Severe acute respiratory syndrome: Clinical features diagnosis, and management

Current Opinion in Pulmonary Medicine

Volumn 10, Issue 3, 2004, Pages 159-165

  Rainer, Timothy H ^a,b  

^a CHINESE UNIVERSITY OF HONG KONG   (Hong Kong)

^b CHINESE UNIVERSITY OF HONG KONG   (Hong Kong)

Author keywords

Coronavirus; Emerging infectious diseases; SARS; Severe acute respiratory syndrome

Indexed keywords

ANTIVIRUS AGENT; IMMUNOSUPPRESSIVE AGENT;

ANTIVIRAL ACTIVITY; CHILDHOOD DISEASE; CLINICAL EXAMINATION; CLINICAL FEATURE; DIAGNOSTIC APPROACH ROUTE; DISEASE ACTIVITY; DRUG EFFECT; DRUG INDICATION; DRUG SAFETY; EARLY DIAGNOSIS; EPIDEMIC; HEMATOLOGIC DISEASE; HIGH RISK PATIENT; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY; HISTOPATHOLOGY; HUMAN; IMMUNOMODULATION; IMMUNOSUPPRESSIVE TREATMENT; IMMUNOTHERAPY; LABORATORY TEST; MORBIDITY; MORTALITY; PATHOPHYSIOLOGY; PROGNOSIS; REVIEW; SARS CORONAVIRUS; SEVERE ACUTE RESPIRATORY SYNDROME; SIDE EFFECT; THORAX RADIOGRAPHY; TREATMENT INDICATION;

EID: 1942501051     PISSN: 10705287     EISSN: None     Source Type: Journal    
DOI: 10.1097/00063198-200405000-00003     Document Type: Review

References (49)

