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]

• High Fever

  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]

  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]

  Copyright © HarperCollins Publishers sostantivo an acute, highly contagious, viral respiratory disease characterized by coughing, a high fever, and breathing difficulty Webster’s New World College Dictionary, 4th Edition. [collinsdictionary.com]

  fever, dry 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]

  Symptoms & Signs  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 [slideshare.net]

• Inflammation

  However, incidence and severity of lung inflammation was not reduced despite the limited viral replication upon rechallenge. [ncbi.nlm.nih.gov]

• Pneumonia

  His clinical course followed a typical pattern with progression of pneumonia during the 2nd week of his illness ( 8 ). [ncbi.nlm.nih.gov]

  The local media must be reminded that SARS is really not the same as atypical pneumonia but rather a subset of this disease. For example, people can have atypical pneumonia but not SARS. [thelancet.com]

• 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]

• 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]

• 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]

• Tachypnea

  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]

• Hypertension

  ACE-2 is a recently described type I transmembrane metallocarboxypeptidase with homology to ACE, an enzyme long-known to be a key player in the renin-angiotensin system (RAS) and a target for the treatment of hypertension.8 Although its roles continue [rndsystems.com]

  The index patient's 43-year-old son (Patient 2), who had an underlying history of type 2 diabetes and hypertension, had fever and diaphoresis on February 27, two days after his mother first noted symptoms. [nejm.org]

  Box 1 Risk factors associated with the development of severe disease, admission to intensive care unit, and mortality Underlying condition Older age Hypertension Cardiovascular disease Chronic obstructive pulmonary disease Diabetes Obesity Malignancy [bmj.com]

  Google Scholar Questions have been raised about using inhibitor therapy with angiotensin II receptor blockers (ARB) and ACE inhibitors for COVID-19 patients with hypertension. [thelancet.com]

  [PMID:32217556] Comment: Patients in this Chinese retrospective study were older (median 68 yrs), male (73%) and had cardiovascular disease, including hypertension. [hopkinsguides.com]

• 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]

• 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]

• Confusion

  WHO has done little to alleviate the confusion surrounding the terminology. SARS is an ambiguous term. The clinical features of many patients are neither severe nor respiratory in nature. [thelancet.com]

  Treatment • No uniform treatment for SARS-CoV • Can easily be confused with other lung related illnesses so patients are usually given:  Broad-spectrum antibiotics  Antiviral agents  Immunomodulatory therapy  Supportive care • Requires intensive care [slideshare.net]

  Now fixed. - In question 7 it’s a little confusing that there are two measures of the rate of mutation and one of these is the mutation rate. [elifesciences.org]

  Muscle stiffness, loss of appetite, malaise, confusion, rash and diarrhea are also common symptoms. Early laboratory findings include low platelet and white blood cell counts. [edition.cnn.com]

  It seems that both abnormal immune responses and injury to immune cells may be key factors in the pathogenesis of this new disease. [ 1 ] NB : SARS should not be confused with another zoonosis from the same area, called avian flu. [patient.info]

• Ataxia

  Additional features include microcephaly, ataxia, and muscle weakness. [uniprot.org]

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

  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]

• 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]

• Bilateral Pulmonary Infiltrates

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

• Lymphopenia

  Treatment with oral prednisolone and ribavirin normalized her lymphopenia, altered transaminases, chest radiograph and high-resolution computed tomography appearances rapidly. [ncbi.nlm.nih.gov]

• Neutrophilia

  […] mortality Underlying condition Older age Hypertension Cardiovascular disease Chronic obstructive pulmonary disease Diabetes Obesity Malignancy Presentation Higher fever (≥39°C on admission) Dyspnoea on admission Higher qSOFA score Laboratory markers Neutrophilia [bmj.com]

  Early findings suggest that there is a relative neutrophilia and a relative lymphopenia - relative because the total white count itself tends to be low. [news-medical.net]

• 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]

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.medscape.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