3101
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Isakbaeva ET, Khetsuriani N, Beard RS, Peck A, Erdman D, Monroe SS, Tong S, Ksiazek TG, Lowther S, Pandya-Smith I, Anderson LJ, Lingappa J, Widdowson MA. SARS-associated coronavirus transmission, United States. Emerg Infect Dis 2004; 10:225-31. [PMID: 15030687 PMCID: PMC3322913 DOI: 10.3201/eid1002.030734] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
To better assess the risk for transmission of the severe acute respiratory syndrome-associated coronavirus (SARS-CoV), we obtained serial specimens and clinical and exposure data from seven confirmed U.S. SARS patients and their 10 household contacts. SARS-CoV was detected in a day-14 sputum specimen from one case-patient and in five stool specimens from two case-patients. In one case-patient, SARS-CoV persisted in stool for at least 26 days after symptom onset. The highest amounts of virus were in the day-14 sputum sample and a day-14 stool sample. Residual respiratory symptoms were still present in recovered SARS case-patients 2 months after illness onset. Possible transmission of SARS-CoV occurred in one household contact, but this person had also traveled to a SARS-affected area. The data suggest that SARS-CoV is not always transmitted efficiently. Routine collection and testing of stool and sputum specimens of probable SARS case-patients may help the early detection of SARS-CoV infection.
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Affiliation(s)
- Elmira T Isakbaeva
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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3102
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Robertson CA, Lowther SA, Birch T, Tan C, Sorhage F, Stockman L, McDonald C, Lingappa JR, Bresnitz E. SARS and pregnancy: a case report. Emerg Infect Dis 2004; 10:345-8. [PMID: 15030710 PMCID: PMC3322896 DOI: 10.3201/eid1002.030736] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We report a laboratory-confirmed case of severe acute respiratory syndrome (SARS) in a pregnant woman. Although the patient had respiratory failure, a healthy infant was subsequently delivered, and the mother is now well. There was no evidence of viral shedding at delivery. Antibodies to SARS virus were detected in cord blood and breast milk.
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3103
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Chan KH, Poon LLLM, Cheng VCC, Guan Y, Hung IFN, Kong J, Yam LYC, Seto WH, Yuen KY, Peiris JSM. Detection of SARS coronavirus in patients with suspected SARS. Emerg Infect Dis 2004; 10:294-9. [PMID: 15030700 PMCID: PMC3322905 DOI: 10.3201/eid1002.030610] [Citation(s) in RCA: 208] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cases of severe acute respiratory syndrome (SARS) were investigated for SARS coronavirus (SARS-CoV) through RNA tests, serologic response, and viral culture. Of 537 specimens from patients in whom SARS was clinically diagnosed, 332 (60%) had SARS-CoV RNA in one or more clinical specimens, compared with 1 (0.3%) of 332 samples from controls. Of 417 patients with clinical SARS from whom paired serum samples were available, 92% had an antibody response. Rates of viral RNA positivity increased progressively and peaked at day 11 after onset of illness. Although viral RNA remained detectable in respiratory secretions and stool and urine specimens for >30 days in some patients, virus could not be cultured after week 3 of illness. Nasopharyngeal aspirates, throat swabs, or sputum samples were the most useful clinical specimens in the first 5 days of illness, but later in the illness viral RNA could be detected more readily in stool specimens.
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Affiliation(s)
- Kwok H Chan
- Queen Mary Hospital, Hong Kong Special Administrative Region, People's Republic of China
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3104
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Lina B. Et les virus respiratoires ! Rev Mal Respir 2004; 21:13-4. [PMID: 15260030 PMCID: PMC7134873 DOI: 10.1016/s0761-8425(04)71227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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3105
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Desenclos JC, van der Werf S, Bonmarin I, Levy-Bruhl D, Yazdanpanah Y, Hoen B, Emmanuelli J, Lesens O, Dupon M, Natali F, Michelet C, Reynes J, Guery B, Larsen C, Semaille C, Mouton D, André M, Escriou N, Burguière A, Manuguerra JC, Coignard B, Lepoutre A, Meffre C, Bitar D, Decludt B, Capek I, Antona D, Che D, Herida M, Infuso A, Sauri C, Brücker G, Hubert B, LeGoff D, Scheidegger S. Introduction of SARS in France, March-April, 2003. Emerg Infect Dis 2004; 10:195-200. [PMID: 15030682 PMCID: PMC3322920 DOI: 10.3201/eid1002.030351] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription-polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22-23. Timely detection, isolation of probable case-patients, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France.
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Affiliation(s)
- Jean-Claude Desenclos
- Département Maladies Infectieuses, Institut de Veille Sanitaire, Saint-Maurice, France.
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3106
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Vu HT, Leitmeyer KC, Le DH, Miller MJ, Nguyen QH, Uyeki TM, Reynolds MG, Aagesen J, Nicholson KG, Vu QH, Bach HA, Plan AJ. Clinical description of a completed outbreak of SARS in Vietnam, February-May 2003. Emerg Infect Dis 2004; 10:334-8. [PMID: 15030707 PMCID: PMC3322907 DOI: 10.3201/eid1002.030761] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We investigated the clinical manifestations and course of all probable severe acute respiratory syndrome (SARS) patients in the Vietnam outbreak. Probable SARS cases were defined by using the revised World Health Organization criteria. We systematically reviewed medical records and undertook descriptive statistical analyses. All 62 patients were hospitalized. On admission, the most prominent symptoms were malaise (82.3%) and fever (79.0%). Cough, chest pain, and shortness of breath were present in approximately one quarter of the patients; 79.0% had lymphopenia; 40.3% had thrombocytopenia; 19.4% had leukopenia; and 75.8% showed changes on chest radiograph. Fever developed on the first day of illness onset, and both respiratory symptoms and radiographic changes occurred on day 4. On average, maximal radiographic changes were observed on day 10, and fevers subsided by day 13. Symptoms on admission were nonspecific, although fever, malaise, and lymphopenia were common. The complications of SARS included invasive intubation and ventilation (11.3%) and death (9.7%).
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3107
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Abstract
Liver impairment is commonly reported in up to 60% of patients who suffer from severe acute respiratory syndrome (SARS). Here we report the clinical course and liver pathology in three SARS patients with liver impairment. Three patients who fulfilled the World Health Organization case definition of probable SARS and developed marked elevation of alanine aminotransferase were included. Percutaneous liver biopsies were performed. Liver specimens were examined by light and electron microscopy, and immunohistochemistry. Reverse-transcriptase polymerase chain reaction (RT-PCR) using enhanced real-time PCR was applied to look for evidence of SARS-associated coronavirus infection. Marked accumulation of cells in mitosis was observed in two patients and apoptosis was observed in all three patients. Other common pathologic features included ballooning of hepatocytes and mild to moderate lobular lymphocytic infiltration. No eosinophilic infiltration, granuloma, cholestasis, fibrosis, or fibrin deposition was noted. Immunohistochemical studies revealed 0.5% to 11.4% of nuclei were positive for proliferative antigen Ki-67. RT-PCR showed evidence of SARS-associated coronavirus in the liver tissues, but not in the sera of all 3 patients. However, electron microscopy could not identify viral particles. No giant mitochondria, micro- or macro-vesicular steatosis was observed. In conclusion, hepatic impairment in patients with SARS is due to SARS-associated coronavirus infection of the liver. The prominence of mitotic activity of hepatocytes is unique and may be due to a hyperproliferative state with or without disruption of cell cycle by the coronavirus. With better knowledge of pathogenesis, specific therapy may be targeted to reduce viral replication and modify the disease course.
