Infectious MERS-CoV Isolated From a Mildly Ill Patient, Saudi Arabia

Abstract

Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with a wide range of clinical presentations, from asymptomatic or mildly ill to severe respiratory illness including death. We describe isolation of infectious MERS-CoV from the upper respiratory tract of a mildly ill 27-year-old female in Saudi Arabia 15 days after illness onset.

Keywords: MERS; asymptomatic; mild; prolonged detection; virus isolation.

Figure 1.

Clinical, laboratory, and hospital findings. A, Timeline of events during the patient’s hospital stay, by days after illness onset. Patient-reported illness onset (represented as day 0) was on September 30, 2015. Hospital admission and discharge were on days 10 and 40 after illness onset, respectively. Reported symptoms, treatments, and laboratory tests are depicted. The patient’s medical chart was systematically reviewed for administration of medications and for mention of the following symptoms on each day of hospitalization: fever, cough (with description if available), headache, sore throat, dyspnea, chest pain, muscle ache, chills, abdominal pain, vomiting, diarrhea, and other; rhinorrhea was reported under other symptoms. A solid circle means that the medication was administered or the symptom was reported in the chart. Symptoms not depicted were not reported throughout hospitalization. Temperature was also recorded from regular vital sign measurements. We defined fever as a measured oral temperature of >38.0°C or a measured axillary temperature of >37.5°C; she remained afebrile throughout. For test results, a solid circle represents a positive result and an open circle represents a negative result; the red circle at day 36 of the Saudi Arabia Ministry of Health (MoH) real-time reverse transcriptase polymerase chain reaction (rRT-PCR) results represents a probable positive result (only 1 of 2 rRT-PCR assays was positive; cycle threshold (Ct) values not available). Nasopharyngeal (NP⁺): live virus was also isolated from the 2 NP specimens submitted to the Centers for Disease Control and Prevention (CDC). B, Middle East respiratory syndrome coronavirus (MERS-CoV) upE rRT-PCR Ct values obtained from MoH diagnostic testing by days after illness onset. The dashed line represents the limit of detection, above which specimens were considered MERS-CoV-negative (open circle). Probable positive (red circle) results were assigned a value of 40 for graphing purposes. A Ct value was not available for the specimen collected 22 days after illness. Abbreviations: ELISA, enzyme-linked immunosorbent assay; N, nucleocapisd; S, spike.