Eurosurveillance, Volume 19, Issue 18, 08 May 2014
Rapid communications
Laboratory-confirmed case of Middle East respiratory
syndrome coronavirus (MERS-CoV) infection in Malaysia: preparedness and
response, April 2014
J Premila Devi (
)1, W Noraini1, R Norhayati1, C Chee Kheong1, A S Badrul1, S Zainah1, K Fadzilah1, I Hirman1, S Lokman Hakim1, A Noor Hisham1
)1, W Noraini1, R Norhayati1, C Chee Kheong1, A S Badrul1, S Zainah1, K Fadzilah1, I Hirman1, S Lokman Hakim1, A Noor Hisham1- Ministry of Health Malaysia
Citation style for this article: Premila Devi J, Noraini
W, Norhayati R, Chee Kheong C, Badrul AS, Zainah S, Fadzilah K, Hirman
I, Lokman Hakim S, Noor Hisham A. Laboratory-confirmed case of Middle
East respiratory syndrome coronavirus (MERS-CoV) infection in Malaysia:
preparedness and response, April 2014. Euro Surveill.
2014;19(18):pii=20797. Available online:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20797
Date of submission: 25 April 2014
On
14 April 2014, the first laboratory-confirmed case of Middle East
respiratory syndrome coronavirus (MERS-CoV) infection was reported in
Malaysia in a man in his mid-fifties, who developed pneumonia with
respiratory distress, after returning from a pilgrimage to Saudi Arabia.
The case succumbed to his illness three days after admission at a local
hospital. The follow-up of 199 close contacts identified through
contact tracing and vigilant surveillance did not result in detecting
any other confirmed cases of MERS-CoV infection.
Date of submission: 25 April 2014
Here we report a laboratory-confirmed case of Middle East respiratory syndrome (MERS-CoV) in a patient returning to Malaysia from an Umrah pilgrimage in Saudi Arabia.
Case report and travel history
Case report
On 9 April 2014, a man aged in his mid-fifties, on treatment for diabetes, presented at the emergency department of a public hospital in Malaysia with complaints of cough, fever and shortness of breath.
Clinical investigation showed the patient to be afebrile with a temperature of 36.7°C and radiographic evidence of pneumonia. The next day, the patient was hospitalised, and because he had been travelling to Saudi Arabia 13 days prior, he was managed in an isolation room for suspected possible MERS-CoV infection.
The staff of the local hospital and caring for the patient complied with infection prevention and control procedures according to national guidelines [1].
The patient was treated for a provisional diagnosis of community-acquired pneumonia. As bacteriological (culture of blood samples) investigation yielded negative results, the patient was treated with oseltamivir.
On 10 April 2014, due to worsening of his condition he was intubated. However, the patient developed consecutive multi-organ failure and his condition further deteriorated.
On 13 April 2014, throat samples were taken and he passed away on the same day.
Laboratory investigation
Diagnosis of MERS-CoV was confirmed by polymerase chain reaction (PCR) in the hospital laboratory on 14 April 2014.A real-time reverse-transcription PCR (rRT-PCR) screening assay targeting upstream of the envelope gene (upE assay) and a rRT-PCR confirmatory assay targeting the open reading frame (ORF)1a yielded positive results.
On 15 April 2014 sample was sent to the Institute for Medical Research (IMR), Kuala Lumpur, for sequencing of genes that code for the nucleocapsid (N) and RNA-dependent RNA polymerase (RdRp) proteins of the MERS-CoV [2].
Travel history
The travel history of the case was obtained from interviewing a relative who travelled with him. The interview was carried out using the standard questionnaire recommended by the World Health Organization (WHO) [3]. The case travelled to Saudi Arabia from 15 to 28 March 2014 to perform the Umrah pilgrimage with a group of 17 fellow pilgrims. Following the Umrah rituals on 26 March, he visited a camel farm in Saudi Arabia, where he patted camels and consumed unpasteurised camel milk sold by vendors at the farm. On 28 March, the case and his travel group boarded a flight from Jeddah, Saudi Arabia, to Istanbul, Turkey, and took another connecting flight from Istanbul to Malaysia where they arrived on 29 March 2014.
The case was well during his travel and went back to his village on same day of arrival. The patient started feeling unwell on 4 April 2014, and sought treatment in a private clinic on 7 April 2014. At the private clinic he complained of body aches and was given analgesics.
A brief timeline of the case’s travel, possible exposure to the virus, healthcare contacts and diagnosis is detailed in the Figure.
Figure. Timeline of possible exposure to Middle East respiratory syndrome coronavirus (MERS-CoV), travel, healthcare contacts and diagnosis of a case of MERS-CoV, Malaysia, March–April 2014
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