SARS is a highly contagious disease that caused a worldwide pandemic in 2002 and 2003 [1] causing the death of many people [2]. The spread of the disease is especially rapid due to the extensive transportation of people and goods worldwide [3]. A high degree of suspicion, awareness, and surveillance is necessary to prevent this life -threatening illness [3]. The cause of SARS is known to be the corona virus [4]. It has an animal reservoir, usually bats, although it may also reside in camels or chimpanzees. The mode of transmission of the virus is either animal to human or most commonly, from infected humans to humans via the droplets of sneeze or a cough. The virus can also spread by direct contact i.e. by touching infected surfaces and then touching one's nose, eyes or mouth. The signs and symptoms of SARS in the initial stages resemble those of the common cold or other common respiratory illnesses but are usually more severe. There may be an initial prodrome of easy fatigability, malaise, and headache during the incubation period which can last from 2 to 10 days. Other symptoms may include high-grade fever, dyspnea, cough, and diarrhea [5]. On auscultation of the chest, inspiratory crackles may be diagnosed. In severe cases, respiratory as well as multi-organ failure will necessitate ventilator and life support measures in the intensive care unit.

Risk factors for mortality include old age, the presence of medical comorbidities, elevated lactic dehydrogenase levels and elevated neutrophil counts.

• Fever

  She presented initially with fever and a normal chest radiograph. [ncbi.nlm.nih.gov]

  You can relieve symptoms with pain and fever medicines and rest. Centers for Disease Control and Prevention [nlm.nih.gov]

• Chills

  He presented with sudden onset of fever, chills, myalgia, headache, and dizziness in early March 2003. He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness. [ncbi.nlm.nih.gov]

  Symptoms of SARS can vary, but may include high fever, chills, headache, body aches, pneumonia, diarrhea, dry cough, low levels of oxygen in the blood. No single medicine can effectively treat SARS. [nj.gov]

  The most common symptoms of SARS are: Fever Cough Chills or shaking Fatigue Shortness of breath Headache Diarrhea What Causes SARS? SARS is caused by a coronavirus, the family of viruses that causes the common cold. [lung.org]

• Malaise

  Common presenting features of SARS are high fever, chills, rigor, malaise, nonproductive cough, lymphopenia and pulmonary infiltrates, followed by rapidly progressive respiratory failure in some cases. [ncbi.nlm.nih.gov]

• Weakness

  It also exposed major weaknesses in several of these countries in coping with an outbreak of a newly emerged infectious disease. [ncbi.nlm.nih.gov]

  E M protein 26,398-27,063 221 666 +1 Strong M ORF 7 27,074-27,265 63 192 +2 Weak X3 ORF 8 27,273-27,641 122 369 +3 Strong X4 ORF 9 27,638-27,772 44 135 +2 Weak N/R ORF 10 27,779-27,898 39 120 +2 Strong N/R ORF 11 27,864-28,118 84 255 +3 Weak X5 N protein [sciencemag.org]

• Fatigue

  Infection initially brings flu-like symptoms including fever and fatigue, but it then attacks the lungs causing a dry cough, difficulty breathing and pneumonia. [newscientist.com]

  SARS infection initially causes a fever, headache and fatigue. Respiratory symptoms including a dry cough and increasing shortness of breath, developing within 2 to 7 days. [lung.org]

  Patient Zero developed symptoms of fatigue the day before his jogging. When Patient Zero jogged, the transmission of the virus increased due to the excessive heavy breathing. [weekly.chinacdc.cn]

• Cough

  Cover your mouth and nose when you sneeze or cough. Droplets that are released when a person sneezes or coughs are infectious. DO NOT share food, drink, or utensils. Clean commonly touched surfaces with an EPA-approved disinfectant. [nlm.nih.gov]

  If you become ill with a fever of more than 100.4ºF that is accompanied by cough or difficulty breathing (or that progresses to a cough and/or difficulty breathing), and you have traveled within the last 10 days to areas where cases of SARS have been [lahey.org]

  Other symptoms may include high-grade fever, dyspnea, cough, and diarrhea. On auscultation of the chest, inspiratory crackles may be diagnosed. [symptoma.com]

• Respiratory Distress

  She developed fever on April 21 and respiratory distress on April 25, and received ribavirin, intravenous immunoglobulin, and steroid. The respiratory distress persisted and worsened, and intubation was performed on April 27. [ncbi.nlm.nih.gov]

  […] syndrome(SARS), known as acute respiratory contagion, can induce lung injury relating to acute respiratory distress syndrome(ARDS) in earlier period, and lung fibrosis in later period. [en.cnki.com.cn]

• Dry Cough

  A 33-year-old gravida 2 para 1 fulfilling the World Health Organization case definition for probable SARS was admitted to our institution at 31 weeks of gestation with fever, a dry cough, and patchy infiltrates on chest X-ray. [ncbi.nlm.nih.gov]

  cough, shortness of breath (dyspnea) or breathing difficulties, and atypical pneumonia, a virus in the genus cornonavirus is the suspected causative agent ICD-9-CM Volume 2 Index entries containing back-references to 079.82 : [icd9data.com]

  […] species Severe acute respiratory syndrome-related virus of the genus Betacoronavirus), is transmitted especially by contact with infectious material (such as respiratory droplets or body fluids), and is characterized by fever, headache, body aches, a dry [merriam-webster.com]

  Symptoms of SARS can vary, but may include high fever, chills, headache, body aches, pneumonia, diarrhea, dry cough, low levels of oxygen in the blood. No single medicine can effectively treat SARS. [nj.gov]

• Sputum

  A sputum culture yielded normal oral flora, and sputum smears were negative for acid-fast bacilli. [ncbi.nlm.nih.gov]

  […] of 100.4°F (38.0°C) or higher Other breathing symptoms The most common symptoms are: Chills and shaking Cough, usually starts 2 to 3 days after other symptoms Headache Muscle aches Tiredness Less common symptoms include: Cough that produces phlegm (sputum [nlm.nih.gov]

• Dyspnea

  Other symptoms may include high-grade fever, dyspnea, cough, and diarrhea. On auscultation of the chest, inspiratory crackles may be diagnosed. [symptoma.com]

  […] elsewhere Approximate Synonyms SARS (severe acute respiratory distress syndrome) SARS (severe acute respiratory syndrome) Severe acute respiratory syndrome Clinical Information Viral disorder characterized by high fever, dry cough, shortness of breath (dyspnea [icd9data.com]

  On admission to National Taiwan University Hospital in Taipei, the patient experienced chest tightness, progressive dyspnea, and low-grade fever. [ncbi.nlm.nih.gov]

• Tachycardia

  Tachycardia (in five of nine cases), tachypnea (in seven of nine), and borderline low blood pressure (in five of nine) were common. Oxygen saturation while breathing room air was less than 95 percent in seven of nine patients. [nejm.org]

• Myalgia

  He presented with sudden onset of fever, chills, myalgia, headache, and dizziness in early March 2003. He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness. [ncbi.nlm.nih.gov]

  Hanoi, Viet Nam On the 26 February 2003, a man (index case) was admitted to hospital in Hanoi with a high fever, dry cough, myalgia and mild sore throat. [who.int]

  In general, SARS patients present with fever (temperature greater than 100.4°F [>38.0°C]), malaise and myalgias quickly followed by respiratory symptoms including shortness of breath and cough. Ten to 20 percent of patients may have diarrhea. [ehs.unc.edu]

  Case definition Clinical description Relatively insidious onset with fever, myalgia, malaise and headache, followed a few days to 1 week later by dry cough and dyspnoea. About 25 percent of cases have diarrhoea. [health.govt.nz]

• Aggressive Behavior

  Disease description An autosomal recessive disorder characterized by delayed psychomotor development, intellectual disability, seizures apparent in infancy, impaired speech, and aggressive behavior. [uniprot.org]

