| ID | 103 |
|---|---|
| Name | SEVERE ACUTE RESPIRATORY SYNDROME (SARS) |
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| Introduction | Background: There has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. We report the clinical, laboratory, and radiologic features of 138 cases of suspected SARS during a hospital outbreak in Hong Kong. Methods: From March 11 to 25, 2003, all patients with suspected SARS after exposure to an index patient or ward were admitted to the isolation wards of the Prince of Wales Hospital. Their demographic, clinical, laboratory, and radiologic characteristics were analyzed. Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed. Results: There were 66 male patients and 72 female patients in this cohort, 69 of whom were health care workers. The most common symptoms included fever (in 100 percent of the patients); chills, rigors, or both (73.2 percent); and myalgia (60.9 percent). Cough and headache were also reported in more than 50 percent of the patients. Other common findings were lymphopenia (in 69.6 percent), thrombocytopenia (44.8 percent), and elevated lactate dehydrogenase and creatine kinase levels (71.0 percent and 32.1 percent, respectively). Peripheral air-space consolidation was commonly observed on thoracic computed tomographic scanning. A total of 32 patients (23.2 percent) were admitted to the intensive care unit; 5 patients died, all of whom had coexisting conditions. Conclusions: SARS is a serious respiratory illness that led tp significant morbidity and mortality in our cohort. Copyright 2003 Massachusetts Medical Society Courtesy: Massachusetts Medical Society Source: Internet (www.pubmed.gov) Case definitions: Suspect case: 1. A person presenting (after 1 November 2002*) with history of: - high fever (>3 8 °C) AND - cough or breathing difficulty AND one or more of the following exposures during the 10 days prior to onset of symptoms: - close contact* with a person who is a suspect or probable case of SARS; - history of travel, to an area with recent local transmission of SARS - residing in an area with recent local transmission of SARS 2. A person with an unexplained acute respiratory illness resulting in death (after 1 November 2002,*) but on whom no autopsy has been performed. AND one or more of the following exposures during to 10 days prior to onset of symptoms: - close contact,* with a person who is a suspect or probable case of SARS; history of travel to an area with recent local transmission of SARS - residing in an area with recent local transmission of SARS Probable case: 1. A suspect case with radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome (RDS) on chest X-ray (CXR). 2. A suspect case of SARS that is positive for SARS coronavirus by one or more assays. See Use of laboratory methods for SARS diagnosis. 3. A suspect case with autopsy findings consistent with the pathology of RDS without an identifiable cause. Exclusion criteria: A case should be excluded if an alternative diagnosis can fully explain their illness. Reclassification of cases: As SARS is currently a diagnosis of exclusion, the status of a reported case may change over time. A patient should always be managed as clinically appropriate, regardless of their case status. - A case initially classified as suspect or probable, for whom an alternative diagnosis can fully explain the illness, should be discarded after carefully considering the possibility of co-infection. - A suspect case who, after investigation, fulfils the probable case definition should be reclassified as “probable”. - A suspect case with a normal CXR should be treated, as deemed appropriate, and monitored for 7 days. Those cases in whom recovery is inadequate should be re-evaluated by CXR. - Those suspect cases in whom recovery is adequate but whose illness cannot be fully explained by an alternative diagnosis should remain as “suspect”. - A suspect case who dies, on whom no autopsy is conducted, should remain classified as “suspect”. However, if this case is identified as being part of a chain transmission of SARS, the case should be reclassified as “probable”. - If an autopsy is conducted and no pathological evidence of RDS is found, the case should be “discarded”. - The surveillance period begins on 1 November 2002 to capture cases of atypical pneumonia in China now recognized as SARS. International transmission of SARS was first reported in March 2003 for cases with onset in February 2003. - Close contact: having cared for, lived with, or had direct contact with respiratory secretions or body fluids of a suspect or probable case of SARS. Courtesy: WHO Source: Internet (www.who.int/csr/sars/casedeflnUion/en/) |
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