1. Update: outbreak of severe acute respiratory syndrome - worldwide. Morbid Mortal Wkly Rep 2003, 52:1779-1785. Important source for epidemiologic, morbidity, and mortality data.
2. World Health Organization. Severe acute respiratory syndrome. Wkly Epidemiol Rec No. 14. 2003, 78:97-120. Summary of knowledge and advisories published in April 2003.
3. World Health Organization: Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). 2003 (http://www.who.int/csr/sars/en/ index.html) accessed on 5th December 2003. Superb consensus document summarizing the global epidemiologic effect of SARS in 2003.
4. World Health Organization: Summary table of areas that experienced local transmission of SARS during the outbreak period from 1 November 2002 to 31 July 2003 (http://www.who.int/csr/sars/areas/areas2003_11_ 21/en/print.html) accessed on 5th December 2003. Source of knowledge for SARS outbreaks.
5. Drosten C, Gunther S, Preiser W, et al.: Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med 2003, 348:1967-1976. An excellent early report showing that the etiologic agent of SARS was a novel coronavirus, that it could be detected in sputum, plasma, and feces, and that infected patients showed seroconversion on Vero cells.
6. Ksiazek TG, Erdman D, Goldsmith C, et al.: A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003, 348:1953-1966. An excellent early report describing the use of electron microscopy, immunohistochemical and immunofluorescent staining, reverse-transcription- polymerase chain reaction, indirect fluorescence antibody, and enzyme-linked immunosorbent assays to identify coronavirus as the etiologic agent of SARS.
7. Peiris JSM, Lai ST, Poon LLM, et al.: Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003, 361:1319-1325. Excellent article detailing viral cause and clinical presentation from sporadic and epidemiologically linked patients in an outbreak in Hong Kong.
8. Marra MA, Jones SJ, Astell CR, et al.: The genome sequence of the SARS-associated coronavirus. Science 2003, 300:1399-1404. Landmark article detailing the completion of the genomic sequence and confirming that SARS is caused by an RNA virus with features similar to the family of coronaviridae, but significantly different from previously sequenced coronaviruses.
9. Rota PA, Oberste MS, Monroe SS, et al.: Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science 2003, 30:1394-1399. Landmark article detailing the completion of the genomic sequence and confirming that SARS is caused by an RNA virus with features similar to the family of coronaviridae, but significantly different from previously sequenced coronaviruses.
10. Ruan YJ, Wei CL, Ee AL, et al.: Comparative full-length genome sequence analysis of 14 SARS coronavirus isolates and common mutations associated with putative origins of infection. Lancet 2003, 361:1779-1785. Article sequencing the entire SARS viral genome from isolates collected in Singapore, and comparison with isolates from other regions.
11. Lee N, Hui D, Wu A, et al.: A major outbreak of severe acute respiratory syndrome (SARS) in Hong Kong. N Engl J Med 2003, 348:1986-1994. First study of more than 100 patients with SARS, describing the clinical features, laboratory changes, and radiologic findings.
12. Poutanen SM, Low DE, Henry B, et al.: Identification of severe acute respiratory syndrome in Canada. N Engl J Med 2003, 348:1995-2005. Case series describing the initial epidemiologic findings, clinical description, and diagnostic findings in patients with SARS.
13. Chan PK, Tam JS, Lam CW, et al.: Human metapneumovirus detection in patients with severe acute respiratory syndrome. Emerg Inf Dis 2003, 9:1058-1063. Article describing the relationship between coronavirus and metapneumovirus.
14. Donnelly C, Ghani AC, Leung GM, et al.: Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome. Lancet 2003, 361:1761-1766. Impressive epidemiologic analysis of the first 1425 SARS cases admitted to hospitals in Hong Kong.
15. Zhong NS, Zheng BJ, Li YM, et al.: Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003. Lancet 2003, 362:1353-1358. Quality article tracking the emergence of SARS at its presumed place of origin.
16. Chiu RW, Chim SS, Lo YM: Molecular epidemiology of SARS - from Amoy Gardens to Taiwan. N Engl J Med 2003, 349:1875-1876. Correspondence demonstrating the importance of molecular epidemiology to show that the same strain of SARS coronavirus was involved in both Hong Kong and Taiwanese outbreaks.
17. Chim SS, Tsui SK, Chan KC, et al.: Genomic characterisation of the severe acute respiratory syndrome coronavirus of Amoy Gardens outbreak in Hong Kong. Lancet 2003, 362:1807-1808. Excellent short article showing, in a small group, that alterations in genomic sequences were unlikely to explain differences in clinical presentation between outbreaks.
18. Chim SS, Tong YK, Hung EC, et al.: Genomic sequencing of a SARS Coronavirus isolate that predated the Metropole Hotel Case Cluster in Hong Kong. Clin Chem 2004, 50:231-232. Technical brief describing differences in the genomic sequence of SARS coronavirus, and showing that the virus underwent gradual evolution as it moved through the epidemic.
19. Riley S, Fraser C, Donnelly CA, et al.: Transmission dynamics of the etiological agent of SARS in Hong Kong: impact of public health interventions. Science 2003, 300:1961-1966. Superb, but complex, study of the rate of spread of SARS during an epidemic.
20. Lipsitch M, Cohen T, Cooper B, et al.: Transmission dynamics and control of severe acute respiratory syndrome. Science 2003, 300:1966-1970. Superb, but complex, study of the rate of spread of SARS during an epidemic.
21. Booth CM, Matukas LM, Tomlinson GA, et al.: Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA 2003, 289:2801-2809. Excellent, retrospective, multicentre, Canadian case series involving 144 adult patients describing the clinical characteristics and short term outcomes of patients with SARS.
22. Rainer TH, Cameron PA, Smit DeV, et al. Evaluation of the WHO criteria for identifying patients with severe acute respiratory syndrome (SARS) pneumonia out of hospital. Prospective observational study. BMJ 2003, 326:1354-1358. Critical evaluation of the accuracy of World Health Organization case definitions if incorporated into clinical guidelines designed for use in primary care settings.
23. Seto WH, Tsang D, Yung RWH, et al.: Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003, 361:1519-1520. Case-control series of 241 noninfected and 13 infected staff with documented exposure to patients with SARS highlighting the importance of wearing masks, and that infection is probably transmitted by droplets.
24. World Health Organization: Case Definitions for Surveillance of Severe Acute Respiratory Syndrome (SARS). (http://www.who.int/csr/sars/casedefinition/ en/)accessed on December 5, 2003. Important Web site with important information on current case definitions.
25. Center for Disease Control and Prevention: Updated interim US case definition for severe acute respiratory syndrome (SARS). 2003. (http://www.cdc.gov/ncidod/sars/casedefinition.htm) accessed on December 5, 2003. Important Web site with important information on current case definitions.