• Headache

  He presented with sudden onset of fever, chills, myalgia, headache, and dizziness in early March 2003. He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness. [ncbi.nlm.nih.gov]

  […] caused by a coronavirus (species Severe acute respiratory syndrome-related virus of the genus Betacoronavirus), is transmitted especially by contact with infectious material (such as respiratory droplets or body fluids), and is characterized by fever, headache [merriam-webster.com]

  Hong Kong Special Administrative Region of China Influenza A(H5N1) reported in February On 12 March 2003, 20 health care workers developed influenza-like symptoms (high fever, headache and lower respiratory symptoms). [who.int]

• Polyneuropathy

  The neuromuscular problems in patients with SARS are considered to be critical-illness polyneuropathy or myopathy, possibly coexistent. [ncbi.nlm.nih.gov]

  Complications include altered lung function, polyneuropathy, and avascular necrosis. The overall death (mortality) rate from SARS is about 10%. Age is a risk factor and plays a large role in the prognosis. [emedicinehealth.com]

  Significant reductions in the diffusing capacity of carbon monoxide and in exercise ability (6-min walking distance) were also documented at 12 months. [50] Polyneuropathy and myopathy associated with critical illness, avascular necrosis (possibly steroid [emedicine.com]

A thorough patient history and clinical suspicion are essential for early diagnosis of the illness. SARS should be suspected in a patient who has a cough, and dyspnea, especially if there is a concomitant history of contact with an infected person and/or recent air travel.

Routine laboratory tests like complete blood count, liver function tests, and creatine kinase assessment are performed and may show leukopenia, lymphopenia, elevated liver enzymes and lactic dehydrogenase and creatine kinase levels [6]. A radiograph of the chest may reveal either focal infiltrates or diffuse pulmonary infiltrates [6]. The rapid polymerase chain reaction (PCR) test, SARS antibody test and isolation of the SARS virus are recommended to identify the causative virus. However, these tests may be negative in the early phase of the illness and have their own limitations.

Other tests like enzyme-linked immunosorbent assay (ELISA) and immunofluorescent antibody tests are still under development [3]. Therefore, the diagnosis has to be based on history and clinical findings to prevent rapid progression of the disease.

• Chest X-Ray Abnormal

  Patient I, a 23-year-old man who had close contact with patient G, had onset of symptoms on April 25; unilateral abnormalities became visible on chest x-ray during the course of his illness. [doi.org]

• X-Ray Abnormal

  Patient I, a 23-year-old man who had close contact with patient G, had onset of symptoms on April 25; unilateral abnormalities became visible on chest x-ray during the course of his illness. [doi.org]

• Bilateral Pulmonary Infiltrates

  He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness. [ncbi.nlm.nih.gov]

• Hypercapnia

  In the early recovery period, potential problems during diving are caused by inadequate lung ventilation in relation to exercise level and increased breathing resistance attributable to weak respiratory muscles, with corresponding risk of hypoxia and hypercapnia [ncbi.nlm.nih.gov]

• Leukocytosis

  Other risk factors include patients with chronic hepatitis B infection, hepatitis from any cause, diabetes, lymphopenia, leukocytosis, and high cytokine levels early (first week) in the SARS infection. SARS Pictures SARS-associated coronavirus. [emedicinehealth.com]

  Certain risk factors, including the following, have been associated with a poorer prognosis [47, 48] : Older age Chronic hepatitis B infection Laboratory features - Including marked lymphopenia and leukocytosis, elevated lactate dehydrogenase level, hepatitis [emedicine.com]

Treatment regimens varied widely but can be classified into two groups, early treatment and rescue treatment given at a later stage of illness. [dx.doi.org]

The standard treatment might be beneficial for decreasing the mortality rate. [ncbi.nlm.nih.gov]

The associations of decreased serum PF4 and increased serum beta-TG levels with poor prognosis were confirmed by Western blot. [ncbi.nlm.nih.gov]

