Debalina Ghosh
Tutor/ Clinical Instructor
AIIMS Kalyani
Severe acute respiratory syndrome
(SARS)
• Severe acute respiratory syndrome (SARS) is a communicable viral disease
caused by a novel strain of coronavirus, which differs significantly in genetic
structure from previously recognized coronaviruses.
• The most common symptoms in a patient progressing to SARS include
fever, malaise, chills, headache, myalgia, dizziness, cough, sore throat, and
a runny nose. In some cases, there is rapid deterioration with low oxygen
saturation and acute respiratory distress requiring ventilatory support. It is
capable of causing death in as many as 10% of cases.
Severe acute respiratory syndrome
(SARS)
• Chest x-ray findings typically begin with a small, unilateral patchy
shadowing and progress over 1-2 days to become bilateral and generalized,
with interstitial/ confluent infiltration. Adult respiratory distress syndrome
has been observed in several patients in the end stages.
• Incubation period: the incubation period has been estimated to be 2-7
days.
• Mode of transmission: the primary mode of transmission appears to be
through direct or indirect contact of mucous membranes of eyes, nose, or
mouth with respiratory droplets or fomites.
Severe acute respiratory syndrome
(SARS)
• Mode of transmission:
• The use of aerosol-generating procedures (endotracheal intubation,
bronchoscopy, nebulization treatments) in hospitals may amplify the
transmission of the SARS coronavirus.
• The virus is shed in stools, but the role of faecal-oral transmission is unknown.
• The SARS virus can survive for hours on common surfaces outside the human
body, and up to 4 days in human waste. The virus can survive at least 24 hours
on a plastic surface @ room temperature and can live for extended periods in
the cold.
Severe acute respiratory syndrome
(SARS)
• Diagnostic test:
• Conventional reserve transcriptase PCR (RT-PCR) and real-time reserve
transcriptase PCR (real-time RT-PCR) assay detecting viral RNA present in at
least 2 different clinical specimens (e.g., nasopharyngeal and stool).
• Enzyme–linked immunosorbent assay (ELISA) and immunofluorescent assay
(IFA).
Severe acute respiratory syndrome
(SARS)
• Epidemiological aspect: maximum virus excretion from the
respiratory tract occurs on about day 10 of illness and then declines. The
efficiency of transmission appears to be greatest usually during the second
week of illness. When symptomatic cases were isolated within 5 days of the
onset of illness, few cases of secondary transmission occurred. There was no
evidence that the patient transmits infection 10 days after the fever has
resolved.
Children are rarely affected by SARS. No evidence of SARS has been
found in infants of mothers who were infected during pregnancy.
Severe acute respiratory syndrome
(SARS)
• Epidemiological aspect:
International flights have been associated with the transmission of
SARS from symptomatic probable cases to passengers or crew. WHO
recommends exit screening and other measures to reduce oppertunities for
further international spread.
Severe acute respiratory syndrome
(SARS)
• Complications:
• Pneumonia, pulmonary decompensation.
• ARDS (16%) among them, 20-30% required mechanical ventilation.
• Tension pneumothorax.
• Noncardiac pulmonary edema.
Severe acute respiratory syndrome
(SARS)
• Prevention: as there is no vaccine against SARS, the preventive measures for
SARS control are appropriate detection and protective measures, including-
• Prompt identification of persons with SARS, their movements, and contacts.
• Effective isolation of SARS patients in hospitals.
• Appropriate protection of medical staff treating these patients.
• Comprehensive identification and isolation of suspected SARS cases.
• Simple hygienic measures such as hand-washing after touching patients, use of
appropriate and well-fitted masks, and introduction of infection control measures.
Severe acute respiratory syndrome
(SARS)
• Prevention:.
• Exit screening of international travellers.
• Timely and accurate reporting and information sharing with other authorities
and/or governments.
Severe acute respiratory syndrome
(SARS)
• Prognosis: The overall mortality rate of identified cases is about 14%.
Mortality is age-related, ranging from <1% under 24 years of age to >50%
in persons over 65 years of age. Poor prognosis factors include advanced
age, chronic hepatitis B infection treated with lamivudine, high initial or high
peak lactate dehydrogenase concentration, high neutrophil count on
presentation, diabetes mellitus, acute kidney disease, and low counts of
CD4 and CD8 on presentation.