Osteonecrosis in Children With Severe Acute Respiratory Syndrome

Chan, Chun-Wing; Chiu, Wa-Keung; Chan, Chak-Chung; Chow, Eudora Y.D.; Cheung, Ho-Man; Ip, Patricia

doi:10.1097/01.inf.0000137570.37856.ea

Cited by 20 publications

(21 citation statements)

References 11 publications

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“…Recent concern has focused on a complication of SARS in the convalescent phase, when avascular necrosis develops on the femoral head. The morbidity of this condition is reported to be 15% to 30% in some SARS patients in Mainland China [8,10]. Among the 78 patients receiving an MRI examination, there were 18 cases of complicated necrosis of the femoral head to different degrees.…”

Section: Discussionmentioning

confidence: 99%

Dynamic changes of serum SARS-Coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge

et al. 2005

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Objective: The intent of this study was to examine the recovery of individuals who had been hospitalized for severe acute respiratory syndrome (SARS) in the year following their discharge from the hospital. Parameters studied included serum levels of SARS coronavirus (SARS-CoV) IgG antibody, tests of lung function, and imaging data to evaluate changes in lung fibrosis. In addition, we explored the incidence of femoral head necrosis in some of the individuals recovering from SARS. Methods:The subjects of this study were 383 clinically diagnosed SARS patients in Beijing, China. They were tested regularly for serum levels of SARS-CoV IgG antibody and lung function and were given chest X-rays and/or high resolution computerized tomography (HRCT) examinations at the Chinese PLA General Hospital during the 12 months that followed their release from the hospital. Those individuals who were found to have lung diffusion abnormities (transfer coefficient for carbon monoxide [D L CO] < 80% of predicted value [pred]) received regular lung function tests and HRCT examinations in the follow-up phase in order to document the changes in their lung condition. Some patients who complained of joint pain were given magnetic resonance imaging (MRI) examinations of their femoral heads. Findings:Of all the subjects, 81.2% (311 of 383 patients) tested positive for serum SARS-CoV IgG. Of those testing positive, 27.3% (85 of 311 patients) were suffering from lung diffusion abnormities (D L CO < 80% pred) and 21.5% (67 of 311 patients) exhibited lung fibrotic changes. In the 12 month duration of this study, all of the 40 patients with lung diffusion abnormities who were examined exhibited some improvement of lung function and fibrosis detected by radiography. Of the individuals receiving MRI examinations, 23.1% (18 of 78 patients) showed signs of femoral head necrosis. Interpretation:The lack of sero-positive SARS-CoV in some individuals suggests that there may have been some misdiagnosed cases among the subjects included in this study. Of those testing positive, the serum levels of SARS-CoV IgG antibody decreased significantly during the 12 months after hospital discharge. Additionally, we found that the individuals who had lung fibrosis showed some spontaneous recovery. Finally, some of the subjects developed femoral head necrosis.

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Section: Discussionmentioning

confidence: 99%

Dynamic changes of serum SARS-Coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge

et al. 2005

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“…Clinical guidance on the identification and evaluation of possible SARS-CoV disease among persons presenting with community-acquired illness (version 2) (updated January 8 2004 Avascular necrosis (AVN) of hips and knees were reported in 30 to 42% of 2 reports of post-discharge Chinese SARS patients [97,98]. Similar high percentage (45%) of AVN were also reported in recovered paediatric SARS patients [99]. Although the use of corticosteroids in the SARS treatment regime appears to be an attractive explanation, additional factors specific to SARS itself may be present and remained to be discovered.…”

Section: Laboratory Parameters Pulmonary Function and Exercise Capacitymentioning

confidence: 52%

Severe Acute Respiratory Syndrome (SARS): A Brief Review With Exploration of the Outcomes, Prognostic Factors and Sequelae

Chan¹,

2005

CRMR

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Severe Acute Respiratory Syndromes (SARS) is a novel infectious disease with significant morbidity and mortality. While heated debates and vigorous scientific investigations are still ongoing over the treatment, prevention and infection control of this deadly disease, substantial data has been accumulated concerning the outcomes and prognostic factors. Postmortem findings of the deceased have revealed diffuse alveolar damage, together with evidence of fibrosis and organization. A number of predicting indicators such as advanced age, presence of co-morbidities, extensive radiological involvement, high coronaviral load and elevated serum lactate dehydrogenase have been identified to be independent predictors for adverse clinical outcomes such as admission to intensive care unit, mechanical ventilation, and death. A number of recovered SARS patients experienced exertional breathlessness, malaise, asthenia during the early recovery phase, while restriction and isolated reduction in diffusion capacity were the commonest lung function abnormalities identified during the subsequent follow-up visits. Radiological abnormalities including residual groundglass appearance and fibrosis were still detectable in these patients from their high-resolution computed tomography after recovery. Some recovered SARS patients were found to be suffering from psychological problems and avascular necrosis of the large joints.

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“…In this regard, it is of interest to note that thrombocytopenia and lymphopenia were commonly observed in patients during the early phase of SRAS-CoV infection [33][34][35]. Furthermore, osteonecrosis has been reported in some convalescent SARS patients [36,37]. Significant levels of anti-N antibody were generally detected 1-2 weeks after the onset of symptoms [7,32], and therefore the inhibitory effect on IL-11 of those cross-reactive anti-N antibody on early SARS symptoms development might play a very limited role.…”

Section: Discussionmentioning

confidence: 98%

“…The administration of steroid in SARS patient has been suggested as the cause for osteonecrosis in convalescent SARS patients, however, the onset of osteonecrosis (91-143 days) is shorter than that of patients receiving chronic steroid therapy [37]. Furthermore, the cumulative prednisolone dosage of convalescent SARS children patients who showed radiologic evidence of osteonecrosis was not significantly different from those not showing any signs of osteonecrosis [36]. As shown in the present study that cross-reactive anti-N neutralized IL-11, the long-term significance of cross-reactive anti-N antibody on IL-11-mediated bone metabolism has to be evaluated.…”

Section: Discussionmentioning

confidence: 99%

Cross-reactivity of antibody against SARS-coronavirus nucleocapsid protein with IL-11

Cheng

Chan

Cheung

et al. 2005

Biochemical and Biophysical Research Communications

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Infection of SARS-associated coronavirus (SARS-CoV) induced a strong anti-nucleocapsid (anti-N) antibody response. However, the pathophysiological significance of the anti-N antibodies in SARS pathogenesis is largely unknown. To profile the anti-N antibodies, a phage-displayed scFv library was prepared from mice immunized with heat-inactivated SARS-CoV-infected Vero E6 cell lysate. Specific anti-N scFvs were isolated by panning against a recombinant nucleocapsid protein and reactivity was confirmed with phage-ELISA. Sequence analysis indicated that two of the isolated anti-N scFv clones were identical and displayed a high homology with an scFv specific for interleukin 11 (IL-11), an anti-inflammatory cytokine derived from bone marrow stroma cells. In a neutralization assay, IL-11-induced STAT 3 phosphorylation in rat intestinal epithelial IEC-18 cells was completely suppressed by the anti-N scFv clone L9N01.

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Osteonecrosis in Children With Severe Acute Respiratory Syndrome

Cited by 20 publications

References 11 publications

Dynamic changes of serum SARS-Coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge

Dynamic changes of serum SARS-Coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge

Severe Acute Respiratory Syndrome (SARS): A Brief Review With Exploration of the Outcomes, Prognostic Factors and Sequelae

Cross-reactivity of antibody against SARS-coronavirus nucleocapsid protein with IL-11

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