Differential Cell Count and CRP Level in Blood as Predictors for Middle East Respiratory Syndrome Coronavirus Infection in Acute Febrile Patients during Nosocomial Outbreak

Park, Ga Eun; Kang, Cheol-In; Ko, Jae-Hoon; Cho, Sun Young; Ha, Young Eun; Kim, Yae-Jean; Peck, Kyong Ran; Song, Jae-Hoon; Chung, Doo Ryeon

The clinical presentations associated with MERS-CoV infection ranged from mild to fulminant, similar to severe acute respiratory syndrome (SARS) (9) (10) (11) . The initial symptoms in the most MERS cases were nonspecific fever, usually accompanied by cough, sore throat, myalgia, headache, and diarrhea. However, these symptoms are also common in other viral infections (1, 3, 5, 7, 8) . Common laboratory findings of MERS were also similar to those of SARS and other respiratory viral infections, and lymphopenia was observed generally among MERS patients (3, 4, 8, 12) . A recent study noted that MERS-confirmed patients were more likely to have normal WBC count than patients with CAP other than MERS-CoV infection (7) . However, these findings may not be applicable to discriminate MERS from acute febrile illness other than MERS because only patients with CAP were included in the previous study (7) . Furthermore, there were few reports regarding specific laboratory features as predictors for MERS-CoV infection in acute febrile patients without pneumonia during the nosocomial outbreak. Several studies reported that initial laboratory results including normal WBC with lymphopenia and thrombocytopenia were common among SARS patients (10, 11, 13, 14) . These laboratory features allowed early classification of febrile patients into likely and unlikely SARS group to utilize limited isolation facilities effectively (9) (10) (11) 13, 14) .