Severe Acute Respiratory Syndrome
(SARS)
Dr. Navin Kumar Chaudhary
Professor
Dept. of Microbiology, CMC-TH Bharatpur, Nepal
2nd March 2025
Human Coronavirus
• Human coronaviruses were first identified in the mid-1960s
• Coronaviruses (CoV) are a large family of viruses that cause
illness ranging from the common cold to more severe
diseases such as
– Middle East Respiratory Syndrome (MERS-CoV)
– Severe Acute Respiratory Syndrome (SARS-CoV)
– A novel coronavirus (nCoV) / COVID-19
• New strain that has not been previously identified in humans
Coronaviruses are
named for the crown-like
spikes on their surface
Human Coronavirus Types
• Four main sub-group: alpha, beta, gamma, and delta
• The seven coronaviruses that can infect human are:
• Common human coronaviruses
– 229E (alpha coronavirus)
– NL63 (alpha coronavirus)
– OC43 (beta coronavirus)
– HKU1 (beta coronavirus)
• Other human coronaviruses
– MERS-CoV (beta coronavirus that causes MERS)
– SARS-CoV (beta coronavirus that causes SARS)
– SARS-CoV-2 (novel coronavirus that causes coronavirus
disease 2019, or COVID-19
Human Coronavirus Types
• Some times coronaviruses that infect animals can evolve
and make people sick and become a new human coronavirus
• Three recent examples of this are 2019-nCoV, SARS-CoV,
and MERS-CoV
SARS
Mid-November 2002
• Guangdong Province, China
“ Outbreak of atypical pneumonia”
• First SARS case: 16th Nov, 2002
11 February 2003
• WHO informed
• 305 cases, 5 deaths
• 30% of health care workers
July 2003
• Worldwide, 8,450 cases, 810 deaths in 33 countries
• Major foci in China, SE Asia, and Toronto
Epidemiology
• Cause : SARS associated Coronavirus (SARS-CoV)
• Means of transmission
Evidence of person-to-person transmission
Close contact with body fluids (especially respiratory droplets)
Contaminated hands, clothes, equipment, environment
• Incubation period: 2 –10 days
• Organism survival in the environment
– Duration unknown
6
– Other coronavirus are known to survive for up to 4 hours
SARS associated Coronavirus ( SARS-CoV)
• Family: Coronaviridae
• Genus: Coronaviruses
• Species: Human Coronavirus (CoV)
• Strain: SARS-CoV
• The virions are about 100 - 140 nm in diameter
• Pleomorphic and enveloped particles
Characteristic long projected surface protein (spike)
about 20 nm long, Membrane glycoprotein, Envelope
protein
The non-segmented, Positive-sense, single-stranded
RNA, linear 29,727 nucleotides long (largest RNA
genome), size ranging from 27 to 32 kb
Replication
•Viral entry: Binds by using spike proteins
•Enters either by membrane fusion or receptor-mediated
endocytosis
•ssRNA used to create (-) ssRNA in cytoplasm
•Has its own RNA poly (-) strand that forms a replication
complex attached to the membrane Complex produces new
genomic RNAs and sub genomic mRNAs; and mRNAs code
for N, M & S
•Ribonucleoproteins form from N + genomic RNA
Ribonucleoproteins attach to S & M proteins at the membrane,
This complex comes detached into the lumen (immature
virion)
•Mature as they progress through the periphery of the Golgi
apparatus and become denser and more icosahedral & Buds off
Replication
SARS natural hosts
• Natural reservoir host: Horseshoe bats
[Link]/. ../images/[Link] [Link]/bats/rusbats/ pictures/[Link]
• Direct human infection is not likely to occur
• Possibly the virus can jump to intermediate animals such as
the civet and adapt in such a way that it can infect humans
•Masked palm civets (Paguma larvata)
Suspect SARS Case Case Definitions
• High fever >38 0C
• One or more respiratory symptoms including:
• Cough
• Shortness of breath or breathing difficulty
• One or more of the following:
• Close contact, within 10 days before the onset of symptoms with
a person diagnosed with SARS
• History of travel, within 10 days before onset of symptoms to an
affected area
Probable Case: A suspect case with chest X-ray findings consistent
with pneumonia or respiratory distress syndrome (RDS) OR A
suspect case with an unexplained illness resulting in death, with
autopsy examination demonstrating the pathology of RDS without
an identifiable cause
Close contact: having cared for, lived with, or had direct contact with the respiratory secretions or body
fluids of a suspect or probable case of SARS; Affected area: an area in which local chain(s) of11
transmission of SARS is/are occurring as reported by the national public health authorities
Symptoms
• Clinical course:
•Short incubation period (6 days/2 -10 days)
•Intensive care usually requires about10 days
after the onset of symptoms
•There are generally 3 phases: [Link]/
images/center/sars_flu.jpg
•Week 1: Cold-like symptoms, fever, myalgia, chill, and a sore throat
•Week 2: Recurrence of fever, Onset diarrhea, and oxygen desaturation
•Only 20% of patients reach this phase, which requires ventilator support
•The fatality rate is about 10% upon infection
Breathing difficulties 3-7 days
Sudden onset of high fever (>38°C) & dry cough Chills and shivering & muscle aches from the onset of symptoms
Clinical picture in SARS patients
Exposure to SARS Fever, myalgia, dry non-productive cough Recovery
cough, headache shortness of breath approx
(early symptoms) 90%
Incubation period Prodrome Lower respiratory
phase
~2 to 10 days ~ 1- to 2 days From day 4 onwards Acute
up to 13 days respiratory
reported distress
syndrome
approx 10%
Infectivity
None /very low Low Very high
13
Diagnosis of SARS
• Clinical characteristics of illness
• Epidemiologic link to SARS, i.e., travel or contact
• Laboratory evidence of SARS-CoV infection
• Detection of virus:
– EM in clinical specimens (CoV-like particles)
– Isolation of virus
– Detection of viral antigens: IFA or ELISA for respiratory specimens
– Detection of viral RNA: Reverse Transcription-PCR
• Detection of SARS-specific antibody
– IFA, ELISA, Neutralization
THANK YOU