Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 32-06: Common Viral Respiratory Infections + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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