SARS

(Severe Acute
Respiratory Syndrome)
Mariano, Jedidiah
Mangabat, Allison Mae T.

First severe infectious disease to emerge in the twenty-
first century.

It is a viral respiratory disease of zoonotic origin.

Severe Acute Respiratory Syndrome
was the name given
to the respiratory disease
by the WHO
on March 15, 2003.

World Health Organization (WHO) physician Dr.
Carlo Urbani identified SARS as a new disease in
2003.

He diagnosed it in a 48-year-old businessman
who had traveled from the Guangdong province
of China, through Hong Kong, to Hanoi,
Vietnam.

The businessman and the doctor who first
diagnosed SARS both died from the illness.
Earliest case: Guangdong Province, China in
November 2002

Global outbreak: March 12, 2003

First case in the Philippines:
April 11, 2003

SARS is caused by a new coronavirus
associated with common cold virus.
EPIDEMIOLOGY
A highly contagious atypical pneumonia first
appeared in the Guangdong Province, People's
Republic of China, in November 2002.

This was not widely publicized, and the
condition remained isolated to China for the
next 3 months.

On February 21, 2003, a Chinese physician from the
Guangdong Province (patient A) who cared for patients
with pneumonia and had himself developed symptoms
and traveled to Hong Kong to visit relatives.
It is caused by a coronavirus, called SARS-
associated coronavirus (SARS-CoV)








has a halo or crownlike (corona) appearance
when viewed under a microscope.


Virus classification

Group: GroupIV (+)ssRNA
Order: Nidovirales
Family: Coronaviridae
Subfamily: Coronavirinae
Genus: Betacoronavirus
Species: SARS coronavirus
Coronaviruses are named after their crown-like halo of
protein spikes, which help them to latch on to their host
cells
SYMPTOMS

high fever (at least
100.4F)

Headache

muscle pain

After 2-7 days
mild respiratory
symptoms (cough,
runny or stuffy nose)

Dyspnea


Pneumonia

diarrhea

decrease in the number of
lymphocytes circulating in
the blood.

SARS pathophysiology
Transmission of SARS
The virus is spread through close contact with
an infected person. It can be passed either
through the air or by touching a contaminated
surface.

PATHOGENESIS
After binding to their respective receptors, using the S
protein, human coronaviruses enter their host cell,
usually a ciliated respiratory tract epithelial cell in the
nasopharynx.

Thereafter, the mechanisms by which SARS-CoV
cause disease can be separated into two:

(i) the direct lytic effects of the virus on host cells, and
(ii) the host immune response to the infection.
Generally, however, the reports agree
that SARS-CoV infection produces a
strong host immune response and that
the complications of SARS may well
be a consequence of this.
INCUBATION PERIOD


typically two to seven days, although in some
cases, it may be as long as 10 days. In some,
up to 14 days have been reported
DIAGNOSIS

Polymerase chain reaction (PCR)
can detect the genetic material of the SARS-CoV in the
blood, stool or nasal secretions of the patient
existing PCR tests are very specific but lack sensitivity.
This means that negative tests cannot rule out the
presence of the SARS virus in patients.
Contamination in the lab yields false positive results
Serologic testing can detect the antibodies of a disease
in the serum of a patient

ELISA (Enzyme Linked ImmunoSorbant Assay):
a test detecting a mixture of IgM and IgG antibodies in the
serum of SARS patients yields positive results reliably
at around day 21 after the onset of illness.

IFA (Immunofluorescence Assay):
a test detecting IgM antibodies in serum of SARS patients
yields positive results after about day 10 of illness.

The IFA test format is also used to test for IgG. This is a
reliable test requiring the use of fixed SARS virus on an
immunofluorescence microscope.

Positive antibody test results
indicate a previous infection with SARS-CoV.
Seroconversion from negative to positive or a four-fold
rise in antibody titre from acute to convalescent serum
indicates recent infection.

