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For further information, see CMDT Part 32-06: Common Viral Respiratory Infections

Key Features

  • Travel to endemic area within 10 days before symptom onset, including mainland China, Hong Kong, Singapore, Taiwan, Vietnam, and Toronto

  • Persistent fever, dry cough, dyspnea in most cases

  • Mortality: as high as 14% in clinically diagnosed cases

Clinical Findings

  • SARS is an atypical pneumonia that affects all age groups

  • Incubation period is 2–7 days; it can be spread to contacts of affected patients for 10 days. Mean time from onset of clinical symptoms to hospital admission is 3–5 days

  • In all clinical cases, persistent fever is present; chills/rigor, cough, shortness of breath, rales, and rhonchi are the rule

  • Headache, myalgias, and sore throat are common

  • Watery diarrhea occurs in subset of patients

  • Elderly patients may report malaise and delirium, without fever

Diagnosis

  • Serologic tests are available, but seroconversion may not occur until 3 weeks after the onset of symptoms

  • Conventional reverse transcriptase polymerase chain reaction (RT-PCR)

    • Detection rates for the virus are generally low in the first week of illness

    • Urine, nasopharyngeal aspirate, and stool specimens are positive in 42%, 68%, and 97%, respectively, on day 14 of illness

  • Leukopenia (particularly lymphopenia) and low-grade disseminated intravascular coagulation are common

  • Modest elevations of alanine aminotransferase (ALT) and creatine kinase are frequently seen

  • Arterial oxygen saturation < 95% with associated nonspecific pulmonary infiltrates is evident in 80% of affected individuals

  • A high-resolution CT scan is abnormal in 67% of patients with initially normal chest radiographs

Treatment

  • No specific treatment

  • Supportive therapy is mainstay

  • The following agents were used during the 2003 epidemic, but their efficacy remains inconclusive

    • Ribavirin (400–600 mg/day and 4 g/day)

    • Lopinavir/ritonavir (400 mg/100 mg)

    • Interferon type I

    • IVIG

    • Systemic corticosteroids

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