Background We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS).Methods We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods.
Findings Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8·9 (SD 3·1) days, 55 (73%) had watery diarrhoea after 7·5 (2·3) days, 60 (80%) had radiological worsening after 7·4 (2·2) days, and respiratory symptoms worsened in 34 (45%) after 8·6 (3·0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3.
Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission.Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0·001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at
day 14. The mean time to seroconversion was 20 days.Interpretation The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage.
Published online May 9, 2003
*Members listed at end of paper
Departments of Microbiology and Medicine, Queen Mary Hospital,University of Hong Kong, Hong Kong, Special Administrative Region, China (Prof J S M Peiris DPhil, V C C Cheng MRCP,I F N Hung MRCP, L L M Poon DPhil, B S F Tang MB, K H Chan PhD,Y Guan PhD, B J Zheng PhD, Prof K Y Yuen MD); Department of
Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong (C M Chu MRCP, K S Chan FRCP,K I Law MRCP, T Y W Hon FRCP, C S Chan FRCP, J S C Ng MB,W L Ng MRCP, R W M Lai FRCPA)
Correspondence to: Prof K Y Yuen, Department of Microbiology,University of Hong Kong, Queen Mary Hospital, Pokfulam Road,Hong Kong, Special Administrative Region, China
