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

  A 57-year-old woman had a typical presentation, including fever, non-productive cough, malaise, lymphopenia, and raised liver aminotransferases. [ncbi.nlm.nih.gov]

• Fatigue

  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]

  The symptoms of SARS include: a high temperature (fever) over 38C (100.4F) extreme tiredness (fatigue) headaches chills muscle pain loss of appetite diarrhoea After these symptoms, the infection will begin to affect your lungs and airways (respiratory [nhs.uk]

  A person with SARS also may experience a headache, muscle aches, a sore throat, fatigue, and diarrhea. [northshore.org]

  Clinical features [ 2, 3, 4 ] The first stage is a flu-like prodrome with fever reported in 99 to 100%, fatigue, headache, chills in 62% and 73%, aching muscles in 69% and 61%, malaise, anorexia, and sometimes diarrhoea. This phase lasts 3-7 days. [patient.info]

• Hypoxemia

  The diagnosis of SARS (Severe Acute Respiratory Syndrome) was made in view of the severe hypoxemia and the characteristic symptoms exhibited by the patient. [ncbi.nlm.nih.gov]

  Although both patients had markedly abnormal PaO 2 :FiO 2 ratios, they were never extremely hypoxemic and probably did not die of severe hypoxemia. Patient 1 also died at home, increasing the total number of deaths to 3 among the 10 patients. [nejm.org]

  Anorexia Less common features include the following [1, 2, 3] : Sputum production Sore throat Coryza Nausea and vomiting Dizziness Diarrhea Stage 2 is the lower respiratory tract phase and is characterized by the following: Dry cough Dyspnea Progressive hypoxemia [emedicine.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]

  A 39-year-old Chinese male presented with fever, sore throat and non-productive cough. During his illness, serial chest radiographs showed increasingly severe air-space shadowing in both lungs. [ncbi.nlm.nih.gov]

• 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]

  Aches and discomfort frequently accompany the fever, and soon a dry cough appears. In a minority of patients, respiratory distress progresses to the point where mechanical ventilation is necessary. [britannica.com]

• Dyspnea

  […] 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]

  The most common clinical presentations of patients with SARS include fever, cough, and dyspnea. [journals.lww.com]

• 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]

• 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]

• 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]

• 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]

  […] that is caused by a coronavirus (species Severe acute respiratory syndrome 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]

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

  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]

• 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 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]

• ST Elevation

  One day after initial stabilization of a non-ST-elevated anterior myocardial infarction (MI), he sustained an ST-elevated anterior MI. [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]

 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]

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]

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]

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]

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]

Copyright information: Copyright 2003 Journal of Epidemiology and Community Health Linked Articles In this issue Journal of Epidemiology & Community Health 2003; 57 641-641 Published Online First: 21 Aug 2003. doi: 10.1136/jech.57.9.641 Read the full [jech.bmj.com]

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]

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