In March 2003, there was an outbreak of atypical pneumonia in China. As of May 14 2003, there have been more than 573 deaths due to SARS and more than 7548 cases described worldwide (1) with most being adults between 25-70 years of age and few cases in children < 15 years. World Health Organization (WHO) has named the illness as SEVERE ACUTE RESPIRATORY SYNDROME (SARS). Within a period of 2 months, SARS has become a global health problem, prompting the WHO to issue a global alert for the first time in more than a decade (1). A novel corona virus is believed to be responsible for the global epidemic of SARS.
CLINICAL FEATURES OF SARS:
The incubation period for SARS is typically 2-7 days. However, it may be as long as 10 days. The clinical and radiological features bear resemblance to atypical pneumonias caused by mycoplasma, chlamydia or legionella. Fever, chills, headache, myalgia and dry cough are the common features in these patients.
The illness usually begins with a prodrome of high spikes of fever followed by dry, non-productive cough or dyspnea on Day 3-7, which may progress to hypoxemia. In 10-20% of cases, the respiratory illness is severe enough to require intubation and mechanical ventilation. The mortality rate is approximately 3%. The severity of illness might be highly variable, ranging from mild illness to death. Although a few close contacts of patients with SARS have developed a similar illness, the majority have remained well.
The primary way that SARS appears to spread is by close person-to-person contact. Potential ways in which SARS can be spread include touching the skin of other people or objects that are contaminated with infectious droplets and then touching your eye(s), nose, or mouth. Information to date suggests that people are most likely to be infectious when they have symptoms, such as fever or cough. However, it is not known how long before or after their symptoms begin that patients with SARS might be able to transmit the disease to others.
Acute and convalescent (greater than 21 days after onset of symptoms) serum samples should be collected from each patient who meets the SARS case definition. The disease is confirmed by detection of antibody to SARS-CoV in specimens obtained during acute illness or >21 days after illness onset or detection of SARS-CoV RNA by RT-PCR or by isolation of SARS-CoV.
Various regimens consisting of several antibiotics, antiviral agents such as oseltamivir or ribavirin, steroids have been tried. At present, the most effective treatment regimen is unknown.
Clinicians evaluating suspected cases should use standard precautions (e.g., hand hygiene) together with airborne (e.g., masks) and contact (e.g., gowns and gloves) precautions. Until the mode of transmission has been defined more precisely, eye protection also should be worn for all patient contact.
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