Infect Chemother.  2016 Jun;48(2):118-126. 10.3947/ic.2016.48.2.118.

Clinical Presentation and Outcomes of Middle East Respiratory Syndrome in the Republic of Korea

Affiliations
  • 1Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 2Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Center for Infectious Disease, National Medical Center, Seoul, Korea.
  • 4Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
  • 5Respiratory Center, National Medical Center, Seoul, Korea.
  • 6Division of Infectious Diseases, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea.
  • 7Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejon, Korea. alice@cnuh.co.kr
  • 8Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 9Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 10Division of Infectious Diseases, Department of Internal Medicine, Seonam University Myongji Hospital, Goyang, Korea.
  • 11Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 12Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
  • 13Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 14Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
  • 15Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
  • 16Division of Infectious Diseases and Office of Infection Control, Armed Forces Capital Hospital, Seongnam, Korea.
  • 17Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.
  • 18Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital, Korea.
  • 19Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Korea.
  • 20Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea.
  • 21Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
  • 22Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
  • 23Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea.
  • 24Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Korea.
  • 25Division of Infectious Diseases, Department of Internal Medicine, Busan Medical Centre, Busan, Korea.
  • 26Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
  • 27Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 28Department of Infectious Diseases, Chonnom National University Medical School, Gwangju, Korea.
  • 29Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea.
  • 30Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea.
  • 31Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
  • 32Division of Infectious Diseases, Konkuk University Hospital, Seoul, Korea.

Abstract

BACKGROUND
From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015.
MATERIALS AND METHODS
We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay.
RESULTS
The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death.
CONCLUSION
The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.

Keyword

Middle East respiratory syndrome; Republic of Korea

MeSH Terms

Antiviral Agents
Aspartate Aminotransferases
Coronavirus Infections*
Disease Outbreaks
Dyspnea
Extracorporeal Membrane Oxygenation
Fever
Humans
Hypotension
Leukocytosis
Leukopenia
Lung Diseases
Middle East Respiratory Syndrome Coronavirus
Middle East*
Mortality
Pneumonia
Polymerase Chain Reaction
Republic of Korea*
Respiration, Artificial
Thrombocytopenia
Antiviral Agents
Aspartate Aminotransferases
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