Update in Infectious Diseases

Respiratory Disease

SARS

As this Update was being prepared for Annual Session in April 2003, cases of SARS were emerging in several sites worldwide; all were eventually linked to one person who had traveled from Guangdong Province in China to Hong Kong in early February 2003. Physicians were just learning how to diagnose and manage the infection. The following symptoms suggest the diagnosis of SARS: fever, chills, severe malaise and myalgia, headache, a dry and persistent cough, shortness of breath, and hypoxemia. Initially, about half of the case-patients were suspected of having pneumonia, which was severe enough in 20% to require intensive care and intubation. In retrospect, it was determined that most proven SARS case-patients (as determined by a significant increase in serum antibody) also had clinical and radiographic evidence of pneumonia. Patients with proven cases of SARS nearly always had lymphopenia, liver enzymes were elevated (with serum levels usually less than twice the upper limit of normal) in about 66% of cases, and creatine kinase levels were elevated in about 50% of cases. Direct fluorescent antibody testing for influenza and respiratory syncytial virus in suspected cases of SARS can help rule out such infections. A critical aspect of the patients' history was recent travel to a high-risk area or contact with a SARS patient.

A person who presents with symptoms of SARS and who may have had contact with the virus should be admitted and placed in respiratory isolation. The extent to …