Atypical presentations of MERS-CoV infection in immunocompromised hosts

Si-Ho Kim; Jae-Hoon Ko; Ga Eun Park; Sun Young Cho; Young Eun Ha; Ji-Man Kang; Yae-Jean Kim; Hee Jae Huh; Chang-Seok Ki; Byeong-Ho Jeong; Jinkyeong Park; Jun Ho Jang; Won Seog Kim; Cheol-In Kang; Doo Ryeon Chung; Jae-Hoon Song; Kyong Ran Peck

doi:10.1016/j.jiac.2017.04.004

Atypical presentations of MERS-CoV infection in immunocompromised hosts

J Infect Chemother. 2017 Nov;23(11):769-773. doi: 10.1016/j.jiac.2017.04.004. Epub 2017 May 23.

Authors

Si-Ho Kim¹, Jae-Hoon Ko¹, Ga Eun Park¹, Sun Young Cho¹, Young Eun Ha¹, Ji-Man Kang², Yae-Jean Kim², Hee Jae Huh³, Chang-Seok Ki³, Byeong-Ho Jeong⁴, Jinkyeong Park⁵, Jun Ho Jang⁶, Won Seog Kim⁶, Cheol-In Kang¹, Doo Ryeon Chung¹, Jae-Hoon Song¹, Kyong Ran Peck⁷

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
² Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
³ Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁵ Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁶ Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁷ Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea. Electronic address: [email protected].

Abstract

During the 2015 Korean MERS outbreak, we experienced atypical presentations of MERS-CoV infections in three immunocompromised hosts that warranted exceptional management. Case 1 showed delayed symptom development after a four-day asymptomatic period, Case 2 experienced a 20-day incubation period, and Case 3 exhibited persistent viral shedding without clinical deterioration. Recognizing these exceptions is extremely important in the management of MERS-CoV-exposed or -infected patients and for control of potential MERS outbreaks.

Keywords: Asymptomatic period; Corticosteroid; Immunocompromised host; Incubation period; Middle East respiratory syndrome coronavirus.

Publication types

Case Reports

MeSH terms

Adult
Antiviral Agents / therapeutic use
Blood Component Transfusion
Coronavirus Infections / diagnosis*
Coronavirus Infections / epidemiology*
Coronavirus Infections / therapy
Coronavirus Infections / virology
Disease Outbreaks / prevention & control*
Fatal Outcome
Female
Glucocorticoids / therapeutic use
Hematologic Neoplasms / therapy
Humans
Immunocompromised Host*
Immunosuppression Therapy / adverse effects
Infectious Disease Incubation Period
Male
Middle Aged
Middle East Respiratory Syndrome Coronavirus / isolation & purification*
Middle East Respiratory Syndrome Coronavirus / physiology
Peripheral Blood Stem Cell Transplantation / adverse effects
Republic of Korea / epidemiology
Reverse Transcriptase Polymerase Chain Reaction
Time Factors
Tomography, X-Ray Computed
Virus Shedding

Substances

Antiviral Agents
Glucocorticoids