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3108
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Chau TN, Lee KC, Yao H, Tsang TY, Chow TC, Yeung YC, Choi KW, Tso YK, Lau T, Lai ST, Lai CL. SARS-associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatology 2004; 39:302-10. [PMID: 14767982 PMCID: PMC7165792 DOI: 10.1002/hep.20111] [Citation(s) in RCA: 297] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2003] [Accepted: 11/19/2003] [Indexed: 02/06/2023]
Abstract
Liver impairment is commonly reported in up to 60% of patients who suffer from severe acute respiratory syndrome (SARS). Here we report the clinical course and liver pathology in three SARS patients with liver impairment. Three patients who fulfilled the World Health Organization case definition of probable SARS and developed marked elevation of alanine aminotransferase were included. Percutaneous liver biopsies were performed. Liver specimens were examined by light and electron microscopy, and immunohistochemistry. Reverse-transcriptase polymerase chain reaction (RT-PCR) using enhanced real-time PCR was applied to look for evidence of SARS-associated coronavirus infection. Marked accumulation of cells in mitosis was observed in two patients and apoptosis was observed in all three patients. Other common pathologic features included ballooning of hepatocytes and mild to moderate lobular lymphocytic infiltration. No eosinophilic infiltration, granuloma, cholestasis, fibrosis, or fibrin deposition was noted. Immunohistochemical studies revealed 0.5% to 11.4% of nuclei were positive for proliferative antigen Ki-67. RT-PCR showed evidence of SARS-associated coronavirus in the liver tissues, but not in the sera of all 3 patients. However, electron microscopy could not identify viral particles. No giant mitochondria, micro- or macro-vesicular steatosis was observed. In conclusion, hepatic impairment in patients with SARS is due to SARS-associated coronavirus infection of the liver. The prominence of mitotic activity of hepatocytes is unique and may be due to a hyperproliferative state with or without disruption of cell cycle by the coronavirus. With better knowledge of pathogenesis, specific therapy may be targeted to reduce viral replication and modify the disease course.
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Affiliation(s)
- Tai-Nin Chau
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, SAR China.
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3109
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Goldsmith CS, Tatti KM, Ksiazek TG, Rollin PE, Comer JA, Lee WW, Rota PA, Bankamp B, Bellini WJ, Zaki SR. Ultrastructural characterization of SARS coronavirus. Emerg Infect Dis 2004; 10:320-6. [PMID: 15030705 PMCID: PMC3322934 DOI: 10.3201/eid1002.030913] [Citation(s) in RCA: 266] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Severe acute respiratory syndrome (SARS) was first described during a 2002-2003 global outbreak of severe pneumonia associated with human deaths and person-to-person disease transmission. The etiologic agent was initially identified as a coronavirus by thin-section electron microscopic examination of a virus isolate. Virions were spherical, 78 nm in mean diameter, and composed of a helical nucleocapsid within an envelope with surface projections. We show that infection with the SARS-associated coronavirus resulted in distinct ultrastructural features: double-membrane vesicles, nucleocapsid inclusions, and large granular areas of cytoplasm. These three structures and the coronavirus particles were shown to be positive for viral proteins and RNA by using ultrastructural immunogold and in situ hybridization assays. In addition, ultrastructural examination of a bronchiolar lavage specimen from a SARS patient showed numerous coronavirus-infected cells with features similar to those in infected culture cells. Electron microscopic studies were critical in identifying the etiologic agent of the SARS outbreak and in guiding subsequent laboratory and epidemiologic investigations.
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Affiliation(s)
- Cynthia S Goldsmith
- Infectious Disease Pathology Activity, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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3110
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Ho KY, Singh KS, Habib AG, Ong BK, Lim TK, Ooi EE, Sil BK, Ling AE, Bai XL, Tambyah PA. Mild illness associated with severe acute respiratory syndrome coronavirus infection: lessons from a prospective seroepidemiologic study of health-care workers in a teaching hospital in Singapore. J Infect Dis 2004; 189:642-7. [PMID: 14767817 PMCID: PMC7109818 DOI: 10.1086/381558] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 11/10/2003] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) is a newly recognized infectious disease that has recently emerged in East Asia and North America. Although the clinical features of acute infection have been well described, mildly symptomatic or asymptomatic infections have not been well characterized. OBJECTIVE To assess the spectrum of illness in health-care workers (HCWs). METHODS A prospective seroepidemiologic cohort study was conducted on 372 HCWs in a large teaching hospital in Singapore who were both exposed and not exposed to patients with SARS. Participating HCWs completed a questionnaire and provided paired serum samples, which were analyzed by 2 different laboratories blinded to clinical data, by use of an enzyme-linked immunosorbent assay based on a protocol developed by the Centers for Disease Control and Prevention and a dot-blot immunoassay, with confirmation by a viral neutralization assay. RESULTS A total of 21 patients with SARS were treated at our hospital. They were associated with transmission to 14 staff members, patients, and visitors in our hospital. Of the 372 HCWs participating in the present study, 8 were found to have positive antibodies to the SARS coronavirus in both samples by use of both test methods, and 6 had pneumonia and had been hospitalized for either probable or suspected SARS infection, whereas 2 had fever but did not have changes on chest radiographs. All seropositive HCWs had been exposed either directly or indirectly to patients with SARS. No asymptomatic, nonexposed staff members were found to be seropositive. There was a trend towards protection for HCWs who, while fully protected, had had contact with patients with SARS. CONCLUSIONS Although the majority of cases of SARS are associated with pneumonia, a small number of mildly symptomatic individuals do seroconvert. HCWs who are exposed to patients with SARS can be infected with SARS, regardless of the intensity of exposure. This has implications for surveillance and infection control planning, in the event that SARS returns next winter.
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Affiliation(s)
- Khek Y Ho
- Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore
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3111
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Cheng VCC, Hung IFN, Tang BSF, Chu CM, Wong MML, Chan KH, Wu AKL, Tse DMW, Chan KS, Zheng BJ, Peiris JSM, Sung JJY, Yuen KY. Viral replication in the nasopharynx is associated with diarrhea in patients with severe acute respiratory syndrome. Clin Infect Dis 2004; 38:467-75. [PMID: 14765337 PMCID: PMC7107995 DOI: 10.1086/382681] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 01/09/2004] [Indexed: 12/15/2022] Open
Abstract
The role of severe acute respiratory syndrome (SARS) coronavirus as an enteric pathogen was investigated in a cohort of 142 patients with SARS who were treated with a standard treatment protocol. Data from daily hematological, biochemical, radiological, and microbiological investigations were prospectively collected, and the correlation of these findings with diarrhea was retrospectively analyzed. Sixty-nine patients (48.6%) developed diarrhea at a mean (± standard deviation [SD]) of 7.6 ± 2.6 days after the onset of symptoms. The diarrhea was most severe at a mean (±SD) of 8.8 ± 2.4 days after onset, with a maximum frequency of 24 episodes per day (median, 5 episodes; range, 3–24 episodes). A higher mean virus load in nasopharyngeal specimens obtained on day 10 after the onset of symptoms was significantly associated with the occurrence of diarrhea (3.1 log10 vs. 1.8 log10 copies/mL; P = .01) and mortality (6.2 vs. 1.7 log10 copies/mL; P < .01). However, diarrhea was not associated with mortality. The lung and the gastrointestinal tract may react differently to SARS coronavirus infection. Additional investigation of the role of SARS coronavirus in the pathogenesis of diarrhea in patients with SARS should be conducted.
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Affiliation(s)
- V. C. C. Cheng
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - I. F. N. Hung
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - B. S. F. Tang
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - C. M. Chu
- Department of Medicine, United Christian Hospital, China
| | - M. M. L. Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre, China
| | - K. H. Chan
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - A. K. L. Wu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - D. M. W. Tse
- Department of Medicine and Geriatrics, Caritas Medical Centre, China
| | - K. S. Chan
- Department of Medicine, United Christian Hospital, China
| | - B. J. Zheng
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - J. S. M. Peiris
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - J. J. Y. Sung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - K. Y. Yuen
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
- Reprints or correspondence: Prof. K. Y. Yuen, Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China ()
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3112
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Abstract
Sixty-one SARS coronavirus genomic sequences derived from the early, middle, and late phases of the severe acute respiratory syndrome (SARS) epidemic were analyzed together with two viral sequences from palm civets. Genotypes characteristic of each phase were discovered, and the earliest genotypes were similar to the animal SARS-like coronaviruses. Major deletions were observed in the Orf8 region of the genome, both at the start and the end of the epidemic. The neutral mutation rate of the viral genome was constant but the amino acid substitution rate of the coding sequences slowed during the course of the epidemic. The spike protein showed the strongest initial responses to positive selection pressures, followed by subsequent purifying selection and eventual stabilization.
