key: cord-0003558-j47sm92k authors: Kim, Mi-Na; Kim, Eui-Chong title: Considering Revision the Criteria for Patients under Investigations for MERS-CoV Infections: Diarrhea or Not date: 2018-12-14 journal: J Korean Med Sci DOI: 10.3346/jkms.2018.33.e344 sha: b1e4e816bbe16c3dd36ffdead29d576677983864 doc_id: 3558 cord_uid: j47sm92k nan MERS has a diverse range of clinical manifestations from asymptomatic to fatal. 4 In 186 cases of the Korean MERS outbreak, fever, cough, sputum, diarrhea, nausea and vomiting, and abdominal pain were observed in 81.7%, 56.9%, 39.8%, 19.4%, 14.0%, and 8.1% 8 and one asymptomatic infection (0.06%) was detected from serological investigation of contact persons. 9 With that evidence, any respiratory symptoms would not be reliable enough to find PUI and gastrointestinal symptoms are too significant to neglect. Although human-to-human transmission in Saudi Arabia is markedly decreasing, 6 the current case clearly showed that MERS-CoV patients can be imported from countries other than Saudi Arabia with atypical presentation in Korea, which will make recognition of PUI more difficult. As we learned from the Korean MERS outbreak, it is an absolute necessity to detect any influx of the MERS-CoV infections at quarantine surveillance to prevent its outbreak. There is a concern of excessive testing and preemptive isolation if diarrhea is added to the criteria of PUI of MERS because traveler's diarrhea is common. During the "watch" period of the national MERS response against the current case in 2018, a tertiary care hospital in Seoul modified the criteria for testing MERS-CoV to include patients with diarrhea associated with traveling history of Middle East countries and total of 16 patients were tested for MERS-CoV but no one was tested because of diarrhea. Therefore, addition of diarrhea in clinical features indicating PUI possibly makes surveillance for MERS infections more thorough with an affordable burden. For 7 weeks during the 2015 outbreak, a total of 27,009 MERS-CoV real-time reverse transcription PCR tests were performed to confirm PUI in clinical laboratories in Korea, 10 which would be much larger than the number of MERS tests future, regardless of PUI criteria if no more outbreak occurs. Considering the detrimental impact on the healthcare system if an index case is missed, better PUI criteria provide tighter guard in quarantine surveillance. Note again that PUI criteria are not a case definition but for testing and revision of national PUI criteria to include diarrhea as a clinical feature would be beneficial in Korea. An Atypical Case of Middle East Respiratory Syndrome in a Returning Traveler to Korea from Kuwait ?cid=141153&menuIds=HOME006-MNU2802-MNU3035-MNU2869 Preliminary epidemiological assessment of MERS-CoV outbreak in South Korea Surveillance for human infection with Middle East respiratory syndrome coronavirus Interim Patient under Investigation (PUI) guidance and case definitions Investigation of cases of human infection with Middle East respiratory syndrome coronavirus Middle East respiratory syndrome case definition for reporting to WHO Interim case definition Clinical presentation and outcomes of Middle East Respiratory Syndrome in the Republic of Korea Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea Survey of clinical laboratory practices for 2015 Middle East Respiratory Syndrome coronavirus outbreak in the Republic of Korea