Clinical Features and Short-term Outcomes of 144 Patients With SARS in the Greater Toronto Area

Booth, Christopher M.; Matukas, Larissa; Tomlinson, George; Rachlis, Anita; Rose, David; Dwosh, Hy A.; Walmsley, Sharon; Mazzulli, Tony; Avendaño, Mónica; Derkach, Peter; Ephtimios, Issa E.; Kitai, Ian; Mederski, Barbara; Shadowitz, Steven; Gold, Wayne L.; Hawryluck, Laura; Rea, Elizabeth; Chenkin, Jordan; Cescon, David W.; Poutanen, Susan M.; Detsky, Allan S.

doi:10.1001/jama.289.21.joc30885

Cited by 1,273 publications

(1,454 citation statements)

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“…SARS acquisition in the hospital setting, in either health care workers, inpatients, or hospital visitors, occurred in 112 (41.3%) cases, and a further 62 individuals acquired SARS following exposure at home to family members or friends with hospital-acquired infections. The clinical features were similar to those reported elsewhere (data not shown) (1,3,5,10,11).…”

supporting

confidence: 89%

Kinetics of Severe Acute Respiratory Syndrome (SARS) Coronavirus-Specific Antibodies in 271 Laboratory-Confirmed Cases of SARS

Zhang

Dong

Zhang

et al. 2004

Clin Vaccine Immunol

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The sensitivities and specificities of an immunofluorescence assay and an enzyme immunoassay for detection of antibodies specific for severe acute respiratory syndrome coronavirus (SARS-CoV) were compared for 148 laboratory-confirmed SARS cases. The appearance and persistence of SARS-CoV-specific antibodies were assessed, with immunoglobulin G detected in 59% of samples collected within 14 days and persisting for 60 to 95 days after the onset of illness. (2-4, 7, 9, 10), although data on the performance of various antibody detection assays and the persistence of SARS-CoV-specific antibodies are lacking.The first aim of this study was to compare the sensitivities and specificities of a commercial immunofluorescence assay (IFA; Euroimmun AG, Lübeck, Germany) and a recombinant double-nucleocapsid antigen sandwich enzyme-linked immunosorbent assay (ELISA; Wantai Biological Pharmacy Enterprise Company, Ltd., Beijing, China) for SARS-CoV-specific immunoglobulin G (IgG) and IgM in patients for whom SARS-CoV RNA had been detected by reverse transcriptase PCR (RT-PCR). The second aim was to assess the timing of the appearance and persistence of SARS-CoV-specific antibodies after the onset of disease.Three hundred four patients fitting the SARS clinical case definition (fever of 38°C or higher, cough or shortness of breath, new pulmonary infiltrates on chest radiography, and close contact with a person with a suspected or probable case) were hospitalized at Ditan Hospital, Beijing, China, between 26 March and 31 May 2003. Probable cases were regarded as laboratory confirmed if SARS-CoV-specific IgG and/or IgM was detected by IFA within 3 weeks of the onset of illness and/or SARS-CoV RNA was detected by RT-PCR within 2 weeks. SARS-CoV infection was laboratory confirmed in 271 of 304 (89.1%) cases, with 33 individuals testing SARS-CoV negative (10.9%; 27 of these had alternative laboratory diagnoses). The mean age of the 271 individuals with laboratoryconfirmed cases was 36 Ϯ 16 years, and they included 92 (33.9%) health care workers and 32 patients with significant underlying illnesses. SARS acquisition in the hospital setting, in either health care workers, inpatients, or hospital visitors, occurred in 112 (41.3%) cases, and a further 62 individuals acquired SARS following exposure at home to family members or friends with hospital-acquired infections. The clinical features were similar to those reported elsewhere (data not shown) (1,3,5,10,11).Comparison of IFA and ELISA for detection of SARS-CoVspecific IgG and IgM. Testing was performed for 148 patients for whom SARS-CoV was detected in respiratory or fecal samples by RT-PCR. SARS-CoV IgM was detected for 117 (79%) people and SARS-CoV IgG was detected for 145 (98%) people by IFA, while IgM was detected for 133 (90%) people and IgG was detected for 120 (82%) people by ELISA. Controls included 105 asymptomatic close contacts of individuals with SARS cases (medical workers) and 90 individuals with chronic hepatitis B (30 cases), hepatitis C (30 cases), or human immunodef...

