Severe Acute Respiratory Syndrome and Coronavirus

Abstract

Severe acute respiratory syndrome (SARS) is a highly infectious disease with a significant morbidity and mortality. Respiratory failure is the major complication, and patients may progress to acute respiratory distress syndrome. Health care workers are particularly vulnerable to SARS. SARS has the potential of being converted from droplet to airborne transmission. There is currently no proven effective treatment of SARS, so early recognition, isolation, and stringent infection control are the key to controlling this highly contagious disease. Horseshoe bats are implicated in the emergence of novel coronavirus infection in humans. Further studies are needed to examine host genetic markers that may predict clinical outcome.

Emerging novel and antimicrobial-resistant respiratory tract infections: new drug development and therapeutic options

“…Although empirical treatment with a range of antivirals has been tried for severe respiratory tract infections caused by MERS-CoV and SARS-CoV, no regimens have been rigorously assessed in clinical trials (panel). 58,59 MERS-CoV elicits attenuated innate immune responses with delayed proinfl ammatory cytokine induction in cell culture and in vivo. 60,61 It is also readily inhibited by type 1 interferons (interferon alfa and especially interferon beta), suggesting a potential therapeutic use for interferons.…”

“…Ribavirin was used extensively in patients with SARS without any benefi cial eff ects and was complicated by haemolytic anaemia and metabolic disturbances in many cases. 58,59 A combination of interferon alfa 2b and ribavirin reduced lung injury and moderately decreased viral replication (<1·0 log 10 reduction in lung titres) when given to rhesus macaques within 8 h of inoculation with MERS-CoV. 63 The treatment combination was given to several severely ill patients with MERS, but the infections proved fatal, probably because of late administration in the advanced stage of the disease.…”

“…Systemic corticosteroids have been used empirically frequently in SARS 58,59 and MERS-CoV 64,65 infections to dampen immunopathological host responses. However, survival benefi t is unclear, 59,64,65 and a randomised controlled trial 74 done in Hong Kong showed that systemic corticosteroids could delay viral clearance in SARS.…”

Coronaviruses

“…The median time from symptom onset of MERS-CoV patients to hospitalization was 3-4 days and the median time from admission to an ICU and to death was 5 and 11.5 days, respectively [ ]. Common presenting symptoms include: fever, cough, dyspnea, chills, rigor, headache, myalgia, and malaise [2,9,33,[40][41][42][43][44]. Atypical initial symptoms of diarrhea and vomiting were reported in patients with MERS and SARS [34 MERS-CoV infection showed relatively different findings from SARS.…”

Towards improving clinical management of Middle East respiratory syndrome coronavirus infection

“…10,11 Convalescent plasma seemed to reduce duration of treatment in hospital and mortality when used early in patients with SARS. 7 For MERS-CoV, low neutralising antibody responses and inability to acquire suffi cient convalescent plasma from survivors with comorbidities might restrict the eff ectiveness of this treatment, although these limitations might not apply to infected health-care workers. Additionally, the availability of human neutralising monoclonal antibodies 12 or polyclonal immune globulin produced in transgenic cows or other hosts 13 could overcome these hurdles.…”