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3113
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van Elden LJR, van Loon AM, van Alphen F, Hendriksen KAW, Hoepelman AIM, van Kraaij MGJ, Oosterheert JJ, Schipper P, Schuurman R, Nijhuis M. Frequent detection of human coronaviruses in clinical specimens from patients with respiratory tract infection by use of a novel real-time reverse-transcriptase polymerase chain reaction. J Infect Dis 2004; 189:652-7. [PMID: 14767819 PMCID: PMC7110206 DOI: 10.1086/381207] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2003] [Accepted: 08/05/2003] [Indexed: 11/03/2022] Open
Abstract
During the past years, human coronaviruses (HCoVs) have been increasingly identified as pathogens associated with more-severe respiratory tract infection (RTI). Diagnostic tests for HCoVs are not frequently used in the routine setting. It is likely that, as a result, the precise role that HCoVs play in RTIs is greatly underestimated. We describe a rapid, sensitive, and highly specific quantitative real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for the detection of HCoV that can easily be implemented in the routine diagnostic setting. HCoV was detected in 28 (11%) of the 261 clinical specimens obtained from patients presenting with symptoms of RTI ranging from common cold to severe pneumonia. Only 1 (0.4%) of the 243 control specimens obtained from patients without symptoms of RTI showed the presence of HCoV. We conclude that HCoVs can be frequently detected in patients presenting with RTI. Real-time RT-PCR provides a tool for large-scale epidemiological studies to further clarify the role that coronavirus infection plays in RTI in humans.
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Affiliation(s)
- Leontine J R van Elden
- Department of Virology, Division of Acute Medicine and Infectious Diseases, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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3114
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Chong PY, Chui P, Ling AE, Franks TJ, Tai DYH, Leo YS, Kaw GJL, Wansaicheong G, Chan KP, Ean Oon LL, Teo ES, Tan KB, Nakajima N, Sata T, Travis WD. Analysis of deaths during the severe acute respiratory syndrome (SARS) epidemic in Singapore: challenges in determining a SARS diagnosis. Arch Pathol Lab Med 2004; 128:195-204. [PMID: 14736283 DOI: 10.5858/2004-128-195-aoddts] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT An outbreak of severe acute respiratory syndrome (SARS), an infectious disease attributed to a novel coronavirus, occurred in Singapore during the first quarter of 2003 and led to 204 patients with diagnosed illnesses and 26 deaths by May 2, 2003. Twenty-one percent of these patients required admission to the medical intensive care unit. During this period, the Center for Forensic Medicine, Health Sciences Authority, Singapore, performed a total of 14 postmortem examinations for probable and suspected SARS. Of these, a total of 8 were later confirmed as SARS infections. OBJECTIVE Our series documents the difficulties encountered at autopsy during the initial phases of the SARS epidemic, when the pattern of infection and definitive diagnostic laboratory criteria were yet to be established. DESIGN Autopsies were performed by pathologists affiliated with the Center for Forensic Medicine, Health Sciences Authority, Singapore. Tissue was accessed and read at the Tan Tock Seng Hospital, Singapore, and at the Armed Forces Institute of Pathology, Washington, DC. Autopsy tissue was submitted to the Virology Department, Singapore General Hospital, for analysis, and in situ hybridization for the SARS coronavirus was carried out at the National Institute of Infectious Diseases, Tokyo, Japan. RESULTS Thirteen of 14 patients showed features of diffuse alveolar damage. In 8 patients, no precipitating etiology was identified, and in all of these patients, we now have laboratory confirmation of coronavirus infection. Two of the 8 patients presented at autopsy as sudden unexpected deaths, while the remaining 6 patients had been hospitalized with varying lengths of stay in the intensive care unit. In 3 patients, including the 2 sudden unexpected deaths, in situ hybridization showed the presence of virally infected cells within the lung. In 4 of the 8 SARS patients, pulmonary thromboemboli were also recognized on gross examination, while one patient had marantic cardiac valvular vegetations. CONCLUSIONS It is unfortunate that the term atypical pneumonia has been used in conjunction with SARS. Although nonspecific by itself, the term does not accurately reflect the underlying dangers of viral pneumonia, which may progress rapidly to acute respiratory distress syndrome. We observed that the clinical spectrum of disease as seen in our autopsy series included sudden deaths. This is a worrisome finding that illustrates that viral diseases will have a spectrum of clinical presentations and that the diagnoses made for such patients must incorporate laboratory as well as clinical data.
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3115
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Ng ML, Tan SH, See EE, Ooi EE, Ling AE. Proliferative growth of SARS coronavirus in Vero E6 cells. J Gen Virol 2004; 84:3291-3303. [PMID: 14645910 DOI: 10.1099/vir.0.19505-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
An isolate of SARS coronavirus (strain 2003VA2774) was obtained from a patient and used to infect Vero E6 cells. The replication cycle of the virus was followed from 1 to 30 h post-infection (p.i.). It was surprising to observe the swift growth of this human virus in Vero cells. Within the first hour of infection, the most obvious ultrastructural change was the proliferation of the Golgi complexes and related vesicles accompanied by swelling of some of the trans-Golgi sacs. Extracellular virus particles were present by 5 h p.i. in about 5 % of the cells and this increased dramatically to about 30 % of the cell population within an hour (6 h p.i.). Swollen Golgi sacs contained virus nucleocapsids at different stages of maturation. These virus precursors were also in large vacuoles and in close association with membrane whorls. The membrane whorls could be the replication complexes, since they appeared rather early in the replication cycle. As infection progressed from 12 to 21 h p.i., the cytoplasm of the infected cells was filled with numerous large, smooth-membraned vacuoles containing a mixture of mature virus and spherical cores. Several of these vacuoles were close to the cell periphery, ready to export out the mature progeny virus particles via exocytosis. By 24 to 30 h p.i., crystalline arrays of the extracellular virus particles were seen commonly at the cell surface.
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Affiliation(s)
- M-L Ng
- Department of Microbiology, 5 Science Drive 2, National University of Singapore, 117597, Singapore
| | - S-H Tan
- Department of Microbiology, 5 Science Drive 2, National University of Singapore, 117597, Singapore
| | - E-E See
- Electron Microscopy Unit, Faculty of Medicine, 5 Science Drive 2, National University of Singapore, 117597, Singapore
| | - E-E Ooi
- Electron Microscopy Unit, Faculty of Medicine, 5 Science Drive 2, National University of Singapore, 117597, Singapore
| | - A-E Ling
- Environmental Health Institute, National Environment Agency, Singapore
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3116
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Miura HS, Nakagaki K, Taguchi F. N-terminal domain of the murine coronavirus receptor CEACAM1 is responsible for fusogenic activation and conformational changes of the spike protein. J Virol 2004; 78:216-23. [PMID: 14671103 PMCID: PMC303413 DOI: 10.1128/jvi.78.1.216-223.2004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mouse hepatitis virus (MHV) receptor (MHVR), CEACAM1, has two different functions for MHV entry into cells: binding to MHV spike protein (S protein) and activation of the S protein to execute virus-cell membrane fusion, the latter of which is accompanied by conformational changes of the S protein. The MHVR comprising the N-terminal and fourth domains [R1(1,4)] displays these two activities, and the N domain is thought to be critical for binding to MHV. In this study, we have addressed whether or not the N domain alone is sufficient for these activities. We examined three types of soluble form MHVR (soMHVR), one consisting of the N domain alone [soR1(1)], one with the N and second domains [soR1(1,2)], and one [soR1(1,4)] expressed by recombinant baculoviruses. We assessed the abilities of these three types of soMHVR to bind to MHV, activate fusogenicity, and induce conformational changes of the S protein. All three types of soMHVR similarly bound to MHV, as examined by a solid-phase binding assay and neutralized MHV infectivity. They also activated S protein fusogenicity and induced its conformational changes with similar levels of efficiency. However, R1(1) expressed on the BHK cell surface failed to serve as a receptor in spite of a sufficient level of expression. The inability of expressed R1(1) to work as a receptor was due to the inaccessibility of virions to R1(1); however, these were accessible using the MHVR-specific monoclonal antibody CC1. These results collectively indicated that the N domain retains all biological activities necessary for receptor function.
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Affiliation(s)
- Hideka S Miura
- National Institute of Neuroscience, NCNP, Kodaira, Tokyo 187-8502, Japan
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3117
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N/A, 张 泰, 杨 惠. N/A. Shijie Huaren Xiaohua Zazhi 2004; 12:233-235. [DOI: 10.11569/wcjd.v12.i1.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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3118
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Poon LLM, Chan KH, Peiris JSM. Crouching tiger, hidden dragon: the laboratory diagnosis of severe acute respiratory syndrome. Clin Infect Dis 2004; 38:297-9. [PMID: 14699466 PMCID: PMC7107928 DOI: 10.1086/380848] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2003] [Accepted: 10/14/2003] [Indexed: 02/04/2023] Open
Affiliation(s)
- L. L. M Poon
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR
| | - K. H. Chan
- Department of Microbiology, Queen Mary Hospital, Hong Kong, SAR
| | - J. S. M. Peiris
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR
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3119
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Xu X, Liu Y, Weiss S, Arnold E, Sarafianos SG, Ding J. Molecular model of SARS coronavirus polymerase: implications for biochemical functions and drug design. Nucleic Acids Res 2004; 31:7117-30. [PMID: 14654687 PMCID: PMC291860 DOI: 10.1093/nar/gkg916] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The causative agent of severe acute respiratory syndrome (SARS) is a previously unidentified coronavirus, SARS-CoV. The RNA-dependent RNA polymerase (RdRp) of SARS-CoV plays a pivotal role in viral replication and is a potential target for anti-SARS therapy. There is a lack of structural or biochemical data on any coronavirus polymerase. To provide insights into the structure and function of SARS-CoV RdRp, we have located its conserved motifs that are shared by all RdRps, and built a three-dimensional model of the catalytic domain. The structural model permits us to discuss the potential functional roles of the conserved motifs and residues in replication and their potential interactions with inhibitors of related enzymes. We predict important structural attributes of potential anti-SARS-CoV RdRp nucleotide analog inhibitors: hydrogen-bonding capability for the 2′ and 3′ groups of the sugar ring and C3′ endo sugar puckering, and the absence of a hydrophobic binding pocket for non-nucleoside analog inhibitors similar to those observed in hepatitis C virus RdRp and human immunodeficiency virus type 1 reverse transcriptase. We propose that the clinically observed resistance of SARS to ribavirin is probably due to perturbation of the conserved motif A that controls rNTP binding and fidelity of polymerization. Our results suggest that designing anti-SARS therapies can benefit from successful experiences in design of other antiviral drugs. This work should also provide guidance for future biochemical experiments.
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Affiliation(s)
- Xiang Xu
- Key Laboratory of Proteomics, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
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3120
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Yam WC, Chan KH, Poon LLM, Guan Y, Yuen KY, Seto WH, Peiris JSM. Evaluation of reverse transcription-PCR assays for rapid diagnosis of severe acute respiratory syndrome associated with a novel coronavirus. J Clin Microbiol 2004; 41:4521-4. [PMID: 14532176 PMCID: PMC254368 DOI: 10.1128/jcm.41.10.4521-4524.2003] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The reverse transcription (RT)-PCR protocols of two World Health Organization (WHO) severe acute respiratory syndrome (SARS) network laboratories (WHO SARS network laboratories at The University of Hong Kong [WHO-HKU] and at the Bernhard-Nocht Institute in Hamburg, Germany [WHO-Hamburg]) were evaluated for rapid diagnosis of a novel coronavirus (CoV) associated with SARS in Hong Kong. A total of 303 clinical specimens were collected from 163 patients suspected to have SARS. The end point of both WHO-HKU and WHO-Hamburg RT-PCR assays was determined to be 0.1 50% tissue culture infective dose. Using seroconversion to CoV as the "gold standard" for SARS CoV diagnosis, WHO-HKU and WHO-Hamburg RT-PCR assays exhibited diagnostic sensitivities of 61 and 68% (nasopharyngeal aspirate specimens), 65 and 72% (throat swab specimens), 50 and 54% (urine specimens), and 58 and 63% (stool specimens), respectively, with an overall specificity of 100%. For patients confirmed to have SARS CoV and from whom two or more respiratory specimens were collected, testing the second specimen increased the sensitivity from 64 and 71% to 75 and 79% for the WHO-HKU and WHO-Hamburg RT-PCR assays, respectively. Testing more than one respiratory specimen will maximize the sensitivity of PCR assays for SARS CoV.
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Affiliation(s)
- W C Yam
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, People's Republic of China
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3121
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Abstract
BACKGROUND Acute respiratory infections are the most common illnesses experienced by people of all ages worldwide. A portion of hitherto unexplained viral respiratory tract illnesses (RTIs) can now be attributed to the human metapneumovirus (hMPV), which was discovered in 2001. Several surveys on the burden of disease of hMPV infection have been conducted in various study groups and with different diagnostic assays. To estimate the impact of hMPV infection in a hospital setting and in the community at large, we reviewed these surveys to establish the burden of disease of hMPV infection. METHODS Published data and our own additional unpublished data on the clinical impact of hMPV infection were reviewed. RESULTS AND CONCLUSION Worldwide, hMPV infections account for at least 5 to 7% of the RTI in hospitalized children, but immunocompromised and elderly individuals are also at risk. In the general community hMPV infections account for at least 3% of patients who visit a general practitioner for RTI. The seasonality of hMPV infections resembles that for respiratory syncytial virus and influenza virus infections, with recurrent epidemics during the winter months. Clinical symptoms and laboratory findings associated with hMPV infection exhibit a spectrum virtually indistinguishable from those associated with respiratory syncytial virus disease. The development of diagnostic assays must take into account the existence of two hMPV serotypes.
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3122
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Poon LLM, Chan KH, Wong OK, Cheung TKW, Ng I, Zheng B, Seto WH, Yuen KY, Guan Y, Peiris JSM. Detection of SARS coronavirus in patients with severe acute respiratory syndrome by conventional and real-time quantitative reverse transcription-PCR assays. Clin Chem 2004; 50:67-72. [PMID: 14709637 PMCID: PMC7108136 DOI: 10.1373/clinchem.2003.023663] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND A novel coronavirus (CoV) was recently identified as the agent for severe acute respiratory syndrome (SARS). We compared the abilities of conventional and real-time reverse transcription-PCR (RT-PCR) assays to detect SARS CoV in clinical specimens. METHODS RNA samples isolated from nasopharyngeal aspirate (NPA; n = 170) and stool (n = 44) were reverse-transcribed and tested by our in-house conventional RT-PCR assay. We selected 98 NPA and 37 stool samples collected at different times after the onset of disease and tested them in a real-time quantitative RT-PCR specific for the open reading frame (ORF) 1b region of SARS CoV. Detection rates for the conventional and real-time quantitative RT-PCR assays were compared. To investigate the nature of viral RNA molecules in these clinical samples, we determined copy numbers of ORF 1b and nucleocapsid (N) gene sequences of SARS CoV. RESULTS The quantitative real-time RT-PCR assay was more sensitive than the conventional RT-PCR assay for detecting SARS CoV in samples collected early in the course of the disease. Real-time assays targeted at the ORF 1b region and the N gene revealed that copy numbers of ORF 1b and N gene sequences in clinical samples were similar. CONCLUSIONS NPA and stool samples can be used for early diagnosis of SARS. The real-time quantitative RT-PCR assay for SARS CoV is potentially useful for early detection of SARS CoV. Our results suggest that genomic RNA is the predominant viral RNA species in clinical samples.
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Affiliation(s)
- Leo L M Poon
- Department of Microbiology, The University of Hong Kong, Hong Kong SAR.
