The worldwide outbreak of simple ac...

The worldwide outbreak of simple acute respiratory syndrome (SARS) has had its epicenter in Asia. to leeward and colleagues from the Prince of Wales Hospital in Hong Kong described pond ed data on clinical presentations and issues from their cluster of patients with SARS.

In early March, an outbreak of atypical, sharp pneumonia was recognized, and a special multidisciplinary team was mobilized. Before the causative agent (a novel coronavirus) was identified, the team used the SARS case criteria established through the Centers for Disease ascendency and Prevention: temperature greater than 38[degrees]C (1004[degrees]F) chest radiography with consolidation, and contact with a previously identified patient with SARS. The authors derived their information from a collection of 138 infected persons, 50 percent of whom were health care workers secondarily infected by means of index patients with SARS.

Initial treatment included empiric antibiotics, followed by dint of corticosteroids and ribavirin when heat persisted for more than 48 hours and patients had a gentle white blood cell or platelet enumerate Intravenous therapy was instituted if lung opacities worsened (ribavirin in a dosage of 12 g three times daily and methylprednisolone in a dosage of 500 mg sum of two units to three times daily). Patients were admitted to the intensive care unit (ICU) if respiratory failure ensued

The incubation period between position and onset of fever ranged from pair to 16 days (mean: six days). SARS appeared to be highly infectious, with 19 percent of cases occurring in tertiary outlooks (i.e., no contact with an index patient, on the contrary rather contact with an infected health care worker with secondary exposure)

The mostly common presenting symptoms were excitement chills or rigors, myalgias, cough headache, and dizziness. Chest radiography conclusions were abnormal in about three fourths of patients at presentation, with chiefly radiographs showing peripheral lung areas with patchy consolidation. Comput tomography of the chest was performed in many patients with suspected SARS and unremarkable plain chest radiography and many times revealed peripheral "ground-glass" opacifications near the exterior edges of the lungs. Progression to ICU admission occurr in 232 percent of patients about 65 days after initial hospitalization, in succession average. Mechanical ventilation was necessary in 138 percent of patients. Five patients (36 percent) all of whom had other major comorbidities (eg myelodysplasia, heart failure, alcoholic cirrhosis, or active hepatitis B infection), died.

A number of clinical factors were associated with ICU admission or death (see accompanying table). The single factors that were independently predictive in multivariate analysis were advanced age, increased lactate dehydrogenase flat or elevated blood neutrophil count

to leeward N, et al. A major outbreak of stiff acute respiratory syndrome in Hong Kong N Engl J M May 15 2003; 348:1986-94

COPYRIGHT 2003 American Academy of Family Physicians

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