(1) A 43 years old male of South Korean nationality was admitted with the complaint of
back ache for 7 days and
fever 2 days with the following characteristics:
back ache 7 days ago, without
fever or
cough or expectoration. He had been suspected to suffer from
infection of Middle East respiratory syndrome coronavirus ( MERS-CoV ) by the Disease Control Department of South Korea, but no specific treatment was given. He had
fever for 2 days with maximum body temperature of 39.7 centigrade. He had no
chills,
cough, expectoration, short of breath,
abdominal pain,
diarrhea, frequent micturition, or urgency or
pain of urination, and no
sore throat. The patient had a history of exposure to MERS-CoV patient. He was considered to be a patient of the second batch of South Korean epidemic. (2) Auxiliary examination: 3 copies of throat swab specimens for virus
nucleic acid detection were performed by the Disease Prevention Control Center of China ( China CDC ), and they were positive on May 29th, 2015, and also for serum, sputum and stool. Based on the results of whole genome sequence analysis, the virus strains were implicated to be derived from Riyahh and Jeddah regions of Saudi Arabia. On admission, the patient's blood test showed that the white blood cell count was low ( 3.22×10(9)/L ), the proportion of the neutrophils was high ( 0.73 ), and that of the platelet was low ( 81×10(9)/L ). On admission, the patient's chest X-ray showed that a small amount of infiltration in the lung. (3) TREATMENT: a high-flow
nasal cannula ( HFNC ) with
oxygen concentration of 0.50-0.80 was given, with a flow rate was set at 60 L/min if tolerated. It was changed to a low flow
oxygen inhalation
nasal cannula on the 20th day, and
oxygen treatment was stopped on the 24th day.
Ribavirin 2.0 g was given as the first dose, and was switched to 600 mg every 8 h ( q8h ), and it was reduced to 600 mg q12h after 10 days, and extenuated since the 13th day.
Ceftriaxone was added on the 4th day with 2.0 g a day , and it was changed to
meropenem 2.0 g, q8h on the 7th day for 2 weeks.
Gamma globulin was given for 7 days ( 20 g, qd ). Thymosin-α1 was given on the 8th day for 2 weeks.
Interferon was given once a week, but only one dose was used. At the same time symptomatic treatment such as
methimazole and liver protection
therapy were given. (4) Patient began to
cough at admission, and it disappeared on the 18th day. There was no sputum at first, then a small amount of sputum with a little blood appeared after the admission. Then there was
cough without sputum. Mild
shortness of breath and
diarrhea after exertion were noticed. He had no
chest pain, difficulty in breathing or other symptoms. There was dullness on percussion in both sides of chest, and it disappeared gradually. Fine moist
rales were detectable in scapular area and interscapular area on the 5th day, and they disappeared after 3 days. Breath sounds on both sides was weak, and it became more obvious in the right lung after 5 days, and returned to normal after 18 days. He had a sustaining
fever for 1 week with the maximum temperature of 39.5 centigrade, then the body temperature returned to normal. The viral
nucleic acid test as performed by the Center for Disease Control of Guangdong ( CDC, Guangdong ) showed that the pharyngeal swab cultured turned negative on the 3rd day, that of serum specimens turned negative on the 8th day, that of stool specimen after 2 weeks, and it was persistently positive for sputum culture until 5 days before discharge. The oxygenation index gradually increased, and it was over 300 mmHg ( 1 mmHg = 0.133 kPa ) after 15 days.
Pleural effusion was rapidly increased during the first week as shown by chest
X-ray films, and it began to be absorbed gradually in the second week, but it was not completely absorbed until discharge.
CONCLUSIONS: