Abstract
Severe acute respiratory syndrome (SARS) is a newly described and highly contagious respiratory infection. Many adult patients will develop progressive hypoxia, and a large proportion will develop respiratory distress syndrome (RDS), possibly related to massive and uncontrolled activation of the immune system. The mortality has been reported to be quite high, especially in the elderly with comorbid conditions. The causative agent has been identified as a novel coronavirus, and children appear to acquire the infection by close‐contact household exposure to an infected adult. However, the severity is much milder and the clinical progression much less aggressive in young children. The exact pathophysiology of SARS is still unclear, and the medical treatment of SARS remains controversial. The main treatment regime used in Hong Kong is a combination of ribavirin and steroid. To date, there have been no reported case fatalities in children with this disease. The success of reducing the burden of this infection in children will depend on proper isolation of infected adults early in the course of illness. Strict public health policy and quarantine measures are the key in controlling the infection in the community. Pediatr Pulmonol. 2003; 36:261–266. © 2003 Wiley‐Liss, Inc.
Keywords: severe acute respiratory syndrome, respiratory infection, coronavirus
REFERENCES
- 1. Centers for Disease Control and Prevention . Severe acute respiratory syndrome (SARS). http://www.cdc.gov/ncidod/sars/ (accessed June 7, 2003).
- 2. Lee N, Hui DS, Wu A, Chan P, Cameron P, Joynt GM, Ahuja A, Yung MY, Leung CB, To KF, Lui SF, Szeto CC, Chung S, Sung JJ. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003; 348: 1986–1994. [DOI] [PubMed] [Google Scholar]
- 3. Poutanen SM, Low DE, Henry B, Finkestein S, Rose D, Green K, Tellier R, Draker R, Adachi D, Ayers M, Chan AK, Skowronski DM, Salit I, Simor AE, Slutsky AS, Doyle PW, Krajden M, Petric M, Brunham RC, McGeer AJ. Identification of severe acute respiratory syndrome in Canada. N Engl J Med 2003; 348: 1995–2005. [DOI] [PubMed] [Google Scholar]
- 4. Hsu LY, Lee CC, Green JA, Ang B, Paton NI, Lee L, Villacian JS, Lim PL, Earnest A, Leo YS. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis 2003; 9: 713–717. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. World Health Organization . WHO collaborative multi‐centre research project on severe acute respiratory syndrome (SARS) diagnosis. http://www.who.int/csr/sars/project/en/ (accessed May 9, 2003).
- 6. Periris JS, Lai ST, Poon LLM, Guan Y, Yam LYC, Lim W, Nicholls J, Yee WK, Yan WW, Cheung MT, Cheng VC, Chan KH, Tsang DN, Yung RW, Ng TK, Yuen KY. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003; 361: 1319–1325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S, Urbani C, Corner JA, Lim W, Rollin PE, Dowell SF, Ling A, Humphrey CD, Shieh WJ, Guarner J, Paddock CD, Rota P, Fields B, DeRisi J, Yang JY, Cox N, Hughes JM, LeDuc JW, Bellini WJ, Anderson LJ. A novel coronavirus associated with severe acute respiratory. N Engl J Med 2003; 348: 1953–1966. [DOI] [PubMed] [Google Scholar]
- 8. Cavanagh D. Nidovirales: a new order comprising Coronaviridae and Arteriviridas. Arch Virol 1997; 142: 629–633. [PubMed] [Google Scholar]
- 9. Siddell SG, Snijder EJ. Coronaviruses, toroviruses, and arteriviruses In: Mahy BWJ, Collier L, editors. Tropley and Wilson's microbiology and microbial infections. London: Edward Arnold; 1998. p 463–484. [Google Scholar]
- 10. Wege H, Siddell S, ter Meulen V. The biology and pathogenesis of coronaviruses. Curr Top Microbiol Immunol 1982; 99: 165–200. [DOI] [PubMed] [Google Scholar]
- 11. Yeager CL, Ashmun RA, Williams RK, Cardellichio CB, Shapiro LH, Look AT, Holmes KV. Human aminopeptidase N is a receptor for human coronavirus 229E. Nature 1992; 357: 420–422. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Centers for Disease Control and Prevention . Interpreting SARS test results. http://www.cdc.gov/ncidod/sars/testresultsc.htm (accessed May 9, 2003).
- 13. Hon EK, Leung CW, Cheng WT, Chan PK, Chu WC, Kwan YW, Li AM, Fong NC, Ng PC, Chiu MC, Li CK, Tam JS, Fok TF. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet 2003; 361: 1701–1703. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Chiu WK, Cheung PC, Ng KL, Ip PL, Sugunan VK, Luk DC, Ma LC, Chan BH, Lo KL, Lai WM. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med 2003; 4: 279–283. [DOI] [PubMed] [Google Scholar]
- 15. Wong GWK, Hui DSC. Severe acute respiratory syndrome (SARS): epidemiology, diagnosis and treatment. Thorax 2003; 58: 558–560. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Centers for Disease Control and Prevention . Severe acute respiratory syndrome (SARS). http://www.cdc.gov/ncidod/sars/casedefinition.htm (accessed June 5, 2003).
- 17. Epler GR. Bronchiolitis obliterans organizing pneumonia. Arch Intern Med 2001; 161: 158–164. [DOI] [PubMed] [Google Scholar]
- 18. Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL, Law KI, Tang BS, Hon TY, Chan CS, Chan KH, Ng JS, Zheng BJ, Ng WL, Lai RW, Guan Y, Yuen KY. 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]
- 19. Seto WH, Tsang D, Yung RW, Ching TY, Ng TK, Ho M, Ho LM, Peiris JS. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003; 361: 1519–1520. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. World Health Organization . First data on stability and resistance of SARS coronavirus complied by members of WHO laboratory network. http://www.who.int/csr/sars/survival_2003_05_04/en/ (accessed May 4, 2003).
- 21. World Health Organization . Hospital infection control guidance for severe acute respiratory syndrome (SARS). http://www.who.int/csr/sars/infectioncontrol/en/ (accessed June 3, 2003).