title: Clinical and laboratory findings of the first imported case of Middle East respiratory syndrome coronavirus to the United States.
abstract: 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.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Minal
authors.initials: M
authors.lastname: Kapoor
authors.affiliation: Epidemic Intelligence Service, Division of Scientific Education and Professional Development.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Pringle
authors.affiliation: Department of Emergency Medicine, Community Hospital, Munster.
authors.forename: Alan
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Indiana State Department of Health, Indianapolis, Indiana.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dearth
authors.affiliation: Indiana State Department of Health, Indianapolis, Indiana.
authors.forename: Lixia
authors.initials: L
authors.lastname: Liu
authors.affiliation: Indiana State Department of Health, Indianapolis, Indiana.
authors.forename: Judith
authors.initials: J
authors.lastname: Lovchik
authors.affiliation: Indiana State Department of Health, Indianapolis, Indiana.
authors.forename: Omar
authors.initials: O
authors.lastname: Perez
authors.affiliation: Indiana State Department of Health, Indianapolis, Indiana.
authors.forename: Pam
authors.initials: P
authors.lastname: Pontones
authors.affiliation: Indiana State Department of Health, Indianapolis, Indiana.
authors.forename: Shawn
authors.initials: S
authors.lastname: Richards
authors.affiliation: Indiana State Department of Health, Indianapolis, Indiana.
authors.forename: Jaime
authors.initials: J
authors.lastname: Yeadon-Fagbohun
authors.affiliation: Epidemic Intelligence Service, Division of Scientific Education and Professional Development.
authors.forename: Lucy
authors.initials: L
authors.lastname: Breakwell
authors.affiliation: Epidemic Intelligence Service, Division of Scientific Education and Professional Development.
authors.forename: Nora
authors.initials: N
authors.lastname: Chea
authors.affiliation: Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases.
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Cohen
authors.affiliation: Division of Viral Diseases.
authors.forename: Eileen
authors.initials: E
authors.lastname: Schneider
authors.affiliation: Division of Viral Diseases.
authors.forename: Dean
authors.initials: D
authors.lastname: Erdman
authors.affiliation: Division of Viral Diseases.
authors.forename: Lia
authors.initials: L
authors.lastname: Haynes
authors.affiliation: Division of Viral Diseases.
authors.forename: Mark
authors.initials: M
authors.lastname: Pallansch
authors.affiliation: Division of Viral Diseases.
authors.forename: Ying
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Division of Viral Diseases.
authors.forename: Suxiang
authors.initials: S
authors.lastname: Tong
authors.affiliation: Division of Viral Diseases.
authors.forename: Susan
authors.initials: S
authors.lastname: Gerber
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: David
authors.initials: D
authors.lastname: Swerdlow
authors.affiliation: Division of Viral Diseases.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
mesh_terms: D000368:Aged; D018352:Coronavirus Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D006801:Humans; D008297:Male; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification*; D012529:Saudi Arabia; D014195:Travel; D014481:United States
keywords: Middle East respiratory syndrome coronavirus; viral pneumonia
references.citation: Lancet Infect Dis. 2013 Sep;13(9):745-51
references.pmid: 23782859
references.citation: N Engl J Med. 2013 Jun 27;368(26):2487-94
references.pmid: 23718156
references.citation: Lancet. 2013 Jun 29;381(9885):2265-72
references.pmid: 23727167
references.citation: Lancet Infect Dis. 2013 Sep;13(9):752-61
references.pmid: 23891402
references.citation: Virol J. 2007 Mar 27;4:32
references.pmid: 17386116
references.citation: Int J Infect Dis. 2014 Jun;23:63-8
references.pmid: 24699184
references.citation: N Engl J Med. 2013 Aug 1;369(5):407-16
references.pmid: 23782161
references.citation: Clin Microbiol Rev. 2006 Jul;19(3):571-82
references.pmid: 16847087
references.citation: Clin Infect Dis. 2014 Nov 1;59(9):1225-33
references.pmid: 24829216
references.citation: Proc Natl Acad Sci U S A. 2004 Feb 24;101(8):2536-41
references.pmid: 14983044
references.citation: CMAJ. 2004 Jan 6;170(1):47-54
references.pmid: 14707219
references.citation: PLoS Med. 2006 Sep;3(9):e343
references.pmid: 16968120
references.citation: MMWR Morb Mortal Wkly Rep. 2013 Sep 27;62(38):793-6
references.pmid: 24067584
references.citation: N Engl J Med. 2012 Nov 8;367(19):1814-20
references.pmid: 23075143
references.citation: Nat Med. 2013 Oct;19(10):1313-7
references.pmid: 24013700
references.citation: Lancet. 2004 May 22;363(9422):1699-700
references.pmid: 15158632
references.citation: MMWR Morb Mortal Wkly Rep. 2014 May 16;63(19):431-6
references.pmid: 24827411
references.citation: J Clin Microbiol. 2014 Jan;52(1):67-75
references.pmid: 24153118
references.citation: Ann Intern Med. 2014 Mar 18;160(6):389-97
references.pmid: 24474051
references.citation: Sci Rep. 2013;3:1686
references.pmid: 23594967