Coronavirus-positive Nasopharyngeal Aspirate as Predictor for Severe Acute Respiratory Syndrome Mortality

Tsang, Owen Tak Yin; Chau, Tai Nin; Choi, Kin Wing; Tso, Eugene Yuk‐Keung; Lim, Wilina; Chiu, Ming Chi; Tong, Wing Lok; Lee, Po Oi; Lam, B; Ng, Tak Keung; Lai, Jak Yiu; Yu, Wai Cho; Lai, Sik To

doi:10.3201/eid0911.030400

Cited by 92 publications

(91 citation statements)

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“…In adult series, the independent predictors of severe illness are advanced age, high initial absolute neutrophil counts, high initial or peak lactate dehydrogenase levels, and positive RT-PCR results for NPA samples. 7,13,28,29 Our clinical case definition has very good sensitivity (97.8%) and specificity (92.7%) in field testing and served us well during the SARS outbreak. However, early in an outbreak, an epidemiologic clue might not be available to satisfy the requirement in the case definition, even for an actual case.…”

Section: Discussionmentioning

confidence: 99%

“…Rapid diagnosis using reverse transcription-polymerase chain reaction (RT-PCR) targeting specific segments of the SARS-CoV genome was performed with RNA extracted from NPA and stool samples as described. 6,7 Serologic studies included Mycoplasma pneumoniae IgM and paired acute and convalescent sera for IgG against M pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Legionella pneumophila, influenza A and B, RSV, adenovirus, and parainfluenza types 1, 2, and 3. Laboratory confirmation of SARS was made with detection of a Ն4-fold increase in convalescent antibody titers against SARSCoV at least 21 days after disease onset, using an indirect fluorescent antibody assay.…”

Section: Microbiologic Investigationsmentioning

confidence: 99%

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Severe Acute Respiratory Syndrome Among Children

Leung¹,

Kwan²,

et al. 2004

Pediatrics

122

152

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ABSTRACT. Objective. To study the epidemiologic, clinical, laboratory, and radiologic features, prognostic indicators, and short-term to medium-term outcomes for children with severe acute respiratory syndrome (SARS) and to validate the performance characteristics of a clinical case definition, calculated with respect to SARSassociated coronavirus (SARS-CoV) seroconversion.Methods. Children <18 years of age, from a singlesite outbreak, who satisfied a clinical case definition for SARS, with subsequent serologic confirmation, were treated according to a standard protocol and prospectively monitored.Results. Forty-four children were included. The median age was 12 years. Forty-two children (95.5%) demonstrated an epidemiologic link. Fever, cough, malaise, coryza, sputum production, headache, myalgia, lymphopenia, and elevated lactate dehydrogenase levels were common presenting features. Radiographic findings were nonspecific, but high-resolution computed tomography of the thorax was an early diagnostic aid. A specific reverse transcription-polymerase chain reaction assay for SARS-CoV yielded positive results for <50% of children. Of 9 children who developed hypoxemia, 8 were treated with methylprednisolone. Of 5 children who received intensive care, 3 required assisted ventilation. All children recovered, and serious adverse events in response to treatment were not observed. The outcomes at 3 to 6 months after disease onset, including exercise tolerance, pulmonary functions, and psychologic status, were favorable. An age of >12 years was associated with methylprednisolone therapy for severe illness. After exclusion of the only infant, an age of >12 years was associated with oxygen requirements. Sore throat, high neutrophil count at presentation, and peak neutrophilia were independent factors predicting severe illness. The clinical case definition demonstrated good sensitivity, specificity, and positive and negative predictive values (97.8%, 92.7%, 88%, and 98.7%, respectively) for diagnostic accuracy.Conclusions. 1 Although the majority were adults, 121 children (6.9%) Ͻ18 years of age were registered, yielding an age-specific attack rate of 8.9 cases per 100 000 persons Ͻ18 years of age and a case fatality rate of 0%. A total of 89 hospitalized children in Hong Kong demonstrated serologic evidence of infection by the SARS-associated coronavirus (SARS-CoV) (e-SARS database, Hospital Authority, Hong Kong Special Administrative Region, data on file).Published articles on pediatric SARS have focused on reporting the demographic, clinical, laboratory, and radiologic characteristics. Definitive virologic data, prognostic indicators, and short-term to medium-term follow-up information were lacking in those preliminary reports. [2][3][4] We prospectively monitored a cohort of 44 children with laboratory confirmation of SARS who were treated at a referral center for pediatric infectious diseases that admitted the largest number of pediatric patients with SARS in Hong Kong. Their epidemiologic links; clinical, laboratory,...

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Section: Discussionmentioning

confidence: 99%

Section: Microbiologic Investigationsmentioning

confidence: 99%

Severe Acute Respiratory Syndrome Among Children

Leung¹,

Kwan²,

et al. 2004

Pediatrics

122

152

View full text Add to dashboard Cite

show abstract

“…The sensitivity of various RT-PCR assays for SARS-CoV ranged from 32% to Ͼ79%, depending on the timing, type, and number of specimens collected (11,12,16,21,22,28,29). The sensitivity of detecting the N protein in sera was recently reported to be 50% and 71% for samples collected between day 3 and day 5 and between day 6 and day 10, respectively (2).…”

mentioning

confidence: 99%

Immunofluorescence Assay for Detection of the Nucleocapsid Antigen of the Severe Acute Respiratory Syndrome (SARS)-Associated Coronavirus in Cells Derived from Throat Wash Samples of Patients with SARS

Liu

Chen²,

Yeh

et al. 2005

J Clin Microbiol

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An antigen detection assay for severe acute respiratory syndrome (SARS) coronavirus was established in this study by an indirect immunofluorescence test, which utilized cells derived from throat wash samples of patients with SARS and a rabbit serum that recognized the nucleocapsid protein of SARS-associated coronavirus (SARS-CoV) but not that of other human coronavirus tested. It detected SARS-CoV in 11 of 17 (65%) samples from SARS patients as early as day 2 of illness but in none of the 10 samples from healthy controls. Compared with other diagnostic modalities for detecting SARS-CoV, this assay is simpler, more convenient, and economical. It could be an alternative for early and rapid diagnosis, should SARS return in the future.

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“…Secondly, the authors reported that 'corticosteroid therapy was commenced at the discretion of the attending physicians', but had not given any reasons to explain why 12/78 patients had not been given corticosteroids, nor whether or not they had laboratory-confirmed SARS, which has been reported to predict outcome. 2 Corticosteroids could have been prescribed for sicker patients, and those not prescribed this drug might have had milder disease, and indeed the median value of peak LDH was lower (though non-significantly) among the cohort not given corticosteroids. Chest X-ray and oxygenation status, which had been reported to have much greater bearing on disease severity and thus the decision to use corticosteroid than the peak LDH values, 4 was not available.…”

mentioning

confidence: 97%

“…[2][3][4][5] In a prospective study, 5 a mortality rate of 3.4% could be achieved 5 if corticosteroids were prescribed in accordance with a strict standard treatment protocol 4 timed to match the appearance of pre-defined worsening of clinical criteria. Other outcome studies following corticosteroids also reported mortality rates of about 10% only.…”

mentioning

confidence: 99%