Severe acute respiratory syndrome: ‘SARS’ or ‘not SARS’

Abstract

Accurate clinical diagnosis of severe acute respiratory syndrome (SARS) based on the current World Health Organization definition is difficult and at times impossible at the early stage of the disease. Both false positive and false negative cases are commonly encountered and this could have far-reaching detrimental effects on the patients, their family and the clinicians alike. Contact history is particularly important in diagnosing SARS in children as their presenting features are often non-specific. The difficulty in making a correct diagnosis is further compounded by the lack of a sensitive rapid diagnostic test. Serology is not particularly helpful in the initial triaging of patients as it takes at least 3 weeks to become positive. Co-infection and other treatable conditions should not be missed and conventional antibiotics should remain as part of the first-line treatment regimen. We report five cases to illustrate the difficulties and dilemmas faced by clinicians in diagnosing SARS in children.

Severe acute respiratory symptoms and suspected SARS again 2020

“…2,5,6 These epidemics are often severe, always acute, and invariably involve pneumonia with respiratory tract symptoms. 4,7 Travel or contact history is pivotal in formulating management protocol during any outbreak when the pathogen is not initially clear, as illustrated by Hong Kong health personnel to obtain the relevant travel history of the recent patients from Wuhan. 3 As an alternative to current convention, we previously proposed the term epidemic pneumonia (EP) and the surveillance classification summarised below, which would remove any confusion associated with respiratory terminology such as SARS or MERS 2 Health authorities should reflect on the SARS epidemic and be vigilant about the potential impact of Wuhan pneumonia.…”

Severe acute respiratory syndrome (SARS) in neonates and children

“…In our hospital, we came across two children who presented with symptoms suggestive of SARS and a definite contact history, but were later diagnosed to have bacterial septicaemia. 25 The World Health Organisation had subsequently modified the definition of a probable case to include a suspected case of SARS that was positive for SARS coronavirus.…”

“…It is important not to miss any potentially treatable but life threatening bacterial infection or atypical pneumonia. 25 Children with fever and pneumonia should be covered with broad spectrum antibiotics such as a third generation cephalosporin and a macrolide. In principle, antiviral therapy should be used in the viral replication phase (phase 1), and immunomodulating therapy in the immunopathological phase (phase 2) of the disease.…”

SARS in Newborns and Children

“…It is important that frontline paediatricians do not miss community-acquired pneumonia or systemic infections due to other treatable microorganisms [23]. Patients with fever and pneumonia are treated with a cephalosporin and a macrolide antibiotic.…”