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3123
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Babyn PS, Chu WCW, Tsou IYY, Wansaicheong GKL, Allen U, Bitnun A, Chee TSG, Cheng FWT, Chiu MC, Fok TF, Hon EKL, Gahunia HK, Kaw GJL, Khong PL, Leung CW, Li AM, Manson D, Metreweli C, Ng PC, Read S, Stringer DA. Severe acute respiratory syndrome (SARS): chest radiographic features in children. Pediatr Radiol 2004; 34:47-58. [PMID: 14624321 PMCID: PMC7080132 DOI: 10.1007/s00247-003-1081-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2003] [Revised: 08/18/2003] [Accepted: 08/21/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) is a recently recognized condition of viral origin associated with substantial morbidity and mortality rates in adults. Little information is available on its radiologic manifestations in children. OBJECTIVE The goal of this study was to characterize the radiographic presentation of children with SARS. MATERIALS AND METHODS We abstracted data (n=62) on the radiologic appearance and course of SARS in pediatric patients with suspect (n=25) or probable (n=37) SARS, diagnosed in five hospital sites located in three cities: Toronto, Singapore, and Hong Kong. Available chest radiographs and thoracic CTs were reviewed for the presence of the following radiographic findings: airspace disease, air bronchograms, airways inflammation and peribronchial thickening, interstitial disease, pleural effusion, and hilar adenopathy. RESULTS A total of 62 patients (suspect=25, probable=37) were evaluated for SARS. Patient ages ranged from 5.5 months to 17 years and 11.5 months (average, 6 years and 10 months) with a female-to-male ratio of 32:30. Forty-one patients (66.1%) were in close contact with other probable, suspect, or quarantined cases; 10 patients (16.1%) had recently traveled to WHO-designated affected areas within 10 days; and 7 patients (11.2%) were transferred from other hospitals that had SARS patients. Three patients, who did not have close/hospital contact or travel history to affected areas, were classified as SARS cases based on their clinical signs and symptoms and on the fact that they were living in an endemic area. The most prominent clinical presentations were fever, with a temperature over 38 degrees C (100%), cough (62.9%), rhinorrhea (22.6%), myalgia (17.7%), chills (14.5%), and headache (11.3%). Other findings included sore throat (9.7%), gastrointestinal symptoms (9.7%), rigor (8.1%), and lethargy (6.5%). In general, fever and cough were the most common clinical presentations amongst younger pediatric SARS cases (age<10 years), whereas, in addition to these symptoms, headache, myalgia, sore throat, chills, and/or rigor were common in older patients (age>/=10 years). The chest radiographs of 35.5% of patients were normal. The most prominent radiological findings that were observed in the remaining patients were areas of consolidation (45.2%), often peripheral with multifocal lesions in 22.6%. Peribronchial thickening was noted on chest radiographs of 14.5% of patients. Pleural effusion was observed only in one patient (age 17 years and 11.5 months), whereas interstitial disease was not observed in any patient. CONCLUSION In pediatric cases, SARS manifests with nonspecific radiographic features making radiological differentiation difficult, especially from other commonly encountered childhood respiratory viral illnesses causing airspace disease. The radiographic presentation of suspected SARS cases ranged from normal to mild perihilar peribronchial thickening. The radiographic presentations, as expected, were relatively more pronounced in the SARS probable cases.
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Affiliation(s)
- Paul S Babyn
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
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3124
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Affiliation(s)
- M G Madariaga
- Infectious Disease and Epidemiology Associates, University of Nebraska Medical Center, Omaha, NE 68131, USA
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3125
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Chen W, Xu Z, Mu J, He B, Yang L, Lin L, Meng S, Mu F, Gan H, Huang S, Wen J, Fang J, Wang J. Real-time quantitative fluorescent reverse transcriptase-PCR for detection of severe acute respiratory syndrome-associated coronavirus RNA. Mol Diagn Ther 2004; 8:231-5. [PMID: 15887978 PMCID: PMC7100218 DOI: 10.1007/bf03260067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM SARS-associated coronavirus (SARS-CoV) has been confirmed as the pathogen for severe acute respiratory syndrome (SARS). The aim of our study was to construct a sensitive and specific real-time quantitative fluorescent (QF) reverse transcriptase (RT)-PCR method for the detection of SARS-CoV RNA. METHODS Stored blood specimens from 44 patients with confirmed SARS were used along with blood samples from two sets of controls, 30 healthy volunteers who had no contact with SARS patients, and 30 healthy doctors and nurses who had contact with SARS patients but were without symptoms of SARS. Two pairs of primers were synthesized by the Shanghai Sangon Company according to SARS-CoV BJ01 strain sequence (AY278488), and then a pair of primers were designed and compared with a pair of primers published by WHO. RESULTS Using serial dilutions of SARS-CoV, the 44 blood samples from SARS patients specimens were tested. Using a 0.01% dilution of SARS-CoV, all 44 clinical samples tested positive in our assay. In comparison, using a 0.1% dilution of SARS-CoV, 26 of the 44 samples tested positive using the WHO primers. In the QF-RT-PCR assay, there was a linear amplification from 100 copies to 10(8) copies of the control RNA per RT-PCR and at least 10 copies, and sometimes even 1 copy, of target RNA tested positive in our assay. CONCLUSION The primer we developed is sufficiently sensitive and specific to diagnose symptomatic SARS-CoV infections and for monitoring virus load.
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Affiliation(s)
- Weijun Chen
- Beijing Genomics Institute, Chinese Academy of Sciences, Beijing Airport Industry Zone B-6, Beijing, 101300 China
- Beijing BGI-GBI Biotech Co. Ltd, Beijing, China
| | - Zuyuan Xu
- Beijing Genomics Institute, Chinese Academy of Sciences, Beijing Airport Industry Zone B-6, Beijing, 101300 China
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | | | - Bo He
- Beijing BGI-GBI Biotech Co. Ltd, Beijing, China
| | - Ling Yang
- Beijing Genomics Institute, Chinese Academy of Sciences, Beijing Airport Industry Zone B-6, Beijing, 101300 China
- Beijing BGI-GBI Biotech Co. Ltd, Beijing, China
| | - Lin Lin
- National Institute for the Control of Pharmaceutical and Biological Products, Beijing, China
| | - Shufang Meng
- National Institute for the Control of Pharmaceutical and Biological Products, Beijing, China
| | - Feng Mu
- Beijing Genomics Institute, Chinese Academy of Sciences, Beijing Airport Industry Zone B-6, Beijing, 101300 China
- Beijing BGI-GBI Biotech Co. Ltd, Beijing, China
| | - Haixue Gan
- Beijing BGI-GBI Biotech Co. Ltd, Beijing, China
| | | | - Jie Wen
- Beijing Genomics Institute, Chinese Academy of Sciences, Beijing Airport Industry Zone B-6, Beijing, 101300 China
- Beijing BGI-GBI Biotech Co. Ltd, Beijing, China
| | - Jianqiu Fang
- Beijing Genomics Institute, Chinese Academy of Sciences, Beijing Airport Industry Zone B-6, Beijing, 101300 China
- Beijing BGI-GBI Biotech Co. Ltd, Beijing, China
| | - Jian Wang
- Beijing Genomics Institute, Chinese Academy of Sciences, Beijing Airport Industry Zone B-6, Beijing, 101300 China
- Beijing BGI-GBI Biotech Co. Ltd, Beijing, China
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3126
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Stavrinides J, Guttman DS. Mosaic evolution of the severe acute respiratory syndrome coronavirus. J Virol 2004; 78:76-82. [PMID: 14671089 PMCID: PMC303383 DOI: 10.1128/jvi.78.1.76-82.2004] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2003] [Accepted: 09/22/2003] [Indexed: 11/20/2022] Open
Abstract
Severe acute respiratory syndrome (SARS) is a deadly form of pneumonia caused by a novel coronavirus, a viral family responsible for mild respiratory tract infections in a wide variety of animals including humans, pigs, cows, mice, cats, and birds. Analyses to date have been unable to identify the precise origin of the SARS coronavirus. We used Bayesian, neighbor-joining, and split decomposition phylogenetic techniques on the SARS virus replicase, surface spike, matrix, and nucleocapsid proteins to reveal the evolutionary origin of this recently emerging infectious agent. The analyses support a mammalian-like origin for the replicase protein, an avian-like origin for the matrix and nucleocapsid proteins, and a mammalian-avian mosaic origin for the host-determining spike protein. A bootscan recombination analysis of the spike gene revealed high nucleotide identity between the SARS virus and a feline infectious peritonitis virus throughout the gene, except for a 200- base-pair region of high identity to an avian sequence. These data support the phylogenetic analyses and suggest a possible past recombination event between mammalian-like and avian-like parent viruses. This event occurred near a region that has been implicated to be the human receptor binding site and may have been directly responsible for the switch of host of the SARS coronavirus from animals to humans.
