TY - JOUR
T1 - Clinical and laboratory findings of the first imported case of middle east respiratory syndrome coronavirus to the United States
AU - Kapoor, Minal
AU - Pringle, Kimberly
AU - Kumar, Alan
AU - Dearth, Stephanie
AU - Liu, Lixia
AU - Lovchik, Judith
AU - Perez, Omar
AU - Pontones, Pam
AU - Richards, Shawn
AU - Yeadon-Fagbohun, Jaime
AU - Breakwell, Lucy
AU - Chea, Nora
AU - Cohen, Nicole J.
AU - Schneider, Eileen
AU - Erdman, Dean
AU - Haynes, Lia
AU - Pallansch, Mark
AU - Tao, Ying
AU - Tong, Suxiang
AU - Gerber, Susan
AU - Swerdlow, David
AU - Feikin, Daniel R.
N1 - Funding Information:
Financial support. This work was supported by Community Hospital, Munster, Indiana; the IDH; and the CDC.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Background. The Middle East respiratory syndrome coronavirus (MERS-CoV) was discovered September 2012 in the Kingdom of Saudi Arabia (KSA). The first US case of MERS-CoV was confirmed on 2 May 2014. Methods. We summarize the clinical symptoms and signs, laboratory and radiologic findings, and MERS-CoV-specific tests. Results. The patient is a 65-year-old physician who worked in a hospital in KSA where MERS-CoV patients were treated. His illness onset included malaise, myalgias, and low-grade fever. He flew to the United States on day of illness (DOI) 7. His first respiratory symptom, a dry cough, developed on DOI 10. On DOI 11, he presented to an Indiana hospital as dyspneic, hypoxic, and with a right lower lobe infiltrate on chest radiography. On DOI 12, his serum tested positive by real-time reverse transcription polymerase chain reaction (rRT-PCR) for MERS-CoV and showed high MERS-CoV antibody titers, whereas his nasopharyngeal swab was rRT-PCR negative. Expectorated sputum was rRT-PCR positive the following day, with a high viral load (5.31 × 106 copies/mL). He was treated with antibiotics, intravenous immunoglobulin, and oxygen by nasal cannula. He was discharged on DOI 22. The genome sequence was similar (>99%) to other known MERS-CoV sequences, clustering with those from KSA from June to July 2013. Conclusions. This patient had a prolonged nonspecific prodromal illness before developing respiratory symptoms. Both sera and sputum were rRT-PCR positive when nasopharyngeal specimens were negative. US clinicians must be vigilant for MERS-CoV in patients with febrile and/or respiratory illness with recent travel to the Arabian Peninsula, especially among healthcare workers.
AB - Background. The Middle East respiratory syndrome coronavirus (MERS-CoV) was discovered September 2012 in the Kingdom of Saudi Arabia (KSA). The first US case of MERS-CoV was confirmed on 2 May 2014. Methods. We summarize the clinical symptoms and signs, laboratory and radiologic findings, and MERS-CoV-specific tests. Results. The patient is a 65-year-old physician who worked in a hospital in KSA where MERS-CoV patients were treated. His illness onset included malaise, myalgias, and low-grade fever. He flew to the United States on day of illness (DOI) 7. His first respiratory symptom, a dry cough, developed on DOI 10. On DOI 11, he presented to an Indiana hospital as dyspneic, hypoxic, and with a right lower lobe infiltrate on chest radiography. On DOI 12, his serum tested positive by real-time reverse transcription polymerase chain reaction (rRT-PCR) for MERS-CoV and showed high MERS-CoV antibody titers, whereas his nasopharyngeal swab was rRT-PCR negative. Expectorated sputum was rRT-PCR positive the following day, with a high viral load (5.31 × 106 copies/mL). He was treated with antibiotics, intravenous immunoglobulin, and oxygen by nasal cannula. He was discharged on DOI 22. The genome sequence was similar (>99%) to other known MERS-CoV sequences, clustering with those from KSA from June to July 2013. Conclusions. This patient had a prolonged nonspecific prodromal illness before developing respiratory symptoms. Both sera and sputum were rRT-PCR positive when nasopharyngeal specimens were negative. US clinicians must be vigilant for MERS-CoV in patients with febrile and/or respiratory illness with recent travel to the Arabian Peninsula, especially among healthcare workers.
KW - Middle east respiratory syndrome coronavirus
KW - Viral pneumonia
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U2 - 10.1093/cid/ciu635
DO - 10.1093/cid/ciu635
M3 - Article
C2 - 25100864
AN - SCOPUS:84922905284
SN - 1058-4838
VL - 59
SP - 1511
EP - 1518
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -