JOURNAL ARTICLE

Clinical and laboratory findings of the first imported case of Middle East respiratory syndrome coronavirus to the United States

Minal Kapoor, Kimberly Pringle, Alan Kumar, Stephanie Dearth, Lixia Liu, Judith Lovchik, Omar Perez, Pam Pontones, Shawn Richards, Jaime Yeadon-Fagbohun, Lucy Breakwell, Nora Chea, Nicole J Cohen, Eileen Schneider, Dean Erdman, Lia Haynes, Mark Pallansch, Ying Tao, Suxiang Tong, Susan Gerber, David Swerdlow, Daniel R Feikin
Clinical Infectious Diseases 2014 December 1, 59 (11): 1511-8
25100864

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 × 10(6) 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.

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