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Severe Acute Respiratory Syndrome

SARS

Severe Acute Respiratory Syndrome (SARS) is an infectious disease whose symptoms mimic those of a common cold but are more severe and can progress to life-threatening respiratory failure. It was first reported in China in 2002 with a high incidence of mortality.


Presentation

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]
  • We describe two patients with systemic lupus erythematosus (SLE) who presented with fever, systemic upset and pulmonary infiltrates between April and June, 2003.[ncbi.nlm.nih.gov]
  • You can relieve symptoms with pain and fever medicines and rest. Centers for Disease Control and Prevention[nlm.nih.gov]
  • Fever followed by rapidly progressive respiratory compromise led to significant morbidity and mortality in this cohort.[ncbi.nlm.nih.gov]
  • 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]
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]
  • 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]
  • Less common symptoms included headache (38.9%), diarrhea (38.9%), dizziness (30.6%), myalgia (25%), chills (19.4%), nausea and vomiting (19.4%) and rigor (the occurrence of a sensation of hot-and-cold and shivering in addition to teeth chattering and[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]
Intravenous Drugs
  • AIM: to evaluate the specificity of the SARS-CoV N protein-based IgG ELISA assay for detection of immunoglobulin G (IgG) in plasma samples obtained from HIV-1 positive and HIV-1 negative intravenous drug users (IDUs).[ncbi.nlm.nih.gov]
Cough
  • Coronaviruses probably spread through the air by coughing or sneezing, or by close personal contact.[nlm.nih.gov]
  • 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]
  • Other symptoms may include high-grade fever, dyspnea, cough, and diarrhea. On auscultation of the chest, inspiratory crackles may be diagnosed.[symptoma.com]
  • A 57-year-old woman had a typical presentation, including fever, non-productive cough, malaise, lymphopenia, and raised liver aminotransferases.[ncbi.nlm.nih.gov]
Dry Cough
  • CASE: 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]
  • RESULTS: Fever, dyspnea, diarrhea, malaise, dizziness and dry cough were initially more common symptoms. Initially chest patterns included focal consolidation, interstitial infiltration or normal.[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]
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]
  • RESULTS: Fever, dyspnea, diarrhea, malaise, dizziness and dry cough were initially more common symptoms. Initially chest patterns included focal consolidation, interstitial infiltration or normal.[ncbi.nlm.nih.gov]
  • FINDINGS: The most common symptoms were cough (83%), dyspnea (80.6%), malaise (69.4%) and fever (61%).[ncbi.nlm.nih.gov]
Severe Clinical Course
  • However, this infant had a more severe clinical course as compared with the older children. This is the youngest patient with symptomatic SARS reported to date.[ncbi.nlm.nih.gov]
  • Patients with extensive lung injury, as indicated by severe clinical courses, and in particular high neutrophil counts, appear to be most at risk.[ncbi.nlm.nih.gov]
Acute Abdomen
  • The present study reports a case of SARS, which presented as acute abdomen, warranting laparotomy.[ncbi.nlm.nih.gov]
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]
  • Less common symptoms included headache (38.9%), diarrhea (38.9%), dizziness (30.6%), myalgia (25%), chills (19.4%), nausea and vomiting (19.4%) and rigor (the occurrence of a sensation of hot-and-cold and shivering in addition to teeth chattering and[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]
  • ., fever or prodromal symptoms of headache, malaise, and myalgias), and diagnostic testing to detect cases is limited. Available nucleic acid amplification assays for SARS-CoV have reported sensitivities as low as 50% ( 4 ).[cdc.gov]
  • He also complained of progressive dyspnea, headache, dizziness, generalized malaise, and myalgia. His pulse and blood pressure were normal, and his oxygen saturation was approximately 98% on room air.[doi.org]

Workup

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.

