Updated: 8/27/2018

Severe Acute Respiratory Syndrome (SARS)

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Snapshot
  • A 43-year-old woman presents to a hospital in Singapore with a 6-day history of fever, headache, myalgias, and a 2-day history of a nonproductive cough. She recently traveled to China on business where she recalls having a sick contact while taking the train. Her temperature is 100.5°F (38.1°C). On physical exam, the patient is lethargic. Chest radiograph shows diffuse interstitial infiltrates. Tests for Legionella, Mycoplasma, and Chlamydia and immunofluorescence for influenza A and B, adenovirus, and respiratory syncytial virus were negative. Laboratory testing is significant for lymphopenia and an elevated lactate dehydrogenase.
Introduction
  • Definition
    • a viral respiratory illness caused by SARS-associated coronavirus
  • Epidemiology
    • first reported in Asia
  • Pathophysiology
    • virus is transmitted via respiratory droplets.
  • Prognosis
    • worse prognosis
      • higher respiratory virus titer
      • older age
      • underlying comorbid conditions such as diabetes and chronic hepatitis B
      • increased lactate dehydrogenase on admission
Presentation
  • Symptoms
    • prodrome (3-7 days)
      • fever
      • malaise
      • headache
      • myalgias
    • respiratory phase
      • nonprodutive cough
      • dyspnea
Imaging
  • Chest radiography
    • findings
      • normal or diffuse interstitial infiltrates
Studies
  • Labs
    • depressed total lymphocytes
    • increased lactate dehydrogenase (LDH)
    • serum antibody (typically with enzyme-linked immunosorbent assay)
Treatment
  • Treatment is typically supportive
    • e.g., supplemented O2 and ventilation as needed
    • there are no specific antiviral medication or steroid intervention that is found to be clinically beneficial
Complications
  • Respiratory failure

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