- •November 16, 2002
- •February 14, 2003
- •February 21
- •February 28
- •March 7
- •March 10
- •March 12
- •March 14
- •March 15
- •March 17
- •March 19
- •March 21
- •March 24
- •March 26
- •March 28
- •March 30
- •March 31
- •April 2
- •April 2
- •April 8-10
- •April 12
- •April 16
- •April 20
- •April 20
- •April 23
- •April 25
- •April 27
- •April 29
- •June 6
- •June 13
- •June 17
- •June 21
- •June 23
- •June 24
- •July 2
- •July 5
- •August 14
- •September 8
- •September 24
- •References
- •Virology
- •Discovery of the SARS Virus
- •Initial Research
- •The Breakthrough
- •Coronaviridae
- •SARS Co-V
- •Genome Sequence
- •Morphology
- •Organization
- •Detection
- •Stability and Resistance
- •Natural Host
- •Antiviral Agents and Vaccines
- •Antiviral Drugs
- •Vaccines
- •Outlook
- •References
- •Routes of Transmission
- •Factors Influencing Transmission
- •Patient Factors in Transmission
- •Asymptomatic Patients
- •Symptomatic Patients
- •Superspreaders
- •The Unsuspected Patients
- •High-Risk Activities
- •Transmission during Quarantine
- •Transmission after Recovery
- •Animal Reservoirs
- •Conclusion
- •References
- •Introduction
- •Modeling the Epidemic
- •Starting Point
- •Global Spread
- •Hong Kong
- •Vietnam
- •Toronto
- •Singapore, February 2003
- •China
- •Taiwan
- •Other Countries
- •Eradication
- •Outlook
- •References
- •Introduction
- •International Coordination
- •Advice to travelers
- •Management of SARS in the post-outbreak period
- •National Measures
- •Legislation
- •Extended Case Definition
- •Quarantine
- •Reduce travel between districts
- •Quarantine after Discharge
- •Infection Control in Healthcare Settings
- •General Measures
- •Protective Measures
- •Hand washing
- •Gloves
- •Face Masks
- •Additional protection
- •Getting undressed
- •Special Settings
- •Intensive Care Units
- •Intubating a SARS Patient
- •Anesthesia
- •Triage
- •Internet Sources
- •Additional information
- •Infection Control in Households
- •Possible Transmission from Animals
- •After the Outbreak
- •Conclusion
- •References
- •Case Definition
- •WHO Case Definition
- •Suspect case
- •Probable case
- •Exclusion criteria
- •Reclassification of cases
- •CDC Case Definition
- •Diagnostic Tests
- •Introduction
- •Laboratory tests
- •Molecular tests
- •Virus isolation
- •Antibody detection
- •Interpretation
- •Limitations
- •Biosafety considerations
- •Outlook
- •Table, Figures
- •References
- •Clinical Presentation and Diagnosis
- •Clinical Presentation
- •Hematological Manifestations
- •Atypical Presentation
- •Chest Radiographic Abnormalities
- •Chest Radiographs
- •CT Scans
- •Diagnosis
- •Clinical Course
- •Viral Load and Immunopathological Damage
- •Histopathology
- •Lung Biopsy
- •Postmortem Findings
- •Discharge and Follow-up
- •Psychosocial Issues
- •References
- •Appendix: Guidelines
- •WHO: Management of Severe Acute Respiratory Syndrome (SARS)
- •Management of Suspect and Probable SARS Cases
- •Definition of a SARS Contact
- •Management of Contacts of Probable SARS Cases
- •Management of Contacts of Suspect SARS Cases
- •SARS Treatment
- •Antibiotic therapy
- •Antiviral therapy
- •Ribavirin
- •Neuraminidase inhibitor
- •Protease inhibitor
- •Human interferons
- •Human immunoglobulins
- •Alternative medicine
- •Immunomodulatory therapy
- •Corticosteroids
- •Other immunomodulators
- •Assisted ventilation
- •Non-invasive ventilation
- •Invasive mechanical ventilation
- •Clinical outcomes
- •Outlook
- •Appendix 1
- •A standardized treatment protocol for adult SARS in Hong Kong
- •Appendix 2
- •A treatment regimen for SARS in Guangzhou, China
- •References
- •Pediatric SARS
- •Clinical Manifestation
- •Radiologic Features
- •Treatment
- •Clinical Course
- •References
Diagnosis 131
Diagnosis
Identifying hospitalized patients with SARS is difficult, especially when no epidemiological link has been recognized and the presentation of symptoms is non-specific. Patients with SARS might develop symptoms common to hospitalized patients (e.g., fever or prodromal symptoms of headache, malaise, and myalgia), and diagnostic testing to detect cases is limited (MMWR 52: 547-50). Unless specific laboratory tests (PCR, detection of SARS antibodies; see Chapter 7: Diagnostic Tests) confirm the initial suspicion of SARS infection, the diagnosis of SARS is based on the clinical findings of an atypical pneumonia not attributed to any other cause, as well as a history of exposure to a suspect or probable case of SARS, or to their respiratory secretions or other body fluids.
As mentioned above, during the early stages, SARS may be difficult to differentiate from other viral infections, especially when symptoms are unspecific (Rainer). The initial diagnostic testing for suspected SARS patients should include chest radiography, pulse oximetry, bacterial cultures of blood, sputum, and urine, serology for mycoplasma, chlamydia, influenza, parainfluenza, respiratory syncytial and adenoviruses, nasopharyngeal aspirates for viral cell cultures, and direct sputum smear for Pneumocystis jiroveci by silver stain. A specimen for Legionella and pneumococcal urinary antigen testing should also be considered (CDC, http://www.cdc.gov/ncidod/sars/diagnosis.htm).
The radiographic appearance of peripheral air-space opacities is indistinguishable from other causes of atypical pneumonia, such as Mycoplasma, Chlamydia, and Legionella, and overlaps with other types of viral pneumonia. The presence of an air-space opacity on chest radiographs has been helpful in the confirmation of the diagnosis (Wong 2003b).
Clinicians should save any available clinical specimens (respiratory, blood, and serum) for additional testing until a specific diagnosis is made. Acute and convalescent (greater than 21 days after the onset of symptoms) serum samples should be collected from each patient who meets the definition criteria for SARS. Specific instructions for collecting specimens from suspected SARS patients are available on the Internet: http://SARSreference.com/link.php?id=19
Kamps and Hoffmann (eds.)