Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
권호 표지
DOI QR코드

DOI QR Code

An Atypical Case of Middle East Respiratory Syndrome in a Returning Traveler to Korea from Kuwait, 2018

  • Bak, Song Lee (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Jun, Kang Il (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Jung, Jongtak (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Jeong-Han (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kang, Chang Kyung (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Park, Wan Beom (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Nam-Joong (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Oh, Myoung-don (Department of Internal Medicine, Seoul National University College of Medicine)
  • Received : 2018.10.12
  • Accepted : 2018.11.29
  • Published : 2018.12.31
⟨ Previous Next ⟩

Abstract

We report a case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in a 61-year-old businessman returning from Kuwait. The patient arrived there on August 16, 2018, developed watery diarrhea on August 28 (day 0), and came back to Korea on September 7 (day 10) as his condition worsened. Upon arrival, he complained of diarrhea and weakness, but denied any respiratory symptoms, and he directly went to visit an emergency room. Chest radiography revealed interstitial infiltrates in the lungs, and he was immediately transferred to an isolation unit. Quantitative real-time PCR analysis of sputum samples taken on day 11 returned positive for MERS-CoV. No secondary MERS-CoV infection was identified among people who had close contact with him. This case underscores the importance of a high index of suspicion of MERS-CoV infection in any febrile patients who present after a trip to the Middle East.

Keywords

References

  1. Arabi YM, Balkhy HH, Hayden FG, Bouchama A, Luke T, Baillie JK, et al. Middle East respiratory syndrome. N Engl J Med 2017;376(6):584-94. https://doi.org/10.1056/NEJMsr1408795
  2. Hijawi B, Abdallat M, Sayaydeh A, Alqasrawi S, Haddadin A, Jaarour N, et al. Novel coronavirus infections in Jordan, April 2012: epidemiological findings from a retrospective investigation. East Mediterr Health J 2013;19 Suppl 1:S12-8. https://doi.org/10.26719/2013.19.supp1.S12
  3. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). http://www.who.int/emergencies/mers-cov/en/. Updated 2018. Accessed Oct 12, 2018.
  4. Kang CK, Song KH, Choe PG, Park WB, Bang JH, Kim ES, et al. Clinical and epidemiologic characteristics of spreaders of Middle East respiratory syndrome coronavirus during the 2015 outbreak in Korea. J Korean Med Sci 2017;32(5):744-9. https://doi.org/10.3346/jkms.2017.32.5.744
  5. Korea Centers for Disease Control and Prevention. Middle East respiratory syndrome statistics (Korean). http://www.cdc.go.kr/CDC/contents/CdcKrContentView.jsp?cid=140626&menuIds=HOME006-MNU2802-MNU3035-MNU2869. Updated 2018. Accessed Oct 12, 2018.
  6. Conzade R, Grant R, Malik MR, Elkholy A, Elhakim M, Samhouri D, et al. Reported direct and indirect contact with dromedary camels among laboratory-confirmed MERS-CoV cases. Viruses 2018;10(8):E425. https://doi.org/10.3390/v10080425
  7. Choi WS, Kang CI, Kim Y, Choi JP, Joh JS, Shin HS, et al. Clinical presentation and outcomes of Middle East respiratory syndrome in the Republic of Korea. Infect Chemother 2016;48(2):118-26. https://doi.org/10.3947/ic.2016.48.2.118
  8. Kim ES, Choe PG, Park WB, Oh HS, Kim EJ, Nam EY, et al. Clinical progression and cytokine profiles of Middle East respiratory syndrome coronavirus infection. J Korean Med Sci 2016;31(11):1717-25. https://doi.org/10.3346/jkms.2016.31.11.1717
  9. Chan JF, Chan KH, Choi GK, To KK, Tse H, Cai JP, et al. Differential cell line susceptibility to the emerging novel human betacoronavirus 2c EMC/2012: implications for disease pathogenesis and clinical manifestation. J Infect Dis 2013;207(11):1743-52. https://doi.org/10.1093/infdis/jit123
  10. Corman VM, Albarrak AM, Omrani AS, Albarrak MM, Farah ME, Almasri M, et al. Viral shedding and antibody response in 37 patients with Middle East respiratory syndrome coronavirus infection. Clin Infect Dis 2016;62(4):477-83. https://doi.org/10.1093/cid/civ951
  11. Wu J, Yi L, Zou L, Zhong H, Liang L, Song T, et al. Imported case of MERS-CoV infection identified in China, May 2015: detection and lesson learned. Euro Surveill 2015;20(24):21158. https://doi.org/10.2807/1560-7917.ES2015.20.24.21158
  12. Zhou J, Li C, Zhao G, Chu H, Wang D, Yan HH, et al. Human intestinal tract serves as an alternative infection route for Middle East respiratory syndrome coronavirus. Sci Adv 2017;3(11):eaao4966. https://doi.org/10.1126/sciadv.aao4966
  13. Kligerman SJ, Franks TJ, Galvin JR. From the radiologic pathology archives: organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. Radiographics 2013;33(7):1951-75. https://doi.org/10.1148/rg.337130057
  14. Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings. AJR Am J Roentgenol 2014;203(4):782-7. https://doi.org/10.2214/AJR.14.13021
  15. El Zein S, Khraibani J, Zahreddine N, Mahfouz R, Ghosn N, Kanj SS. Atypical presentation of Middle East respiratory syndrome coronavirus in a Lebanese patient returning from Saudi Arabia. J Infect Dev Ctries 2018;12(9):808-11. https://doi.org/10.3855/jidc.9979
  16. World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance. http://apps.who.int/iris/handle/10665/178529. Updated 2015. Accessed Oct 12, 2018.

Cited by

  1. Considering Revision the Criteria for Patients under Investigations for MERS-CoV Infections: Diarrhea or Not vol.33, pp.53, 2018, https://doi.org/10.3346/jkms.2018.33.e344
  2. Potential fecal transmission of SARS-CoV-2: Current evidence and implications for public health vol.95, pp.None, 2020, https://doi.org/10.1016/j.ijid.2020.04.057
  3. Increased Pathogenicity and Virulence of Middle East Respiratory Syndrome Coronavirus Clade B In Vitro and In Vivo vol.94, pp.15, 2018, https://doi.org/10.1128/jvi.00861-20