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Updated on May 8, 2003 更新

非典型肺炎 (Atypical Pneumonia)

嚴重急性呼吸系統綜合症 (SARS: Severe Acute Respiratory Syndrome)

1. Sudden acute respiratory syndrome ---response to this article
2. Journal of Virology: search JVI for coronavirus
3. Complete coronaviridae genomes
4. A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong (source) (April 7, 2003)
5. SARS Summary on major findings in relation to coronavirus by members of the WHO multi-centre collaborative network on SARS aetiology and diagnosis 4/4/2003
6. A Cluster of Cases of Severe Acute Respiratory Syndrome in Hong Kong. (source) 1/4/2003
7. Summary on major findings in relation to coronavirus by members of the WHO multi-centre collaborative network on SARS aetiology and diagnosis 4 April 2003 (source)
8. SARS: detection of chlamydia-like and coronavirus-like agents in 7 fatal cases
9. Survival characteristics of airborne human coronavirus 229E
10. Rhinovirus and coronavirus infection-associated hospitalizations among older adults (Abstract) 5/2002
11. Localization to the Nucleolus Is a Common Feature of Coronavirus Nucleoproteins, and the Protein May Disrupt Host Cell Division 10/2001 (pdf)
12. Coronavirus-related nosocomial viral respiratory infections in a neonatal and paediatric intensive care unit: a prospective study. (source) 5/2002
13. Human Coronavirus 229E Infects Polarized Airway Epithelia from the Apical Surface 10/2000
14. Multiple Sclerosis & CoronaVirus (list of article)
15. Molecular Mimicry: CoronaVirus Human CoronaVirus Infections: Importance And Diagnosis (Abstract)
16. CoronaVirus Infection & DeMyelination Development Of Lesions In Lewis Rats (Abstract)
17. Sudden acute respiratory syndrome ---response to this article
18. Biosynthesis, purification, and characterization of the human coronavirus 229E 3C-like proteinase 5/1997 (pdf)
19. Feline aminopeptidase N serves as a receptor for feline, canine, porcine, and human coronaviruses in serogroup I (pdf) 12/1996

A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong (source) (April 7, 2003) (Full Text in PDF)

• Published at www.nejm.org April 7, 2003 (10.1056/NEJMoa030685)
• Nelson Lee, M.D., David Hui, M.D., Alan Wu, M.D., Paul Chan, M.D., Peter Cameron, M.D., Gavin M. Joynt, M.D., Anil Ahuja, M.D., Man Yee Yung, B.Sc., C.B. Leung, M.D., K.F. To, M.D., S.F. Lui, M.D., C.C. Szeto, M.D., Sydney Chung, M.D., and Joseph J.Y. Sung, M.D.
  
  ABSTRACT

Background: There has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. We report the clinical, laboratory, and radiologic features of 138 cases of suspected SARS during a hospital outbreak in Hong Kong.

Methods: From March 11 to 25, 2003, all patients with suspected SARS after exposure to an index patient or ward were admitted to the isolation wards of the Prince of Wales Hospital. Their demographic, clinical, laboratory, and radiologic characteristics were analyzed. Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed.

Results: There were 66 male patients and 72 female patients in this cohort, 69 of whom were health care workers. The most common symptoms included fever (in 100 percent of the patients); chills, rigors, or both (73.2 percent); and myalgia (60.9 percent). Cough and headache were also reported in more than 50 percent of the patients. Other common findings were lymphopenia (in 69.6 percent), thrombocytopenia (44.8 percent), and elevated lactase dehydrogenase and creatine kinase levels (71.0 percent and 32.1 percent, respectively). Peripheral air-space consolidation was commonly observed on thoracic computed tomographic scanning. A total of 32 patients (23.2 percent) were admitted to the intensive care unit; 5 patients died, all of whom had coexisting conditions.

In a multivariate analysis, the independent predictors of an adverse outcome were

1. advanced age (odds ratio per decade of life, 1.80; 95 percent confidence interval, 1.16 to 2.81; P=0.009),
2. a high peak lactate dehydrogenase level (odds ratio per 100 U per liter, 2.09; 95 percent confidence interval, 1.28 to 3.42; P=0.003),
3. and a high absolute neutrophil count on presentation (odds ratio, 1.60; 95 percent confidence interval, 1.03 to 2.50; P=0.04).

Conclusions: SARS is a serious respiratory illness that led to significant morbidity and mortality in our cohort.

A Cluster of Cases of Severe Acute Respiratory Syndrome in Hong Kong. (source) 1/4/2003 (April 1, 2003) (Full Text in PDF)

• N Engl J Med 2003 Apr 1; [epub ahead of print] Related Articles, Links
• Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, Lam WK, Seto WH, Yam LY, Cheung TM, Wong PC, Lam B, Ip MS, Chan J, Yuen KY, Lai KN.

