Severe Acute Respiratory Syndrome (SARS)

I. Definition

Severe Acute Respiratory Syndrom (SARS) is a new communicable disease that has spread worldwide in Hong Kong, Singapore, and Canada within a few months since its onset in China in winter 2002. The cause of SARS is SARS coronavirus (SARS-associated coronavirus). The existing coronavirus has been classified into three antigen groups (I, II, III), and SARS-coV has been identified as a coronavirus belonging to a new genetically different group. SARS-coV has been isolated from animals by the animal host coronavirus strain. It is estimated that infection has occurred beyond the walls of the species as a person.

II. Patient and Contact Management

1. Patient Care

Since SARS-coV is capable of spreading in the air as well as droplets by infected body fluids and respiratory secretions, isolation of patients with SARS prevents isolation in single-person rooms with independent air circulation. In principle.

2. Contact Management

For high-risk contacts, it is recommended to stay away from home for 10 days from the date of last contact with the patient.In this case, do not leave the workplace or school outside, and do not visit outsiders during the incubation period, and measure the temperature by measuring the temperature every day. You should. For everyday contact, if you develop fever or respiratory symptoms within 10 days of contact, the first 72 hours of home isolation should be observed.

III. Mechanical characteristics

1. Global Contagion

SARS spread rapidly after the WHO alarm on March 12, 2003, with 167 patients and four deaths in seven countries, including Hong Kong and Vietnam, followed by Germany, Canada, Switzerland and Thailand on March 17. By December 31, 2003, there were 8,096 estimated patients and 774 deaths in 29 countries around the world.

2. Contagious Pathway

The basic route of transmission is by direct or indirect contact of the mucosa through the patient’s respiratory droplets or contaminated media. Rarely reported cases of contact with the rectum, planes, or taxis have been reported, but are not clear about the anal-oral route, but large amounts of virus are released into the stool, and diarrhea is a common symptom. Et al suggest the possibility that this pathway played a role in the spread of the disease.

IV. Clinical findings

After the incubation period of 2 to 10 days after exposure to Sascoronavirus, influenza-like symptoms develop during the first week of onset. The main symptoms are fever, malaise, muscle pain, headache, chills, and no specific symptoms or symptoms. Fever is the most common symptom, but there may be no fever at first; cough (in the early stages, dry cough without sputum), shortness of breath, diarrhea may also appear in the first week of onset, but it is common in the second week of onset, such as runny nose or sore throat. Symptoms are uncommon: severely ill patients develop rapid respiratory failure and, in about 20%, lack oxygen to require intensive care. Many patients complain of symptoms of massive watery diarrhea without blood or mucus. Infection occurs mainly in the second week of development. In the elderly, atypical symptoms such as no fever or bacterial sepsis / pneumonia were problematic. With chronic diseases and frequent use of health care institutions, the possibility of transmission to hospital infections was high.
Children had relatively low SARs and mild symptoms. Pregnant women are infected with SARS, which can lead to miscarriage in the early stages of pregnancy and maternal deaths.

V. Diagnostic Findings

SARS diagnosis is based on tests for the virus. These methods include separating viruses or detecting antigens from samples obtained through nasal and throat smears, and identifying specific antibody values ​​through serological diagnosis. Hematologic findings are the most common findings of lymphopenia, sometimes with thrombocytopenia and delayed aPTT. I have suggested. Elevated levels of ALT, AST, and CPK have been reported, and abnormal serum electrolytes such as hyponatremia, hypokalemia, hypomagnesemia, and hypocalcemia have been reported during symptoms or during hospitalization.

Radiographic findings

Most patients showed changes in chest radiographs or CT findings in the early 3-4 days of the onset despite no respiratory symptoms. Typical findings were patchy consolidation at the unilateral peripheral area. Or ground-glass appearence. Some areas may have shifting findings and later in the onset of spontaneous pneumothorax, pneumomediastinum, sub-pleural fibrosis and / or cyctic changes.

VI. Treatments

There is no special treatment for SARS. Treatment based on severe pneumonia that requires attention is recommended, and treatment is mainly used to relieve symptoms such as shortness of breath and hypoxia. The efficacy of various antiviral agents for Sascoronavirus is currently being reviewed.

VII. Preventions

No vaccine has been developed that works against SARS. Restrict travel to areas where SARS is prevalent, and preventive effects can be obtained by strengthening personal hygiene such as washing your hands and wearing personal protective equipment.