Importància clínica dels nous virus emergents: grip i coronavirus

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1 Importància clínica dels nous virus emergents: grip i coronavirus Carolina Garcia-Vidal Servei de Malaties Infeccioses Hospital Universitari de Bellvitge Barcelona, Spain

2 Neumonía viral: no sólo afecta a niños!

3 MERS-CoV Avian influenza A H7N9 Avian influenza A H10N8

4 Desde SARS hasta MERS: 10 años de investigación sobre los coronavirus Hace 10 años: Síndrome respiratorio agudo grave (SARS) -Primeros casos en China, manipuladores de alimentos y chefs. -Murciélagos y otros mamíferos pequeños son reservorios de coronavirus -Trasmisión de infección a parientes, staff médico, y contactos cercanos. -Diseminación global global village -Mortalidad cercana al 10% Hilgenfeld R, et al. Antiv Res 2013

5 Coronavirus Study Group of the International Committee on Taxonomy of Viruses (Mayo de 2013)

6 A 60-yr-old Saudi man was admitted on June 13, 2012, with fever X 7 days, cough, expectoration, and shortness of breath; rx oseltamivir, levo, P/T, and micafungin. ICU admission and IMV. On June 24, he died of ARDS and ARF. A new betacoronavirus in lineage C; HCoV-EMC, along with other bat coronavirus Zaki AM. N Engl J Med 2012

7 971 cases 356 deaths (26%) WHO, 5 Febr 2015

8 Affected countries (8 May 2014) Middle East Jordan Kuwait Oman Qatar Saudi Arabia United Arab Emirates Yemen Africa Egypt Tunissia Europe France Germany Greece Italy United Kingdom Asia Malaysia Philippines North America USA

9

10 WHO. GAR

11 47 individuals from Saudi Arabia with lab-confirmed MERS-CoV were identified between Sep 1, 2012, and June 15, 2013; 60% case-fatality rate Assiri A. Lancet Infect Dis 2013

12 Imaging findings at presentations in Saudi patients with Middle East respiratory syndrome Assiri A. Lancet Infect Dis 2013

13 Active replication of Middle East Respiratory Syndrome Coronavirus replication and aberrant induction of inflammatory cytokines and chemokines Study of viral replication, cytokine/chemokines response, and antigen presentation in MERS-CoV- infected human monocyte-derived macrophages (MDMs) vs SARS-CoV infected MDMs Zhou J. J Infect Dis 2013

14 Arabi YM. Ann Intern Med 2014

15 Arabi YM. Ann Intern Med 2014

16 Memish ZA. N Engl J Med 2013 Guery B. Lancet 2013 Assiri A. N Engl J Med 2013

17 WHO, 8 May 2014

18 23 cases of MERS-CoV in the eastern province of Saudi Arabia The median incubation period was 5.2 days 21 of 23 cases were acquired by person-to-person transmission - hemodialysis units - ICUs - in-patient units 15 patients died (65%) Among 217 household contacts and > than 200 HCW, MERS-CoV infection developed in 5 family members and in 2 HCW. Assiri A. N Engl J Med 2013

19 Assiri A. N Engl J Med 2013

20 Avian influenza A(H7N9) virus

21

22 >450 cases since April 2013 with more than 130 deaths WHO, October 2014

23

24 Li Q. N Engl J Med 2014

25 Li Q. N Engl J Med 2014

26 Of the 111 pts studied, 77% were admitted to an ICU, and 27% died. The median age was 61 yrs, and 69.5% of pts were male. A total of 61% of the pts had at least one underlying medical condition. 56% of pts had exposure to live poultry in the previous 14 days. On admission, 108 pts (97%) had findings consistent with pneumonia. Lymphocytopenia was observed in 88% of pts; thrombocytopenia in 73%. Antiviral therapy was initiated in 97% of pts at a median of 7 days. after the onset of illness. The median time from therapy to negative PCR was 6 days (4 7 d). Gao HN. N Engl J Med 2013

27 Gao HN. N Engl J Med 2013

28 Gao HN. N Engl J Med 2013

29 Cytokine and Chemokine Levels in Patients Infected With the Novel Avian Influenza A (H7N9) Virus in China Host cytokine and chemokine profiles in serum samples of 16 pts admitted to hospitals in Jianghu, China. 8 pts H3N2, and 9 healthy controls. IP-10, IL-6, IL-17, and IL-2 were increased in H7N9 pts. Proinflammatory cytokine responses, characterized by combined Th1/Th17 cytokine induction, are partially responsible for the disease progression Chi Y. J nfect Dis 2013

30 Hu Y. Lancet 2013

31 Emergence in China of human disease due to avian influenza A(H10N8) Cause for concern? To KKW. J Infect 2014

32 A 73-yrs-old woman presented with fever and was admitted to hospital on Nov 30, She developed multiple organ failure and died 9 days after illness onset. A new reassortant avian influenza A H10N8 virus was isolated from tracheal aspirate. Chen H. Lancet 2014

33 Chen H. Lancet 2014

34 Comments The MERS-CoV is an emerging virus originally identified in Saudi Arabia in It has been involved in 971 cases of severe acute respiratory disease, including 356 deaths (26%), mainly in the Middle East. Person-to-person transmission occurs and may be associated with considerable morbidity and mortality. Major gaps in our knowledge of the epidemiology, community prevalence, treatment and prevention warrant urgent research.

35 Comments A novel avian influenza A H7N9 first detected in Shanghai in March 2013, has been involved in >450 cases with more than 130 deaths mainly in eastern China. The majority of the pts have presented with rapidly progressive pneumonia and developed ARDS. The neuraminidase inhibitors have been the main drugs used for treatment of pts with H7N9. In December 2013, China reported the first human case of avian influenza A H10N8; with fatal outcome.

36 Contacte:

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