Viral culture and isolation
growing the culture and identifying it as SARS-CoV


Chest radiograph

Sputum Gram stain and culture, blood
culture

Pulse oximetry

Consider testing for other pathogens such
as influenza, respiratory syncytial
virus, Legionella

Save clinical specimens (respiratory, blood,
serum, stool) for possible additional testing
until a definitive diagnosis is made

Acute and convalescent serum (>21 days after
symptom onset)

Contact local and state health departments for
SARS-CoV testing

TREATMENT
At the moment, there is no vaccine or
cure for SARS.
SARS patients should be referred to the
nearest DOH SARS Referral Hospital for
clinical management.
The CDC recommends that people with
SARS receive the same treatment as
people with community acquired atypical
pneumonia.



Before, because the diagnosis is uncertain,
empirical therapy for community-acquired
pneumonia should be administered by

using antibiotics with activity against both typical
and atypical respiratory pathogens including
influenza when appropriate.

Therapy has involved broad-spectrum antibiotics,
including a fluoroquinolone or macrolide.



The antiviral drug ribavirin has been used in most
patients treated in Hong Kong and in Toronto,
without evidence of efficacy.

The adverse effects of ribavirin are significant,
particularly hemolytic anemia and electrolyte
disturbances such as

hypokalemia and hypomagnesemia; hence,
empirical therapy with ribavirin is not warranted.


Anecdotal evidence suggests that corticosteroids
may be beneficial, particularly in patients with
progressive pulmonary infiltrates and hypoxemia.

Various regimens have been used in different
centers, with dosages of methylpred-nisolone.

Because corticosteroids have potential adverse
effects, clinicians should carefully assess the risk
vs the benefit on a case-by-case basis.

largely supportive with antipyretics,
supplemental oxygen and mechanical
ventilation as needed.

Since no proven effective drug treatments,
early recognition, isolation, and stringent
infection control measures are the key to
controlling the disease.

Avoid using nebulizers
PREVENTION

Wash your hands.
Wear disposable gloves.
Wear a surgical mask.
Wash personal items.
Disinfect surfaces.

Health screening in airports and seaports of
passengers from SARS affected countries
during outbreaks.

Quarantine of contacts of SARS patients and of
new arrivals during outbreaks.
Prognosis
Respiratory failure is the major complication

reports on some recovered SARS patients showed
most typical diseases include, among other things,
pulmonary fibrosis, osteoporosis, and femoral
necrosis.


led to the complete loss of working ability or
even self-care ability of these cases. Resulting
to some post-SARS patients in suffering
from major depressive disorder.
On October 5, 2012, the National Select Agent
Registry Program published a final rule
declaring SARS coronavirus a select agent.

A select agent is a bacterium, virus or toxin that
has the potential to pose a severe threat to
public health and safety.

In the Philippines
A total of 92 cases, mostly suspect SARS cases that were eventually diagnosed
to have other infections or underlying conditions, were admitted in RITM, San
Lazaro Hospital or the regional hospitals in the provinces.
14 probable cases were reported in the Philippines. Two of these were confirmed
and had died (a daughter and her father in Pangasinan). Six of these were either
relatives of these two fatal cases or health workers that had been inadvertently
infected.
Four were imported cases from SARS affected areas Hong Kong, Singapore
and Taiwan. In addition, two cases were attributed by the World Health
Organization to the Philippines. A British couple who had probably gotten
infected in Hong Kong were seen and treated as cases of ordinary pneumonia
during their stay in the Philippines (last week of February) before the WHO
issued a worldwide health emergency (March 12) and before the first travel
advisory was issued (March 15).
This couple had been diagnosed retrospectively by
blood tests by health officials in the United Kingdom
sometime in May. With the results of studies and the
development of an effective diagnostic test, the world
has benefitted from the appearance of SARS as the
first global health threat of the new millennium.

As countries have been alerted, the WHO and the rest
of the United Nations have woken up to an urgent
need to change policies and health systems for disease
surveillance and reporting and encourage the
international mobilization of health officials during
public health emergencies.


SARS is still considered a relatively rare
disease. To date, 8439 people have been
infected, and 812 have died from SARS.

Since 2004, there have been no new SARS
outbreaks anywhere in the world.

Organizations such as the Centers for Disease
Control and Prevention (CDC) are preparing
and planning in case the threat of SARS re-
emerges.
SOURCES

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