Clinical Progression and Cytokine Profiles of Middle East Respiratory Syndrome Coronavirus Infection

Kim, Eu Suk; Choe, Pyoeng Gyun; Park, Wan Beom; Oh, Hong Sang; Kim, Eun Jung; Nam, Eun Young; Na, Sun Hee; Kim, Moonsuk; Song, Kyoung-Ho; Bang, Ji Hwan; Park, Sang Won; Kim, Hong Bin; Kim, Nam Joong; Oh, Myoung-don

The clinical manifestations of MERS-CoV infection range from asymptomatic infection to fatal pneumonia (13) . In this study, common presenting symptoms were fever, chills, and cough. Upper respiratory symptoms such as rhinorrhea and sore throat were rare. Previous studies reported that pneumonia progresses very rapidly, with a median time to the need for mechanical ventilation of 7 days (range, 3 to 11 days) (14, 15) . In this study, however, most patients had pneumonia in week 1, but their symptoms were not so severe that they did not feel they needed to stay at home ("walking pneumonia"). Dyspnea requiring oxygen supplementation and sudden progression of pneumonia usually developed during the second week. Similar to SARS (16), the median time from symptom onset to ventilator support was 11 days. Because of this clinical progression of initial mild symptoms followed by sudden clinical deterioration, patients with MERS-CoV infection may present at emergency room (ER). Therefore, ER department should prepare for the early detection and isolation of a possible MERS case with appropriate infection prevention and control methods.