X-Ray Abnormal
  • On the same day, fever and chest x-ray abnormalities developed in eight of her relatives, including her husband, sons, daughters, and son-in-law, and they were diagnosed as having probable SARS ( Figure 1 ). Figure 2 Figure 2 .[doi.org]
  • On the same day, fever and chest x-ray abnormalities developed in eight of her relatives, including her husband, sons, daughters, and son-in-law, and they were diagnosed as having probable SARS ( Figure 1 ).[ncbi.nlm.nih.gov]
Chest X-Ray Abnormal
  • On the same day, fever and chest x-ray abnormalities developed in eight of her relatives, including her husband, sons, daughters, and son-in-law, and they were diagnosed as having probable SARS ( Figure 1 ). Figure 2 Figure 2 .[doi.org]
  • On the same day, fever and chest x-ray abnormalities developed in eight of her relatives, including her husband, sons, daughters, and son-in-law, and they were diagnosed as having probable SARS ( Figure 1 ).[ncbi.nlm.nih.gov]
Bilateral Pulmonary Infiltrate
  • He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness.[ncbi.nlm.nih.gov]
Bilateral Pulmonary Infiltrate
  • He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness.[ncbi.nlm.nih.gov]
Normal Chest X-Ray
  • Computed tomographic (CT) scan images may show parenchymal abnormalities in patients with seemingly normal chest x-rays [30-32].[web.archive.org]

Treatment

  • The standard treatment might be beneficial for decreasing the mortality rate.[ncbi.nlm.nih.gov]
  • During that time we investigated the clinical features, treatment, and nursing care of 36 patients and reported on 12 of these patients' perceptions of their illness experience.[ncbi.nlm.nih.gov]
  • Postexposure treatment with MAb 201 can alleviate the viral burden and associated pathological findings in a golden Syrian hamster model of SARS-CoV infection.[ncbi.nlm.nih.gov]
  • Their treatment modalities included empirical antibiotics, steroids, and anti-viral agents. As SARS becomes an emerging infectious disease in the 21st century, its clinical manifestations and treatment will be discussed.[ncbi.nlm.nih.gov]
  • During this period the World Health Organisation issued a global alert about SARS and together with the Centre for Disease Control have coordinated their efforts to investigate its pathogenesis and treatment.[ncbi.nlm.nih.gov]

Prognosis

  • A rapid clinical and electrophysiologic improvement was evident during follow-up examinations, with a good prognosis.[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]
  • 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]
  •  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 for SARS? SARS can result in serious illness and medical complications that require hospitalization, intensive care treatment, and mechanical ventilation.[emedicinehealth.com]

Etiology

  • The etiology of SARS is likely a novel coronavirus. During the winter of 2003, an outbreak of SARS involving several hospitals occurred in Toronto, Canada.[ncbi.nlm.nih.gov]
  • 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]
  • Abstract Severe acute respiratory syndrome coronavirus (SARS-CoV) is the etiological agent of SARS, a fatal pulmonary disorder with no effective treatment.[ncbi.nlm.nih.gov]
  • SARS is a severe form of the epidemic outbreak of atypical pneumonia which remains poorly defined regarding etiology and special therapy recommendations.[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]

Epidemiology

  • 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]
  • In this review, we describe virological, clinical, epidemiological features and interim travel advice and guidelines regarding MERS-CoV. We compare and contrast these with the severe acute respiratory syndrome coronavirus (SARS-CoV).[ncbi.nlm.nih.gov]
  • This report summarizes epidemiologic features of this outbreak in Singapore, including the influence of super spreaders and the national prevention and control strategy.[ncbi.nlm.nih.gov]
  • Epidemiological News Bulletin , 29 (4), 15. Retrieved 2016, July 30 from Ministry of Health website: 18. Heng, B. H., & Lim, S. W. (2003, July). Epidemiology and control of SARS in Singapore. Epidemiological News Bulletin , 29 (7), 46.[eresources.nlb.gov.sg]
  • Treatment directed against SARS was prompted by an epidemiological link and the clinical picture as the disease evolved. This atypical presentation posed a diagnostic challenge for physicians.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • 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]

Prevention

  • BACKGROUND: The clinical importance and efficacy of facemasks in infection prevention have been documented in the international literature.[ncbi.nlm.nih.gov]
  • […] and to pioneer strategies that prevent escape.[ncbi.nlm.nih.gov]
  • MAb 201 is a severe acute respiratory syndrome-associated coronavirus (SARS-CoV)-specific MAb that prevents establishment of viral replication in vitro and prevents viral replication in vivo when administered prophylactically.[ncbi.nlm.nih.gov]
  • There is no vaccine to prevent coronavirus infection. There are no specific treatments. You can relieve symptoms with pain and fever medicines and rest. Centers for Disease Control and Prevention[nlm.nih.gov]
  • IMPORTANCE: Preventing recognition by the host immune response represents a critical aspect necessary for successful viral infection.[ncbi.nlm.nih.gov]

Summary

References

Article

  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

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Last updated: 2018-06-21 17:55