Severe Acute Respiratory Syndrome

Aka: Severe Acute Respiratory Syndrome, SARS

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II. Epidemiology

  1. Asia has been epicenter of SARS outbreaks

III. Pathophysiology

  1. Coronavirus spread by respiratory droplet transmission

IV. Symptoms

  1. Fever (Temperature over 100.4 F or 38 C)
  2. Chills
  3. Myalgias
  4. Non-productive Cough
  5. Headache
  6. Dizziness

V. Radiology

  1. Chest XRay (abnormal in 75% of cases at presentation)
    1. Patchy consolidation in peripheral lung fields
  2. Chest CT
    1. Peripheral "ground-glass" opacifications

VI. Labs: Complete Blood Count with Platelets

  1. Lymphocyte Count >4000/uL or <1500/uL
  2. Neutrophil Count <2000/uL
  3. Platelet Count <150,000/mm3

VII. Management

  1. Cover differential diagnosis
    1. Empiric treatment for Bacterial Pneumonia
  2. Non-specific measures used in SARS cases
    1. Indications
      1. Fever >48 hours
      2. Thrombocytopenia
      3. Leukopenia
    2. Management
      1. Ribavirin
      2. Methylprednisolone

VIII. Course

  1. Incubation Period: 2-16 days (mean 5-6 days)
  2. ICU admission rate: 23%
  3. Mechanical Ventilation required: 13.8%
  4. Mortality: 3.6%
    1. Associated with major comorbidities
  5. Time at which further hospital transmission unlikely
    1. Twenty days from last known SARS case onset

IX. Prevention

  1. Respiratory protection
    1. N95 or equivalent mask
  2. SARS Vaccine
    1. WHO trials of Vaccine due to start winter of 2004

X. Risk Factors

  1. Close contact to infected patients
    1. Household contacts
    2. Healthcare workers
  2. Highest risk transmission to unmasked healthcare worker
    1. BiPap or CPAP administration
    2. Nebulizer administration
    3. Intubation
    4. Bronchoscopy

XI. Prognosis: Predictors of worse prognosis

  1. Advanced age
  2. Lactate Dehydrogenase (LDH) increased
  3. Neutrophilia

XII. References

  1. Lee (2003) N Engl J Med 348:1986-94 [PubMed]
  2. Varia (2003) CMAJ 169(4):285-92 [PubMed]

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