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Case Reports
. 2014 Sep;20(9):1527-30.
doi: 10.3201/eid2009.140378.

Family cluster of Middle East respiratory syndrome coronavirus infections, Tunisia, 2013

Fekri Abroug, Amine Slim, Lamia Ouanes-Besbes, Mohamed-Ali Hadj Kacem, Fahmi Dachraoui, Islem Ouanes, Xiaoyan Lu, Ying Tao, Clinton Paden, Hayat Caidi, Congrong Miao, Mohammed Mohammed Al-Hajri, Mokhtar Zorraga, Wissem Ghaouar, Afif BenSalah, Susan I Gerber; World Health Organization Global Outbreak Alert and Response Network Middle East Respiratory Syndrome Coronavirus International Investigation Team
Collaborators
Case Reports

Family cluster of Middle East respiratory syndrome coronavirus infections, Tunisia, 2013

Fekri Abroug et al. Emerg Infect Dis. 2014 Sep.

Abstract

In 2013 in Tunisia, 3 persons in 1 family were infected with Middle East respiratory syndrome coronavirus (MERS-CoV). The index case-patient's respiratory tract samples were negative for MERS-CoV by reverse transcription PCR, but diagnosis was retrospectively confirmed by PCR of serum. Sequences clustered with those from Saudi Arabia and United Arab Emirates.

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Figures

Figure 1
Figure 1
Clinical course of disease for patients with confirmed Middle East respiratory syndrome coronavirus Infection, Tunisia, 2013. RH, regional hospital; DH, district hospital; rRT-PCR, real-time reverse transcription PCR.
Figure 2
Figure 2
Midpoint-rooted phylogenetic trees of the full-length nucleocapsid (N) (panel A) and spike (S) (panel B) open-reading frames (ORFs) of isolates obtained from index case-patient with Middle East respiratory syndrome coronavirus (MERS-CoV) infection, Tunisia, 2013. Serum and available nucleotide sequences from GenBank and Public Health England (http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317136246479) and the Institut Für Virologie (http://www.virology-bonn.de/index.php?id = 46). The estimated neighbor-joining trees were constructed from nucleotide alignments by using MEGA version 6.06 (http://www.megasoftware.net). Sequence names are written as GenBank accession number|virus strain name|month-year of collection. Numbers in parentheses denote the number of additional sequences from viruses isolated from humans that are identical to the listed sequence. Solid circles indicate sequences from MERS-CoV from Tunisia, 2013. Camel icons indicate MERS-CoV sequences derived from isolates from camels. Bootstrap support values (1,000 replicates) ≥75% were plotted at the indicated internal branch nodes. Scale bars indicate number of nucleotide substitutions per site.
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