Clinical and Laboratory Findings of the First Imported Case of Middle East Respiratory Syndrome Coronavirus to the United States

November 30, 2014 at 8:13 pm

Clinical Infectious Diseases December 1, 2014 V.59 N.11 P.1511-1518

Minal Kapoor1, Kimberly Pringle4, Alan Kumar2, Stephanie Dearth3, Lixia Liu3, Judith Lovchik3, Omar Perez3, Pam Pontones3, Shawn Richards3, Jaime Yeadon-Fagbohun3, Lucy Breakwell4, Nora Chea4, Nicole J. Cohen5, Eileen Schneider6, Dean Erdman6, Lia Haynes6, Mark Pallansch6, Ying Tao6, Suxiang Tong6, Susan Gerber6, David Swerdlow7, and Daniel R. Feikin6

1Division of Infectious Diseases

2Department of Emergency Medicine, Community Hospital, Munster

3Indiana State Department of Health, Indianapolis, Indiana

4Epidemic Intelligence Service, Division of Scientific Education and Professional Development

5Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases

6Division of Viral Diseases

7National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Correspondence: Daniel R. Feikin, MD, MSPH, Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A34, Atlanta, GA 30030 (


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.


We summarize the clinical symptoms and signs, laboratory and radiologic findings, and MERS-CoV–specific tests.


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.


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.



Entry filed under: Biología Molecular, Epidemiología, FIEBRE en el POST-VIAJE, Infecciones emergentes, Infecciones respiratorias, Infecciones virales, Medicina del viajero, Metodos diagnosticos, REPORTS, REVIEWS, Sepsis, Update.

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