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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2019, Vol. 13 Issue (1) : 126-130
Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia
Sarah H. Alfaraj1,2, Jaffar A. Al-Tawfiq3,4, Talal A. Altuwaijri5, Ziad A. Memish6,7,8()
1. University of British Columbia, Vancouver, V6T 1Z4, Canada
2. Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh 11676, Saudi Arabia
3. Indiana University School of Medicine, Indianapolis, IN 46202, USA
4. Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
5. Department of Surgery, King Saud University, Riyadh 11692, Saudi Arabia
6. College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
7. Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh 11676, Saudi Arabia
8. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 as an important respiratory disease with high fatality rates of 40%–60%. Despite the increased number of cases over subsequent years, the number of pediatric cases remained low. A review of studies conducted from June 2012 to April 19, 2016 reported 31 pediatric MERS-CoV cases. In this paper, we present the clinical and laboratory features of seven patients with pediatric MERS. Five patients had no underlying medical illnesses, and three patients were asymptomatic. Of the seven cases, four (57%) patients sought medical advice within 1–7 days from the onset of symptoms. The three other patients (43%) were asymptomatic and were in contact with patients with confirmed diagnosis of MERS-CoV. The most common presenting symptoms were fever (57%), cough (14%), shortness of breath (14%), vomiting (28%), and diarrhea (28%). Two (28.6%) patients had platelet counts of<150 × 109/L, and one patient had an underlying end-stage renal disease. The remaining patients presented with normal blood count, liver function, and urea and creatinine levels. The documented MERS-CoV Ct values were 32–38 for four of the seven cases. Two patients (28.6%) had abnormal chest radiographic findings of bilateral infiltration. One patient (14.3%) required ventilator support, and two patients (28.6%) required oxygen supplementation. All the seven patients were discharged without complications.

Keywords Middle East respiratory syndrome coronavirus      MERS-CoV      pregnancy      pediatrics     
Corresponding Authors: Ziad A. Memish   
Just Accepted Date: 12 February 2018   Online First Date: 09 April 2018    Issue Date: 12 March 2019
 Cite this article:   
Sarah H. Alfaraj,Jaffar A. Al-Tawfiq,Talal A. Altuwaijri, et al. Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia[J]. Front. Med., 2019, 13(1): 126-130.
Number Age Gender Symptom Comorbidity CXR finding Intensive care unit Day of illness before hospitalization Linked to O2 requirement
1 16 Male Fever, SOB, diarrhea, vomiting ESRD, asthma Pneumonic infiltration YES 2 Contact with confirmed case 6 days
2 10 Female Fever, cough, vomiting, diarrhea NO Normal NO 7 NA Nil
3 13 Female Fever Miliary TB Bilateral diffuse NO 2 NA 12 days
4 6 Female Fever NO Normal NO 1 No Nil
5 0.75 Male Asymptomatic NO Normal NO Asymptomatic Mother and grandmother confirmed cases Nil
6 9 Female Asymptomatic Sickle cell anemia Normal NO Asymptomatic NA Nil
7 1.5 Male Asymptomatic NO Normal NO Asymptomatic Mother confirmed case Nil
Tab.1  Summary of clinical presentation and outcome of pediatric MERS-CoV cases
Fig.1  Graph showing the most common clinical findings (percentage) among the presented pediatric MERS-CoV cases.
Number Viral Ct value WBC Hgb Plat Neut count Neut % CK ALT AST Creat Albumin
1 NA 6.1 91 58 4.95 81.0 169 37 91 1256.1 NA
2 37 3.8 149 145 0.18 4.6 NA NA NA NA 34
3 32 3 90 467 2.25 70.6 NA 6 71 44 26
4 36 8.6 138 500 5.14 60.0 NA NA NA NA 41
5 NA 17.9 105 406 1.93 10.8 62 NA NA 36.3 NA
6 38 13.3 77 352 9.19 69.2 NA NA NA NA 44
7 NA 11 113 383 2.16 19.6 NA 23 42 NA 45
Tab.2  Laboratory data on presentation of pediatric MERS-CoV cases
Fig.2  Portable chest X-ray showing bilateral mid and lower zone patchy air space consolidation with mild right-sided pleural effusion.
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