In particular, the primary analysis focused on age, clinical manifestations, diagnostic and therapeutic management, and prognosis of children with COVID-19. [jamanetwork.com]

 Acute  Sudden onset of a high fever  Can be lethal for severe cases  10.9% average death rate in the most severe cases  Not lethal for mildly affected people  With time, relief of symptoms, and no complications  Difficult to make an accurate prognosis [slideshare.net]

What Is the Prognosis? Most people recover from SARS. However, in the initial outbreaks of 2002 and 2003, there were 774 deaths among the more than 8,000 cases that were identified. [healthychildren.org]

The origin of its etiological agent, the SARS coronavirus (SARS-CoV), remains elusive. Here we report that species of bats are a natural host of coronaviruses closely related to those responsible for the SARS outbreak. [ncbi.nlm.nih.gov]

Because SARS is a new emerging disease, this review describes the current understanding about the etiology, clinical pictures, laboratory and radiological findings of SARS. [journals.lww.com]

Dutartre, H., Snijder, E.J., Gorbalenya, A.E., Cambillau, C., Canard, B. (2004) Proc.Natl.Acad.Sci.USA 101 : 3792-3796 PubMed : 15007178 Search on PubMed Search on PubMed Central DOI: 10.1073/pnas.0307877101 PubMed Abstract: The recently identified etiological [rcsb.org]

Epidemiology and control of SARS in Singapore. Epidemiological News Bulletin, 29 (7), 44. [eresources.nlb.gov.sg]

This study described the similarities and differences in epidemiological and clinical characteristics of 183 confirmed global MERS cases and 98 SARS cases in Taiwan associated with HCP. [ncbi.nlm.nih.gov]

Report for 2015 Publication Severe acute respiratory syndrome - Annual Epidemiological Report 2016 [2014 data] Publication Respiratory tract infections - Annual epidemiological report for 2012-13 There are currently no items to display There are currently [ecdc.europa.eu]

The pathophysiology and therapeutic strategy of this special type of permanent olfactory dysfunction deserve further investigation. [ncbi.nlm.nih.gov]

Additional goals of the protocol are to elucidate the pathophysiology of SARS, characterize the immune response during SARS, and evaluate diagnostic tests for the rapid identification of SARS in clinical specimens. [clinicaltrials.gov]

[…] headache, and taste and smell disturbance—rather than severe pneumonia (although emerging evidence about long term consequences is yet to be understood in detail).1 In this review, we provide a broad update on the emerging understanding of SARS-CoV-2 pathophysiology [bmj.com]

Pathophysiology The lungs and gastrointestinal tract have been demonstrated to be the only major organ systems that support SARS-CoV replication. [14, 15] After establishment of infection, SARS-CoV causes tissue damage by (1) direct lytic effects on host [emedicine.com]

[…] and to pioneer strategies that prevent escape. [ncbi.nlm.nih.gov]

1. Anderson RM, Fraser C, Ghani AC, et al. Epidemiology, transmission dynamics and control of SARS: the 2002–2003 epidemic. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 2004;359:1091–1105.
2. Centers for Disease Control and Prevention, 2014. https://www.cdc.gov/sars/about/fs-sars.pdf. Accessed January 12,2017
3. Al-Hazmi A. Challenges presented by MERS corona virus and SARS corona virus to global health. Saudi J Bio Sci. 2016 Jul; 23(4): 507-511
4. Poon LL, Guan Y, Nicholls JM, et al. The etiology, origins, and diagnosis of severe acute respiratory syndrome. The Lancet Infectious Diseases 2004; 4: 663–671.
5. Leung CW, Chiu WK. Clinical picture, diagnosis, treatment and outcome of severe acute respiratory syndrome (SARS) in children. Paediatr. Respir. Rev. 2004;5(4):275–288.
6. Manocha S, Walley KR, Russell JA. Severe acute respiratory distress syndrome(SARS): a critical care perspective. Crit Care Med. 2003 Nov; 31(11): 2684 -92