Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)

Epidemiology

  • Outbreak: 2003 outbreak in Hong Kong

Microbiology

  • Severe Acute Respiratory Syndrome Coronavirus (SARS CoV) (see Coronaviruses, [[Coronaviruses]])

Diagnosis

  • Sputum GS/Cult+Sens:

HRCT: appears similar to findings in BOOP (however, nodules, lymphadenopathy, and pleural effusion are uncommon in SARS)
1) Ground Glass Pattern with/without Consolidation (predominantly lower lobe, peripheral distribution): common pattern
2) Thickened Interlobular Septa:
3) Thickened Intralobular Septa: crazy paving pattern (this is a non-specific pattern seen in a variety of lung diseases, including UIP, etc.)
4) Bronchiectasis: may be seen


Clinical Manifestations

CDC Criteria

  • Fever >38°C (see Fever, [[Fever]])
  • One or more of the following: cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of either pneumonia or acute respiratory distress syndrome
  • Travel within 10 days of onset of symptoms to an area with documented or suspected community transmission of SARS, or close contact within 10 days of onset of symptoms with either a person with a respiratory illness who traveled to a SARS area or a person known to be a suspect SARS case (close contact is defined as having cared for, having lived with, or having had direct contact with respiratory secretions and/or body fluids of a patient suspected of having SARS

Treatment

Supportive Care

  • Intensive Care Unit Care/Mechanical Ventilation: as required
    • Canadian Case Series: only 19% of cases required ICU care [MEDLINE]

Treatments Without Defined Clinical Benefit

  • General Comments
    • No Treatments Have Demonstrated Clinical Benefit [MEDLINE]
  • Glucocorticoids (see Corticosteroids, [[Corticosteroids]])
  • Inhaled Nitric Oxide (iNO) (see Nitric Oxide, [[Nitric Oxide]])
    • iNO has been shown to inhibit in vitro replication of SARS-CoV [MEDLINE]
  • Ribavirin and Interferon-Beta (see Ribavirin, [[Ribavirin]]) [MEDLINE] [MEDLINE] [MEDLINE]

References

  • Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367-73 [MEDLINE]
  • Dual effect of nitric oxide on SARS-CoV replication: viral RNA production and palmitoylation of the S protein are affected. Virology. 2009;395:1-9 [MEDLINE]
  • Ribavirin and interferon-beta synergistically inhibit SARS-associated coronavirus replication in animal and human cell lines. Biochem Biophys Res Commun. 2005;326: 905-8 [MEDLINE]
  • Interferon alfacon1 is an inhibitor of SARS-corona virus in cell-based models. Antiviral Res. 2005;66:99-102 [MEDLINE]
  • SARS: systematic review of treatment effects. PLoS Med. 2006;3(9):e343 [MEDLINE]
  • Interferon interplay helps tissue cells to cope with SARS-coronavirus infection. Virulence. 2010;1:273-5 [MEDLINE]