Atypical SARS andEscherichia coliBacteremia

Abstract

We describe a patient with severe acute respiratory syndrome (SARS) whose clinical symptoms were masked by Escherichia coli bacteremia. SARS developed in a cluster of healthcare workers who had contact with this patient. SARS was diagnosed when a chest infiltrate developed and when the patient’s brother was hospitalized with acute respiratory failure. We highlight problems in atypical cases and offer infection control suggestions.

Epidemiologic Study and Containment of a Nosocomial Outbreak of Severe Acute Respiratory Syndrome in a Medical Center in Kaohsiung, Taiwan

“…Atypical clinical manifestations of SARS, which are not uncommonly encountered in hosts with comorbidities and/ or underlying immunocompromise, make recognition of SARS difficult for medical professionals inexperienced with this newly emerging disease. [8][9][10][11][12] In this series of patients, a body temperature of less than 38ЊC, which failed to meet the WHO criteria for SARS, was observed in 1 patient (patient 4); leukocytosis, instead of a normal peripheral white cell count or leukopenia, which have been reported in a large number of patients with SARS, 13,14 was documented in 3 patients (patients 4, 10, and 18). The finding of additional consolidation on chest radiographs of these vulnerable patients with copious purulent respiratory excretion was more consistent with nosocomial bacterial pneumonia.…”

Atypical COVID-19 Infections -- The Challenge of Predicting the Unpredictable

“…[2] The index patient central to another cluster of 60 patients at a second hospital in March 2003, had presented with atypical features, masked by E. coli bacteremia. [2][3] Our small case series illustrate the vulnerability of our inpatient cohort where atypical COVID-19 presentation can potentially result in secondary nosocomial transmission.…”

Cost-effectiveness Analysis of Hospital Infection Control Response to an Epidemic Respiratory Virus Threat

“…Singapore and many of the other countries badly affected by the SARS epidemic of 2003 launched comprehensive pandemic response plans based on a SARS model ( 5 ). The lessons of the SARS epidemic, in particular the effect of protecting HCWs from patients with undiagnosed, unisolated respiratory viral infections ( 16 , 17 ), have been applied rigorously to the pandemic plans of the Singapore Ministry of Health. Although it is difficult to quantify the impact of these interventions when they are taken as a whole, data from our modeling show that a nuanced approach that concentrates on administrative measures to isolate patients and selectively use PPE when working with patients suspected of having novel strains of pandemic (H1N1) 2009 virus would have a relatively favorable cost-effectiveness ratio.…”