Abstract
We examined the radiological and pulmonary function outcomes of children affected with severe acute respiratory syndrome (SARS) at 6 months from diagnosis. Twenty‐one female and 26 male Chinese patients (median age, 13.6 years; interquartile range, 9.9–16.0) were studied. In each subject, high‐resolution computed tomography (HRCT) of the thorax and pulmonary function were assessed. All children were asymptomatic and had a normal clinical examination. Mild pulmonary abnormalities were detected on HRCT in 16 (34.0%) subjects, including residual ground‐glass opacification (n = 5), air trapping (n = 8), and a combination of ground‐glass changes and air trapping (n = 3). The need for oxygen supplementation (P = 0.02) and lymphopenia during the course of illness (P = 0.012) were significant risk factors in predicting abnormal HRCT. There were no significant lung function differences between those with and without HRCT abnormalities. Despite complete clinical resolution, a considerable proportion of children affected with SARS had abnormal HRCT findings at 6 months. These abnormalities were more prevalent in those with severe disease. It is important that careful follow‐up be carried out to assess the clinical significance and persistence of such abnormalities. Pediatr Pulmonol. 2004; 38:427–433. © 2004 Wiley‐Liss, Inc.
Keywords: severe acute respiratory syndrome, outcome, lung function, high‐resolution computed tomography
This paper was presented at the 6th International Congress of Pediatric Pulmonology in 2004 and received the Young Investigator Award.
REFERENCES
- 1. Peiris JSM, Lai ST, Poon LLM, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003; 361: 1319–1325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003; 348: 1953–1966. [DOI] [PubMed] [Google Scholar]
- 3. Drosten C, Gunther S, Preiser W, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med 2003; 348: 1967–1976. [DOI] [PubMed] [Google Scholar]
- 4. Peiris JSM, Chu CM, Cheng VCC, et al. Clinical progression and viral load in a community outbreak of coronavirus‐associated SARS pneumonia: a prospective study. Lancet 2003; 361: 1767–1772. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Hon KLE, Leung CW, Cheng WTF, et al. Clinical presentation and outcome of severe acute respiratory syndrome in children. Lancet 2003; 361: 1701–1703. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Wong GWK, Li AM, Ng PC, Fok TF. Severe acute respiratory syndrome in children. Pediatr Pulmonol 2003; 36: 261–266. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Simila S, Linna O, Lanning P, Heikkinen E, Ala‐Houhala M. Chronic lung damage caused by adenovirus type 7: a ten‐year follow‐up study. Chest 1981; 80: 127–131. [DOI] [PubMed] [Google Scholar]
- 8. Winterbauer RH, Ludwig WR, Hammar SP. Clinical course, management and long‐ term sequelae of respiratory failure due to influenza viral pneumonia. Johns Hopkins Med J 1977; 141: 148–155. [PubMed] [Google Scholar]
- 9. Korppi M, Kuikka L, Reijonen T, Remes K, Juntunen‐Backamn K, Laumiala K. Bronchial asthma and hyperreactivity after early childhood bronchiolitis and pneumonia. An 8‐year follow‐up study. Arch Pediatr Adolesc Med 1994; 148: 1079–1084. [DOI] [PubMed] [Google Scholar]
- 10. Clark CE, Coote JM, Silver DAT, Halpin DMG. Asthma after childhood pneumonia: six year follow up study. Br Med J [Clin Res] 2000; 320: 1514–1516. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Tanner JM. Physical growth and development In: Forfar JO, Arneil GC, editors. Textbook of paediatrics. Edinburgh: Churchill Livingstone; 1984. p 304–305. [Google Scholar]
- 12. Ambrosino NM, Genieser NB, Roche KJ, et al. Feasibility of high‐resolution, low‐dose chest CT in evaluation of the pediatric chest. Pediatr Radiol 1994; 24: 6–10. [DOI] [PubMed] [Google Scholar]
