MERS-CoV: Overview and a Case of Misdiagnosis in Rawalpindi

Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) is a severe respiratory illness caused by a virus that was first identified in Saudi Arabia in 2012. While it is much less prevalent than other viral infections such as COVID-19, MERS-CoV is a global concern due to its high mortality rate, which hovers around 36%. MERS-CoV infections are most commonly reported in the Arabian Peninsula, and the virus is transmitted through close contact with infected individuals or animals, particularly camels.

Although the number of reported cases worldwide is relatively low, experts believe many mild cases may go undetected, causing the mortality rate to appear inflated. Symptoms of MERS-CoV often mimic other respiratory illnesses, such as fever, cough, and difficulty breathing, which can make early diagnosis challenging.

Recent Case of Misdiagnosis in Rawalpindi

A recent incident in Rawalpindi, Pakistan, underscores the difficulties in diagnosing respiratory illnesses that share symptoms with more severe conditions like MERS-CoV. Muhammad Ameen, a 55-year-old man from Kharian, was admitted to Benazir Bhutto Hospital in early September 2024 after returning from a trip to the Middle East. Upon his return, Ameen developed respiratory symptoms that mirrored those of MERS-CoV, raising concerns about a potential outbreak.

As a precautionary measure, Ameen was isolated in the hospital’s Intensive Care Unit (ICU), and tests were conducted on him and 40 of his family members. The hospital staff acted swiftly to contain what was initially thought to be a serious viral infection, implementing standard isolation protocols to prevent transmission.

However, further testing revealed that Ameen’s illness was not MERS-CoV but a less severe viral infection. He was treated accordingly, and his condition improved, leading to his recovery and discharge from the hospital. None of the family members tested showed signs of the virus.

The Challenge of Diagnosing MERS-CoV

MERS-CoV presents a significant challenge to healthcare professionals because its early symptoms are nonspecific and easily confused with more common respiratory infections. Patients with MERS-CoV often present with fever, cough, and shortness of breath—symptoms that are typical of many viral illnesses.

In Ameen’s case, his recent travel to the Middle East, where MERS-CoV is more prevalent, heightened concerns, and triggered an immediate response. While the hospital’s prompt actions prevented any unnecessary spread of a potential outbreak, this case demonstrates the need for cautious diagnosis when dealing with respiratory illnesses.

Vigilance Remains Key

Although MERS-CoV has a higher mortality rate compared to other coronaviruses, it is far less common. However, the virus still poses a significant public health risk, especially in regions with heavy international travel. The Rawalpindi incident serves as a reminder for health authorities to remain vigilant and ensure accurate diagnosis of viral infections, particularly in high-risk populations returning from regions where the virus is prevalent.

Thankfully, Muhammad Ameen has recovered, and no further cases were reported in his family or community. However, the incident underscores the importance of rapid testing, isolation, and public health measures to control potential outbreaks. As international travel continues to resume following the COVID-19 pandemic, the ability of healthcare providers to accurately diagnose and manage MERS-CoV cases is critical to preventing its spread and protecting public health globally.

In conclusion, while MERS-CoV remains a rare but deadly virus, healthcare systems need to stay prepared for the challenges it presents. Misdiagnoses like the one in Rawalpindi highlight the complexities of diagnosing respiratory illnesses and the critical role that vigilance and early testing play in managing potential outbreaks.