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Affiliation(s)
- John Stavrinides
- Department of Botany, University of Toronto, Toronto, Ontario M5S 3B2, Canada
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3127
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Bitar R, Weiser WJ, Avendaño M, Derkach P, Low DE, Muradali D. Chest Radiographic Manifestations of Severe Acute Respiratory Syndrome in Health Care Workers: The Toronto Experience. AJR Am J Roentgenol 2004; 182:45-8. [PMID: 14684510 DOI: 10.2214/ajr.182.1.1820045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the chest radiographic manifestations of severe acute respiratory syndrome (SARS) in previously uninfected health care workers during the early stages of an outbreak in Toronto, Canada. CONCLUSION The study group was composed of 13 patients from a single institution. Three distinct chest radiographic patterns were observed: focal peripheral air-space disease at presentation with gradual resolution (most common pattern, 10/13 patients), normal findings on chest radiography at presentation followed by focal air-space disease (2/13 patients), and normal findings on chest radiography at presentation followed by a "round" pneumonia pattern (1/13 patients). There was no evidence of pleural reaction, lymphadenopathy, or interstitial changes.
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Affiliation(s)
- Richard Bitar
- Department of Medical Imaging, St. Michael's Hospital, 60 Bond St., Toronto, ON M5B 1W8, Canada.
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3128
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Mei H, Sun L, Zhou Y, Xiong Q, Li Z. Identification of encoding proteins related to SARS-CoV. ACTA ACUST UNITED AC 2004; 49:2037-2040. [PMID: 32214714 PMCID: PMC7089014 DOI: 10.1360/03wb0198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
By sampling 100 encoding proteins from SARS-coronavirus (SARS-CoV, NC 004718) and other six coronaviruses and selecting 23 variables through stepwise multiple regression (SMR) from 172 variables, the multiple linear regression (MLR) model was established with good results of the quantitative modelling correlation coefficient R 2 = 0.645 and the cross-validation correlation coefficient R CV 2 = 0.375. After removing 4 outliers, the quantitative modelling and cross-validation correlation coefficients were R 2= 0.743 and R CV 2 = 0.543, respectively.
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Affiliation(s)
- Hu Mei
- 1College of Chemistry and Chemical Engineering, Chongqing University, 400044 Chongqing, China.,Key Laboratory of Biomedical Engineering of Ministry of Education and Chongqing City, 400044 Chongqing, China.,3College of Bioengineering, Chongqing University, 400044 Chongqing, China
| | - Lili Sun
- Key Laboratory of Biomedical Engineering of Ministry of Education and Chongqing City, 400044 Chongqing, China.,3College of Bioengineering, Chongqing University, 400044 Chongqing, China
| | - Yuan Zhou
- 1College of Chemistry and Chemical Engineering, Chongqing University, 400044 Chongqing, China.,Key Laboratory of Biomedical Engineering of Ministry of Education and Chongqing City, 400044 Chongqing, China
| | - Qing Xiong
- Key Laboratory of Biomedical Engineering of Ministry of Education and Chongqing City, 400044 Chongqing, China.,3College of Bioengineering, Chongqing University, 400044 Chongqing, China
| | - Zhiliang Li
- 1College of Chemistry and Chemical Engineering, Chongqing University, 400044 Chongqing, China.,Key Laboratory of Biomedical Engineering of Ministry of Education and Chongqing City, 400044 Chongqing, China
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3129
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Berger A, Drosten C, Doerr HW, Stürmer M, Preiser W. Severe acute respiratory syndrome (SARS)--paradigm of an emerging viral infection. J Clin Virol 2004; 29:13-22. [PMID: 14675864 PMCID: PMC7128705 DOI: 10.1016/j.jcv.2003.09.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2003] [Indexed: 02/04/2023]
Abstract
An acute and often severe respiratory illness emerged in southern China in late 2002 and rapidly spread to different areas of the Far East as well as several countries around the globe. When the outbreak of this apparently novel infectious disease termed severe acute respiratory syndrome (SARS) came to an end in July 2003, it had caused over 8000 probable cases worldwide and more than 700 deaths. Starting in March 2003, the World Health Organization (WHO) organised an unprecedented international effort by leading laboratories working together to find the causative agent. Little more than one week later, three research groups from this WHO-coordinated network simultaneously found evidence of a hitherto unknown coronavirus in SARS patients, using different approaches. After Koch's postulates had been fulfilled, WHO officially declared on 16 April 2003 that this virus never before seen in humans is the cause of SARS. Ever since, progress around SARS-associated coronavirus (SARS-CoV) has been swift. Within weeks of the first isolate being obtained, its complete genome was sequenced. Diagnostic tests based on the detection of SARS-CoV RNA were developed and made available freely and widely; nevertheless the SARS case definition still remains based on clinical and epidemiological criteria. The agent's environmental stability, methods suitable for inactivation and disinfection, and potential antiviral compounds have been studied, and development of vaccines and immunotherapeutics is ongoing. Despite its grave consequences in humanitarian, political and economic terms, SARS may serve as an example of how much can be achieved through a well-coordinated international approach, combining the latest technological advances of molecular virology with more "traditional" techniques carried out to an excellent standard.
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Affiliation(s)
- A Berger
- Institute for Medical Virology, Johann Wolfgang Goethe University Hospital, Paul Ehrlich-Street 40, D-60596 Frankfurt a. M., Germany.
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3130
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Ng PC, Lam CWK, Li AM, Wong CK, Cheng FWT, Leung TF, Hon EKL, Chan IHS, Li CK, Fung KSC, Fok TF. Inflammatory cytokine profile in children with severe acute respiratory syndrome. Pediatrics 2004; 113:e7-14. [PMID: 14702488 DOI: 10.1542/peds.113.1.e7] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To study the inflammatory cytokine profile in children with severe acute respiratory syndrome (SARS) and to investigate whether monoclonal antibody to tumor necrosis factor-alpha (TNF-alpha) could be considered for treatment of these patients. METHODS Plasma inflammatory cytokine concentrations (interleukin [IL]-1beta, IL-6, IL-8, IL-10, IL-12p70, and TNF-alpha) were monitored longitudinally on admission, immediately before corticosteroids, and 1 to 2 days and 7 to 10 days after the drug treatment in a cohort of pediatric patients (n = 8) with virologic confirmed SARS-associated coronavirus infection. None of the patients required mechanical ventilation or intensive care treatment. All children except 1 (patient 3) received corticosteroids. RESULTS Plasma IL-1beta levels (excluding patient 3) were substantially elevated immediately before (range: 7-721 ng/L) and 7 to 10 days after (range: 7-664 ng/L) corticosteroid treatment. In contrast, the plasma concentrations of other key proinflammatory cytokines, including IL-6 and TNF-alpha, were not overtly increased in any of the patients throughout the course of illness. In addition, plasma IL-10 concentration was significantly lower 1 to 2 days and 7 to 10 days after corticosteroid treatment, compared with the immediate pretreatment level. Similarly, plasma IL-6 and IL-8 concentrations were significantly decreased 7 to 10 days after the drug treatment. CONCLUSIONS Pediatric SARS patients have markedly elevated circulating IL-1beta levels, which suggests selective activation of the caspase-1-dependent pathway. Other key proinflammatory cytokines, IL-6 and TNF-alpha, showed only mildly elevated levels at the initial phase of the illness. The current evidence does not support the use of TNF-alpha monoclonal antibody in this group of children.
