Middle East Respiratory Syndrome (MERS) Clinical Presentation

Updated: Jun 22, 2015
  • Author: Diana M Salazar, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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The reported median incubation period of Middle East respiratory syndrome (MERS) infection is 5.2 days, [28] but periods of up to 12 days have been reported. [29]

The initial presentation usually includes flulike symptoms, including fever, chills, rhinorrhea, fatigue, and myalgias. Respiratory symptoms, including shortness of breath and dyspnea, may become predominant later in the course. In more severe cases, patients who developed acute respiratory failure may require mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Gastrointestinal symptoms including anorexia, nausea, diarrhea, and abdominal pain have been reported.

Several patients with severe illness have developed acute renal failure requiring hemodialysis, lymphopenia, thrombocytopenia, and/or multiorgan failure with coagulopathy.

Older age and comorbidities including diabetes, end-stage renal disease, and chronic cardiac and pulmonary conditions have been associated with more severe presentation and higher risk of mortality.


Physical Examination

Physical examination findings associated with MERS-CoV infection are similar to those presenting with any flulike illness, including the following:

  • Fever
  • Rhinorrhea, mostly clear
  • Pulmonary findings such as rhonchi and rales (some patients may have a normal auscultation)
  • Tachycardia, mostly secondary to fever