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supporting

confidence: 89%

Kinetics of Severe Acute Respiratory Syndrome (SARS) Coronavirus-Specific Antibodies in 271 Laboratory-Confirmed Cases of SARS

Zhang

Dong

Zhang

et al. 2004

Clin Vaccine Immunol

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“…5 Despite existing safety protocols, 51% of the SARS cases were HCWs of which three died. 6 In several cases, the disease was transmitted to family members of HCWs including children. Intubation occurred in 26% of cases and was considered a high-risk procedure for SARS transmission.…”

Section: Purposementioning

confidence: 99%

Intubation of SARS patients: infection and perspectives of healthcare workers

Caputo

Byrick

Chapman

et al. 2006

Can J Anesth/J Can Anesth

104

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Purpose:The outbreak of severe acute respiratory syndrome (SARS) in 2003 presented major challenges to the safety of anesthesiologists and other healthcare workers (HCWs). This study determined the incidence of SARS transmission to HCWs who intubated patients and analyzed the concerns of HCWs regarding personal and patient safety. Methods: Healthcare workers who performed tracheal intubation in 10 Toronto hospitals were identified using the Ontario Public Health database. A questionnaire was used to collect information from the HCWs. To determine if the patterns of personal protection or concerns changed over time, data were analyzed according to whether the intubation occurred during SARS 1 (February 23 to April 21) or SARS 2 (April 22 to July 1). Results: Thirty-three HCWs who performed 39 intubations on 35 SARS patients were interviewed. Three of 23 HCWs (13%) acquired SARS during SARS 1 whereas none (0/10) acquired SARS during SARS 2. Personal protection increased from SARS 1 to SARS 2 and HCWs' concerns changed over time. During SARS 1, concerns focused on the need for personal protective equipment whereas during SARS 2, concerns focused on the need for strict training and patient care protocols. HCWs perceived that their experiences were ineffectively integrated into risk management protocols. Conclusions: Protection guidelines failed to completely prevent the transmission of SARS to HCWs. Nine percent of the interviewed HCWs who intubated patients contracted SARS. A Risk Analysis Framework is presented to facilitate the rapid integration of HCWs' experiences into practice guidelines. Objectif : L'éclosion du syndrome respiratoire aigu sévère (SRAS) en 2003 a présenté des défis importants à la sécurité des anesthésiologistes et des autres travailleurs de la santé (TS). L'étude a déterminé l'incidence de transmission du SRAS aux TS qui ont intubé des patients et a analysé les préoccupations des TS concernant la sécurité du personnel et des patients. Méthode : Nous avons repéré les TS qui ont réalisé des intubations dans 10 hôpitaux de Toronto grâce à la base de données sur la santé publique de l'Ontario. Un questionnaire a été utilisé pour recueillir les informations des TS. Pour vérifier si les modèles de protection individuelle et les préoccupations avaient changé avec le temps, l'analyse a tenu compte des intubations réalisées pendant les phases I ou II du SRAS

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“…En la mayoría de los pacientes la fase respiratoria coincide con infiltrados focales intersticiales que evolucionan a infiltrados intersticiales generalizados. 11,12,17,29 En fases tardías pueden encontrarse áreas de consolidación alveolar (cuadro II).…”

Section: Características Clínicas Y Diagnósticounclassified

“…19 Sin embargo, debido a la falta de evidencia clínica y de laboratorio en diversas series, además de una elevada toxicidad (en 76% de los casos) las autoridades canadienses no están recomendando ni autorizando el empleo de ribavirina. 29 No obstante la ausencia de controles en el estudio de Peiris y colaboradores, 19 y ante la, hasta este momento, imposibilidad de desarrollar ensayos clínicos controlados sugerimos que, cuando se decida utilizar empíricamente estos medicamentos, se documente cuidadosamente la experiencia clínica para poder trazar conclusiones más específicas acerca de la utilización clínica de dichos fármacos.…”

Section: Tratamientounclassified

“…34 Se ha descrito recientemente que en estudios de replicación in vitro el interferón alfa resulta también altamente efectivo, lo cual no ha sido hasta el momento probado clínica-mente. 29 El papel de los esteroides en el tratamiento de esta enfermedad no está bien esclarecido. Sin embargo, su uso en diversas series se ha asociado a un mejor pronóstico, especialmente cuando han sido utilizados entre los días 6 a 8 de la enfermedad.…”

Section: Tratamientounclassified

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