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Affiliation(s)
- Pak C Ng
- Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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3131
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3132
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Fina Avilés F, Vaqué Rafart J. El síndrome respiratorio agudo grave: primera pandemia del siglo XXI. An Pediatr (Barc) 2004; 60:503-6. [PMID: 15207160 PMCID: PMC7128663 DOI: 10.1016/s1695-4033(04)78318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - J. Vaqué Rafart
- Correspondencia: Servicio de Medicina Preventiva y Epidemiología. Hospital Universitario Vall d'Hebron. Universidad Autónoma de Barcelona. P.° Vall d'Hebron, 119–129. 08035 Barcelona. España
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3133
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Ng LFP, Wong M, Koh S, Ooi EE, Tang KF, Leong HN, Ling AE, Agathe LV, Tan J, Liu ET, Ren EC, Ng LC, Hibberd ML. Detection of severe acute respiratory syndrome coronavirus in blood of infected patients. J Clin Microbiol 2004; 42:347-50. [PMID: 14715775 PMCID: PMC321706 DOI: 10.1128/jcm.42.1.347-350.2004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Revised: 09/09/2003] [Accepted: 09/25/2003] [Indexed: 02/04/2023] Open
Abstract
Severe acute respiratory syndrome (SARS) has caused major outbreaks worldwide, resulting in an urgent need to obtain sensitive and accurate diagnosis of this disease. PCR-based detection methods were developed for use on a variety of samples, including blood. Eighteen subjects were investigated, and results indicated that blood samples contain sufficient virus for detection by using quantitative real-time PCR.
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Affiliation(s)
- Lisa F P Ng
- Genome Institute of Singapore, Singapore, Republic of Singapore
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3134
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Domínguez A, Gudiol F, Pumarola T, Salleras L. [Severe acute respiratory syndrome epidemics: the end or a hiatus of the epidemic?]. Med Clin (Barc) 2003; 121:340-6. [PMID: 14499072 PMCID: PMC7130471 DOI: 10.1016/s0025-7753(03)73942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Angela Domínguez
- Dirección General de Salud Pública, Departamento de Sanidad y Seguridad Social, Barcelona, España.
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3135
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Ng EKO, Ng PC, Hon KLE, Cheng WTF, Hung ECW, Chan KCA, Chiu RWK, Li AM, Poon LLM, Hui DS, Tam JS, Fok TF, Lo YMD. Serial analysis of the plasma concentration of SARS coronavirus RNA in pediatric patients with severe acute respiratory syndrome. Clin Chem 2003; 49:2085-8. [PMID: 14633884 PMCID: PMC7108135 DOI: 10.1373/clinchem.2003.024588] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Leo L M Poon
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region
| | | | - John S Tam
- Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR
| | | | - Y M Dennis Lo
- Departments of Chemical Pathology
- address correspondence to this author at: Department of Chemical Pathology, The Chinese University of Hong Kong, Room 38023, 1/F Clinical Sciences Building, Prince of Wales Hospital, 30--32 Ngan Shing St., Shatin, New Territories, Hong Kong Special Administrative Region, China; e-mail
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3136
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Affiliation(s)
- Isabelle Tratner
- Médecine/sciences, Faculté Xavier-Bichat, 16, rue Henri Huchard, 75018 Paris, France.
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3137
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Ng EKO, Hui DS, Chan KCA, Hung ECW, Chiu RWK, Lee N, Wu A, Chim SSC, Tong YK, Sung JJY, Tam JS, Lo YMD. Quantitative analysis and prognostic implication of SARS coronavirus RNA in the plasma and serum of patients with severe acute respiratory syndrome. Clin Chem 2003; 49:1976-80. [PMID: 14633867 PMCID: PMC7108161 DOI: 10.1373/clinchem.2003.024125] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: The availability of an early diagnostic tool for severe acute respiratory syndrome (SARS) would have major public health implications. We investigated whether the SARS coronavirus (SARS-CoV) can be detected in serum and plasma samples during the early stages of SARS and studied the potential prognostic implications of such an approach. Methods: We developed two real-time quantitative reverse transcription-PCR (RT-PCR) assays, one for the polymerase and the other for the nucleocapsid region of the virus genome, for measuring the concentration of SARS-CoV RNA in serum/plasma samples from SARS patients. Plasma samples were obtained from 12 confirmed SARS patients on the day of hospital admission, as well as on days 7 and 14 after fever onset. Serum samples were also obtained from 23 confirmed SARS patients on the day of hospital admission, 11 of whom subsequently required intensive care. Viral RNA was extracted from the plasma/serum samples. The extracted RNA was subjected to analysis by the RT-PCR assays. Results: The RT-PCR system for the polymerase region detected SARS-CoV RNA in 50% of plasma and 78% of serum samples from SARS patients during the first week of illness. The detection rates for plasma dropped to 25% at day 14 after fever onset. The median serum SARS-CoV concentrations in patients who required and did not require intensive care unit admission during the course of hospitalization were 5800 and 140 copies/mL, respectively (Mann–Whitney test, P <0.005). These data were confirmed by the RT-PCR system for the nucleocapsid region, which showed an even higher detection rate of 87%. The correlation between the results obtained by the two RT-PCR systems was high (Pearson correlation analysis, r = 0.998; P <0.001). Conclusion: Plasma/serum SARS-CoV quantification represents a potentially useful early diagnostic and prognostic tool for SARS.
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Affiliation(s)
| | | | | | | | | | | | - Alan Wu
- Medicine and Therapeutics, and
| | | | | | | | - John S Tam
- Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Y M Dennis Lo
- Departments of Chemical Pathology
- Address correspondence to this author at: Department of Chemical Pathology, The Chinese University of Hong Kong, Room 38023, 1/F Clinical Sciences Bldg., Prince of Wales Hospital, 30-32 Ngan Shing St., Shatin, New Territories, Hong Kong Special Administrative Region, China. E-mail
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3138
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Eickmann M, Becker S, Klenk HD, Doerr HW, Stadler K, Censini S, Guidotti S, Masignani V, Scarselli M, Mora M, Donati C, Han JH, Song HC, Abrignani S, Covacci A, Rappuoli R. Phylogeny of the SARS coronavirus. Science 2003; 302:1504-5. [PMID: 14645828 DOI: 10.1126/science.302.5650.1504b] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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3139
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Grant PR, Garson JA, Tedder RS, Chan PKS, Tam JS, Sung JJY. Detection of SARS coronavirus in plasma by real-time RT-PCR. N Engl J Med 2003; 349:2468-9. [PMID: 14681520 DOI: 10.1056/nejm200312183492522] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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3140
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Affiliation(s)
- Joseph S M Peiris
- Department of Microbiology and Division of Infectious Diseases, the University of Hong Kong, Hong Kong
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3141
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Yan L, Velikanov M, Flook P, Zheng W, Szalma S, Kahn S. Assessment of putative protein targets derived from the SARS genome. FEBS Lett 2003; 554:257-63. [PMID: 14623076 PMCID: PMC7159027 DOI: 10.1016/s0014-5793(03)01115-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ability to rapidly and reliably develop hypotheses on the function of newly discovered protein sequences requires systematic and comprehensive analysis. Such an analysis, embodied within the DS GeneAtlas™ pipeline, has been used to critically evaluate the severe acute respiratory syndrome (SARS) genome with the goal of identifying new potential targets for viral therapeutic intervention. This paper discusses several new functional hypotheses on the roles played by the constituent gene products of SARS, and will serve as an example of how such assignments can be developed or extended on other systems of interest.
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Affiliation(s)
- Lisa Yan
- Accelrys Inc., 9685 Scranton Road, San Diego, CA 92121, USA
| | | | - Paul Flook
- Accelrys Inc., 9685 Scranton Road, San Diego, CA 92121, USA
| | - Wenjin Zheng
- Accelrys Inc., 9685 Scranton Road, San Diego, CA 92121, USA
| | - Sándor Szalma
- Accelrys Inc., 9685 Scranton Road, San Diego, CA 92121, USA
| | - Scott Kahn
- Accelrys Inc., 9685 Scranton Road, San Diego, CA 92121, USA
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3142
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Jiang SS, Chen TC, Yang JY, Hsiung CA, Su IJ, Liu YL, Chen PC, Juang JL. Sensitive and quantitative detection of severe acute respiratory syndrome coronavirus infection by real-time nested polymerase chain reaction. Clin Infect Dis 2003; 38:293-6. [PMID: 14699465 PMCID: PMC7107825 DOI: 10.1086/380841] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Accepted: 09/09/2003] [Indexed: 02/04/2023] Open
Abstract
A quantitative, real-time, nested polymerase chain reaction (PCR) method, combining the high sensitivity of nested PCR with time-saving real-time instrumentation, was developed for large-scale screening for severe acute coronavirus (SARS) coronavirus. Forty-six clinical specimens were analyzed by this method, and results were compared with those obtained by conventional, single-round, real-time reverse-transcriptase PCR (RT-PCR) performed in parallel. Of the 17 positive results, 2 identified by our method were not detected by single-round, real-time RT-PCR, which suggests that real-time nested PCR has the potential for increased sensitivity, leading to earlier detection of SARS.
