Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

1334 Severe Acute Respiratory Syndrome

Epidemiology: Reported from Guangdong Province in China, Hong

Kong, SE Asia and Canada. Major epidemic ended 2003, last lab related

outbreaks in 2004.

■Exposure; Travel to affected area. Healthcare workers and those in

contact with infected individuals. Adults infected more than chil-

dren. Spread person to person via droplets.

Etiology: novel coronavirus (SARS CoV ) isolated.

Incubation: 2–7 days before symptoms

Signs & Symptoms

Two stage: prodrome – fever, malaise, myalgias, can have diarrhea

Respiratory phase (begins in 3–7 days) – nonproductive cough, dyspnea

and can have progressive respiratory distress.

■WHO case definition: Suspected case

➣Fever >38.0 AND

➣Cough or respiratory distress AND

➣Close contact with known patient with SARS or travel to area of

known transmission in previous 10 days.

■Probable case:

➣CXR suggesting pneumonia or acute respiratory distress syn-

drome (ARDS) OR

➣Suspected case positive in one or more lab assays for SARS OR

➣Suspected case who dies of severe respiratory illness of unknown

cause and pathology consistent with ARDS.

tests

■Basic tests: blood: lymphopenia may be present, LFTs and CK may

be elevated.

■Radiology: CXR can range from normal to diffuse interstitial infil-

trates of ARDS or focal consolidation. CT may reveal abnormalities

with normal CXR.

■Pathology: diffuse alveolar damage

■Serology: ELISA may be available from CDC. IgG usually present, but

may not be in early disease.

■Other tests: PCR in development, but not currently standardized.

differential diagnosis

Other treatable bacterial or viral causes of severe pneumonia must be

considered.

management

What to Do First

■Assess severity and whether suspected case