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Updated: Dec 23 2021

Severe Acute Respiratory Syndrome (SARS)

  • 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.
  • 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
  • Prognosis
    • Worse prognosis
      • higher respiratory virus titer
      • older age
      • underlying comorbid conditions such as diabetes and chronic hepatitis B
      • increased lactate dehydrogenase on admission
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