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

Methods: We abstracted 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:

1. Exposure between the source patient and subsequent patients ranged from minimal to that between patient and health care provider.
2. The incubation period ranged from 2 to 11 days.
3. All patients presented with fever (temperature, >38 degrees C for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise, headache, and hypoxemia.
4. Physical examination of the chest revealed crackles and percussion dullness.
5. Lymphopenia was observed in nine patients, and most patients had mildly elevated aminotransferase levels but normal serum creatinine levels.
6. Serial chest radiographs showed progressive air-space disease.
7. Two patients died of progressive respiratory failure; histologic analysis of their lungs showed diffuse alveolar damage.
8. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila.
9. 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 radiological 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.

Summary on major findings in relation to coronavirus by members of the WHO multi-centre collaborative network on SARS aetiology and diagnosis 4 April 2003 (source)

Since its inception on 17 March network members obtained the following results:

• A new coronavirus which is unlike any other known members of the genus Coronavirus has been isolated consistently by several network laboratories from SARS patients from several countries.
• This virus causes a cytopathogenic effect (CPE) in VERO cells and FRhk-4 cells, which can be inhibited with serum from SARS convalescent patients.
• Electron microscopic pictures from cell-culture and respiratory specimens from SARS patients show coronavirus-like particles.
• Immunofluorescence assays (IFA) with serum from convalescent patients detect cells infected with the virus in cell-culture.
• Reactivity with a new coronavirus could not be detected in serum from several hundreds of non-SARS individuals in the U.S.A., Canada and Hong Kong.
• Generic coronavirus primers detect a new coronavirus RNA in cell-culture and in specimens from SARS patients. Specific primers have been developed in several laboratories and are currently been compared for sensitivity ( PCR primers for SARS developed by WHO Network Laboratories ).
• Hyperimmune sera against Transmissible Gastroenteritis Virus (TGEV), Feline Infectious Peritonitis virus (FIPV), Murine Hepatitis Virus (MHV) and 229E human coronavirus inhibit growth of a new coronavirus in cell-culture.
• Partial sequencing of a new coronavirus in several laboratories confirms affiliation of a new coronavirus to the genus Coronavirus as well as dissimilarities with known members belonging to each of the three existing groups of this genus.
• Animal inoculation experiments are ongoing.

1. It is currently agreed that this coronavirus is the major causative agent of SARS.
2. Human metapneumovirus (hMPV) has also been found in respiratory specimens and antibodies against hMPV in serum of some SARS patients,
3. as well as evidence of dual infection with hMPV and the new coronavirus.
4. The significance of hMPV in SARS remains unclear at this time and will be reported on later.

Survival characteristics of airborne human coronavirus 229E. (Please note that the SARS virus is a new strand.) (source)

• J Gen Virol 1985 Dec;66 ( Pt 12):2743-8 Related Articles, Links
• Ijaz MK, Brunner AH, Sattar SA, Nair RC, Johnson-Lussenburg CM.

The survival of airborne human coronavirus 229E (HCV/229E) was studied under different conditions of temperature (20 +/- 1 degree C and 6 +/- 1 degree C) and low (30 +/- 5%), medium (50 +/- 5%) or high (80 +/- 5%) relative humidities (RH).

At 20 +/- 1 degree C, aerosolized HCV/229E was found to survive best

• at 50% RH with a half-life of 67.33 +/- 8.24 h while
• at 30% RH the virus half-life was 26.76 +/- 6.21 h.
• At 50% RH nearly 20% infectious virus was still detectable at 6 days.

High RH at 20 +/- 1 degree C, on the other hand,

• was found to be the least favourable to the survival of aerosolized virus and under these conditions the virus half-life was only about 3 h;
• no virus could be detected after 24 h in aerosol.

At 6 +/- 1 degree C, in either 50% or 30% RH conditions,

• the survival of HCV/229E was significantly enhanced,
• with the decay pattern essentially similar to that seen at 20 +/- 1 degree C.

At low temperature and high RH (80%), however, the survival pattern was completely reversed,

• with the HCV/229E half-life increasing to 86.01 +/- 5.28 h, nearly 30 times that found at 20 +/- 1 degree C and high RH.

Although optimal survival at 6 degree C still occurred at 50% RH, the pronounced stabilizing effect of low temperature on the survival of HCV/229E at high RH indicates that the role of the environment on the survival of viruses in air may be more complex and significant than previously thought.

PMID: 2999318 [PubMed - indexed for MEDLINE]