28 in the Annals of Internal Medicine.

Yaseen M. Arabi, MD, from King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia, and colleagues describe critical illness associated with MERS-CoV in a cases series of 12 patients with confirmed or probable infection.

The researchers note that 114 patients were tested for suspected MERS-CoV between December 2012 and August 2013, of whom 11 intensive care unit patients met the definition of confirmed or probable cases. A health care-associated cluster was identified that included three of these patients and three health care workers, one of whom became critically ill and was the 12th patient in the MERS-CoV series. Among the patients, the median Acute Physiology and Chronic Health Evaluation II score was 28. All patients presented with acute severe hypoxemic respiratory failure and had underlying comorbid conditions. 92% of the patients had extrapulmonary manifestations. 42% were alive at day 90. Only 1% of the 520 exposed health care workers were positive.

“Community-acquired and health care-associated MERS-CoV infection occurs in patients with chronic comorbid conditions,” the authors write. “The health care-associated cluster suggests that human-to-human transmission does occur with unprotected exposure.”

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