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	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Holmes, K. V. Editorial by Drazen, J. M. Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article by Ksiazek, T. G. Related Article by Drosten, C. PubMed Citation

ABSTRACT

Background Information on the clinical features of the severe acute respiratory syndrome (SARS) will be of value to physicians caring for patients suspected of having this disorder.

Methods We abstracted data on the clinical presentation and course of disease in 10 epidemiologically linked Chinese patients (5 men and 5 women 38 to 72 years old) in whom SARS was diagnosed between February 22, 2003, and March 22, 2003, at our hospitals in Hong Kong, China.

Results Exposure between the source patient and subsequent patients ranged from minimal to that between patient and health care provider. The incubation period ranged from 2 to 11 days. All patients presented with fever (temperature, >38°C for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed crackles and percussion dullness. Lymphopenia was observed in nine patients, and most patients had mildly elevated aminotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive air-space disease. Two patients died of progressive respiratory failure; histologic analysis of their lungs showed diffuse alveolar damage. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy a mean (±SD) of 9.6±5.42 days after the onset of symptoms, and eight were treated earlier with a combination of beta-lactams and macrolide for 4±1.9 days, with no clinical or radiologic efficacy.

Conclusions SARS appears to be infectious in origin. Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name. The microbiologic origins of SARS remain unclear.

Source Information

From the University Departments of Medicine (K.W.T., M.C.-Y., W.K.L., P.C.W., B.L., M.S.I., J.C., K.N.L.), Clinical Microbiology (P.L.H., T.W., W.H.S., K.Y.Y.), and Diagnostic Radiology (G.C.O.), University of Hong Kong; the Department of Medicine, Kwong Wah Hospital (W.K.Y.); and the Department of Medicine, Pamela Youde Nethersole Eastern Hospital (L.Y.Y., T.M.C.) — all in Hong Kong, China.

This article was published at www.nejm.org on March 31, 2003.

Address reprint requests to Dr. Lai at the University Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China.

Full Text of this Article

Related Letters:

Coronavirus Genomic-Sequence Variations and the Epidemiology of the Severe Acute Respiratory Syndrome
Tsui S. K.W., Chim S. S.C., Lo Y.M. D., the Chinese University of Hong Kong (CUHK) Molecular SARS Research Group
Extract | Full Text | PDF  
N Engl J Med 2003; 349:187-188, Jul 10, 2003. Correspondence

Pseudo-SARS
Johnson S., Patel M., Mullane K., Tsang K. W., Ho P. L., Low D. E.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:709-711, Aug 14, 2003. Correspondence

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