26. World Health Organization: Management of severe acute respiratory syndrome (SARS). (http://www.who.int/csr/sars/management/en/) accessed on December 5, 2003. Web site with current management guidelines issued by the World Health Organization.
27. Center for Disease Control and Prevention: Interim guidelines for laboratory diagnosis of SARS-CoV infection. 2003. (http://www.cdc.gov/ncidod/ sars/labdiagnosis.htm) accessed on December 5, 2003. Important website with interim guidelines for laboratory diagnosis of SARS.
28. Peiris JSM, Chu CM, Cheng VCC, et al.: Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003, 361:1 767-1772. Excellent prospective study of changing patterns of clinical disease, viral load, risk factors for poor clinical outcome, and usefulness of virologic diagnostic methods in 75 patients admitted to the hospital from a housing estate in Hong Kong. Patients were followed for about 24 days.
29. Tsang KW, Ho PL, Ooi GC, et al.: A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003, 348:1977-1985. Important case series describing the clinical features and epidemiologic linkage between SARS patients.
30. Wong WN, Sek ACH, Lau RFL, et al.: Early clinical predictors of severe acute respiratory syndrome in the emergency department. Can J Emerg Med 2004, in press. Important study highlighting diagnostic predictors in patients presenting to an emergency department from the Amoy Gardens Outbreak in Hong Kong. Gastrointestinal symptoms, especially diarrhea, were particularly common in this outbreak.
31. Wong RSM, Wu A, To KF, et al.: Hematological manifestations of patients with severe acute respiratory syndrome: retrospective analysis. BMJ 2003, 326:1358-1362. Excellent article reporting the demographic, clinical, and laboratory characteristics of patients with SARS. Depletion of T lymphocyte subsets is associated with adverse outcomes.
32. So LK-Y, Lau ACW, Yam LYC, et al.: Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet 2003, 361:1615-1617. Early case series of 31 patients with probable SARS describing the typical treatment protocols followed by one institution early in the SARS outbreak.
33. Wong KT, Antonio GE, Hui DSC, et al.: Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients. Radiology 2003, 228:401-406. Well-illustrated article, describing the radiographic progression of chest changes in patients with SARS.
34. Antonio GE, Wong KT, et al.: Imaging of severe acute respiratory syndrome in Hong Kong. Am J Radiol 2003, 181:11-17. Superb pictorial essay illustrating the different types of progression of radiographic changes observed on chest radiographs in patients with SARS. Features of SARS observable on high-resolution computed tomography are also illustrated and discussed.
35. Wong KT, Antonio GE, Hui DSC, et al.: Radiological appearances of severe acute respiratory syndrome. J Hong Kong Coll Radiol 2003, 6:4-6. Well-illustrated article, describing the radiographic progression of chest changes in patients with SARS.
36. Wong KT, Antonio GE, Hui DSC, et al.: Thin-section CT of severe acute respiratory syndrome: evaluation of 73 patients exposed to or with the disease. Radiology 2003, 228:395-400. Well-illustrated article describing the computed tomography changes in patients with SARS.
37. Antonio GE, Wong KT, Hui DSC, et al.: Thin-section computed tomography in severe acute respiratory syndrome (SARS) patients following hospital discharge. Preliminary experience. Radiology 2003, 228:810-815. Excellent study showing persistent pulmonary changes identified by computed tomography in 24 patients in the second month after the onset of SARS.
38. Nicholls JM, Poon LL, Lee KC, et al.: Lung pathology of fatal severe acute respiratory syndrome. Lancet 2003, 361:1773-1778. Important article of six patients with SARS undergoing postmortem. The article highlights the inflammatory pathology of SARS, including cytokine dysregulation.
39. Hon KLE, Leung CW, Cheng WTF, et al.: Research letters: clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet 2003, 361:1701-1703. Early case series reporting the clinical, radiologic, and laboratory changes and management in children with SARS.
40. Chiu WK, Cheung PC, Ng KL, et al.: Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med 2003, 4:279-283. Retrospective case series of 21 children reporting their clinical presentation and short-term outcomes.
41. Ng EK, Ng PC, Hon KL, et al.: Serial analysis of the plasma concentrations of SARS coronavirus RNA in pediatric patients with severe acute respiratory syndrome. Clin Chem 2003, 49:2085-2088. Technical brief describing the temporal changes in plasma SARS-CoV in eight pediatric patients with SARS.
42. Hung EC, Chim SS, Chan PK, et al.: Detection of SARS coronavirus RNA in the cerebrospinal fluid of a patient with severe acute respiratory syndrome. Clin Chem 2003, 49:2108-2109. Case report describing the clinical and laboratory evidence of neurological involvement in a SARS patient, and showing that SARS-CoV crosses the blood-brain barrier.
43. Ng EK, Hui DS, Chan KC, et al.: Quantitative analysis and prognostic implication of SARS coronavirus RNA in the plasma and serum of patients with severe acute respiratory syndrome. Clin Chem 2003, 49:1976-1980. Early report on a limited number of patients (n = 35), reporting the potential for reverse transcriptase-polymerase chain reaction as an early diagnostic tool for measuring concentrations of SARS-CoV early in the course of the illness.
44. Poon LL, Chan KH, Wong OK, et al.: Early Diagnosis of SARS coronavirus infection by real time RT-PCR. J Clin Virol 2003, 28:233-238. Article detailing the current potential for early diagnosis of SARS using real time polymerase chain reaction.
45. Gao W, Tamin A, Soloff A, et al.: Effects of SARS-associated coronavirus vaccine in monkeys. Lancet 2003, 362:1895-1896. Animal study showing that a SARS-CoV-specific vaccine can be produced in monkeys.
46. Chen S-Y, et al.: Predictive model of diagnosing probable cases of severe acute respiratory distress syndrome in febrile patients with exposure risk. Ann Emerg Med 10.1067/mem. 2003, 424, in press. Small study showing the development of a prediction rule in 78 patients, 8 of whom had SARS.
47. Chen S-Y, et al.: Sequential symptomatic analysis in probable severe acute respiratory distress syndrome cases. Ann Emerg Med 10.1010/mem. 2003, 424, in press. Chronologic documentation of symptom development in 289 patients, 79 of whom had SARS.
48. Wang T-L, et al.: Establishing a clinical decision rule of severe acute respiratory distress syndrome at the emergency department. Ann Emerg Med 10.1010/mem. 2003, 424, in press. Development of a scoring system for detecting SARS in a group of patients meeting the World Health Organization criteria for suspect SARS cases (n = 175).
49. Su C-P, et al. Validation of a novel severe acute respiratory distress syndrome scoring system. Ann Emerg Med 10.1016/j.annemergmed.2003.10.424, in press. Study to validate a previously derived scoring system for diagnosing SARS.