- 13. Chang AB, Masel JP, Masters B. Post‐infectious bronchiolitis obliterans: clinical, radiological and pulmonary function sequelae. Pediatr Radiol 1998; 28: 25–29. [DOI] [PubMed] [Google Scholar]
- 14. Austin JHM, Muller NL, Friedman PJ, et al. Glossary of terms of CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology 1996; 200: 327–331. [DOI] [PubMed] [Google Scholar]
- 15. Webb WR, Muller NL, Naidich DP. HRCT findings of lung disease In: Muller NL, Naidich DP, Webb WR, editors. High resolution CT of the lung, 2nd ed. Philadelphia: Lippincott‐Raven; 1996. p 41–108. [Google Scholar]
- 16. Westcott JL, Cole SR. Traction bronchiectasis in end‐stage pulmonary fibrosis. Radiology 1986; 161: 665–669. [DOI] [PubMed] [Google Scholar]
- 17. British Thoracic Society, Association of Respiratory Technicians and Physiologists . Recommendations of the British Thoracic Society and the Association of Respiratory Technicians and Physiologists. Topical review: guidelines for the measurement of respiratory function. Respir Med 1994; 88: 165–194. [PubMed] [Google Scholar]
- 18. Ip MS, Karlberg EM, Karlberg JP, Luk KD, Leong JC. Lung function reference values in Chinese children and adolescents in Hong Kong. Am J Respir Crit Care Med 2000; 162: 424–429. [DOI] [PubMed] [Google Scholar]
- 19. Thurlbeck WM. Chronic airflow obstruction In: Thurlbeck WM, Chung KF, editors. Pathology of the lung. New York: Thieme Medical; 1995. p 739–826. [Google Scholar]
- 20. Zhang L, Irion K, Kozakewich H, Reid L, Camargo JJ, da Silva Porto N, Abreu e Silva F. Clinical course of postinfectious bronchiolitis obliterans. Pediatr Pulmonol 2000; 29: 341–350. [DOI] [PubMed] [Google Scholar]
- 21. Webb WR. High‐resolution computed tomography of obstructive lung disease. Radiol Clin North Am 1994; 32: 745–757. [PubMed] [Google Scholar]
- 22. Lucaya J, Le Pointe HD. High‐resolution CT of the lung in children In: Lucaya J, Strife JL, editors. Pediatric chest imaging. Berlin: Springer; 2002. p 55–91. [Google Scholar]
- 23. Stern EJ, Frank MS. Small‐airway diseases of the lungs: findings at expiratory CT. AJR 1994; 163: 37–41. [DOI] [PubMed] [Google Scholar]
- 24. Kim CK, Chung CY, Kim JS, Kim WS, Park Y, Koh YY. Late abnormal findings on high‐resolution computed tomography after mycoplasma pneumonia. Pediatrics 2000; 105: 372–378. [DOI] [PubMed] [Google Scholar]
- 25. Farng KT, Wu KG, Lee YS, Lin YH, Hwang BT. Comparison of clinical characteristics of adenovirus and non‐adenovirus pneumonia in children. J Microbiol Immunol Infect 2002; 35: 37–41. [PubMed] [Google Scholar]
- 26. Mok JYQ, Waugh PR, Simpson H. Mycoplasma pneumoniae infection: a follow‐up study of 50 children with respiratory illness. Arch Dis Child 1979; 54: 506–511. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Sabato AR, Martin AJ, Marmion BP, Kok TW, Cooper DM. Mycoplasma pneumoniae: acute illness, antibiotics and subsequent pulmonary function. Arch Dis Child 1984; 59: 1034–1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Padley SPG, Adler BD, Hansell DM, Muller NL. Bronchiolitis obliterans: high resolution CT findings and correlation with pulmonary function tests. Clin Radiol 1993; 47: 236–240. [DOI] [PubMed] [Google Scholar]
- 29. O'Donnell DR, Carrington D. Peripheral blood lymphopaenia and neutrophilia in children with severe respiratory syncytial virus disease. Pediatr Pulmonol 2002; 34: 128–130. [DOI] [PubMed] [Google Scholar]
- 30. Wong RSM, Wu A, To KF, Lee N, Lam CWK, Wong CK, Chan PKS, Ng MHL, Yu LM, Hui DS, Tam JS, Cheng G, Sung JJY. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. Br Med J [Clin Res] 2003; 326: 1358–1362. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31. Haagmans BL, Egberink HF, Horzinek MC. Apoptosis and T‐cell depletion during feline infectious peritonitis. J Virol 1996; 70: 8977–8983. [DOI] [PMC free article] [PubMed] [Google Scholar]