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Affiliation(s)
- Shih Sheng Jiang
- Divisions of Molecular and Genomic Medicine, Center for Disease Control, Department of Health, Taipei, Taiwan
| | - Tsan-Chi Chen
- Divisions of Molecular and Genomic Medicine, Center for Disease Control, Department of Health, Taipei, Taiwan
| | - Jyh-Yuan Yang
- Division of Laboratory Research and Development, Center for Disease Control, Department of Health, Taipei, Taiwan
| | - Chao A. Hsiung
- Biostatistics and Bioinformatics, National Health Research Institutes, Taipei, Taiwan
| | - Ih-Jen Su
- Division of Laboratory Research and Development, Center for Disease Control, Department of Health, Taipei, Taiwan
| | - Ying-Lan Liu
- Divisions of Molecular and Genomic Medicine, Center for Disease Control, Department of Health, Taipei, Taiwan
| | - Po-Cheng Chen
- Divisions of Molecular and Genomic Medicine, Center for Disease Control, Department of Health, Taipei, Taiwan
| | - Jyh-Lyh Juang
- Divisions of Molecular and Genomic Medicine, Center for Disease Control, Department of Health, Taipei, Taiwan
- Reprints or correspondence: Dr. Jyh-Lyh Juang, Div. of Molecular and Genomic Medicine, National Health Research Institutes, 128 Yen-Chiu-Yuan Rd., Sec. 2, Taipei, Taiwan ()
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3143
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Ho JC, Ooi GC, Mok TY, Chan JW, Hung I, Lam B, Wong PC, Li PC, Ho PL, Lam WK, Ng CK, Ip MS, Lai KN, Chan-Yeung M, Tsang KW. High-dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome. Am J Respir Crit Care Med 2003; 168:1449-56. [PMID: 12947028 DOI: 10.1164/rccm.200306-766oc] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The treatment of atypical pneumonia, subsequently termed severe acute respiratory syndrome (SARS), is controversial, and the efficacy of corticosteroid therapy is unknown. We have evaluated the clinical and radiographic outcomes of 72 patients with probable SARS (median age 37 years, 30 M), who received ribavirin and different steroid regimens in two regional hospitals. Chest radiographs were scored according to the percentage of lung field involved. Seventeen patients initially received pulse steroid (PS) (methylprednisolone > or =500 mg/day) and 55 patients initially received nonpulse steroid (NPS) (methylprednisolone <500 mg/day) therapy. The cumulative steroid dosage; intensive care unit admission, mechanical ventilation, and mortality rates; and hematologic and biochemical parameters were similar in both groups after 21 days. However, patients in the PS group had less oxygen requirement, better radiographic outcome, and less likelihood of requiring rescue PS therapy than their counterparts. There was no significant difference between the two groups in hemolytic anemia, severe secondary infections, or hematemesis, but patients in the PS group had less hyperglycaemia. Initial use of pulse methylprednisolone therapy appears to be a more efficacious and an equally safe steroid regimen when compared with regimens with lower dosage and should be considered as the preferred steroid regimen in the treatment of SARS, pending data from future randomized controlled trials.
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Affiliation(s)
- James C Ho
- University Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, People's Republic of China
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3144
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3145
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Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, Somasundaran M, Sullivan JL, Luzuriaga K, Greenough TC, Choe H, Farzan M. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003; 426:450-4. [PMID: 14647384 PMCID: PMC7095016 DOI: 10.1038/nature02145] [Citation(s) in RCA: 4440] [Impact Index Per Article: 211.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2003] [Accepted: 10/23/2003] [Indexed: 11/08/2022]
Abstract
Spike (S) proteins of coronaviruses, including the coronavirus that causes severe acute respiratory syndrome (SARS), associate with cellular receptors to mediate infection of their target cells. Here we identify a metallopeptidase, angiotensin-converting enzyme 2 (ACE2), isolated from SARS coronavirus (SARS-CoV)-permissive Vero E6 cells, that efficiently binds the S1 domain of the SARS-CoV S protein. We found that a soluble form of ACE2, but not of the related enzyme ACE1, blocked association of the S1 domain with Vero E6 cells. 293T cells transfected with ACE2, but not those transfected with human immunodeficiency virus-1 receptors, formed multinucleated syncytia with cells expressing S protein. Furthermore, SARS-CoV replicated efficiently on ACE2-transfected but not mock-transfected 293T cells. Finally, anti-ACE2 but not anti-ACE1 antibody blocked viral replication on Vero E6 cells. Together our data indicate that ACE2 is a functional receptor for SARS-CoV.
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Affiliation(s)
- Wenhui Li
- Department of Medicine (Microbiology and Molecular Genetics), Partners AIDS Research Center, Brigham and Women's Hospital,
| | - Michael J. Moore
- Department of Medicine (Microbiology and Molecular Genetics), Partners AIDS Research Center, Brigham and Women's Hospital,
| | - Natalya Vasilieva
- Perlmutter Laboratory, Pulmonary Division, Children's Hospital, Department of Pediatrics,
| | - Jianhua Sui
- Dana-Farber Cancer Institute, Department of Medicine, Harvard Medical School, Massachusetts 02115 Boston, USA
| | - Swee Kee Wong
- Department of Medicine (Microbiology and Molecular Genetics), Partners AIDS Research Center, Brigham and Women's Hospital,
| | - Michael A. Berne
- Tufts University Core Facility, Tufts University School of Medicine, Massachusetts 02111 Boston, USA
| | - Mohan Somasundaran
- Program in Molecular Medicine, University of Massachusetts Medical School, Massachusetts 01605 Worcester, USA
| | - John L. Sullivan
- Program in Molecular Medicine, University of Massachusetts Medical School, Massachusetts 01605 Worcester, USA
| | - Katherine Luzuriaga
- Program in Molecular Medicine, University of Massachusetts Medical School, Massachusetts 01605 Worcester, USA
| | - Thomas C. Greenough
- Program in Molecular Medicine, University of Massachusetts Medical School, Massachusetts 01605 Worcester, USA
| | - Hyeryun Choe
- Perlmutter Laboratory, Pulmonary Division, Children's Hospital, Department of Pediatrics,
| | - Michael Farzan
- Department of Medicine (Microbiology and Molecular Genetics), Partners AIDS Research Center, Brigham and Women's Hospital,
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3146
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Wong SK, Li W, Moore MJ, Choe H, Farzan M. A 193-amino acid fragment of the SARS coronavirus S protein efficiently binds angiotensin-converting enzyme 2. J Biol Chem 2003; 279:3197-201. [PMID: 14670965 PMCID: PMC7982343 DOI: 10.1074/jbc.c300520200] [Citation(s) in RCA: 543] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The coronavirus spike (S) protein mediates infection of receptor-expressing host cells and is a critical target for antiviral neutralizing antibodies. Angiotensin-converting enzyme 2 (ACE2) is a functional receptor for the coronavirus (severe acute respiratory syndrome (SARS)-CoV) that causes SARS. Here we demonstrate that a 193-amino acid fragment of the S protein (residues 318-510) bound ACE2 more efficiently than did the full S1 domain (residues 12-672). Smaller S protein fragments, expressing residues 327-510 or 318-490, did not detectably bind ACE2. A point mutation at aspartic acid 454 abolished association of the full S1 domain and of the 193-residue fragment with ACE2. The 193-residue fragment blocked S protein-mediated infection with an IC(50) of less than 10 nm, whereas the IC(50) of the S1 domain was approximately 50 nm. These data identify an independently folded receptor-binding domain of the SARS-CoV S protein.
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Affiliation(s)
- Swee Kee Wong
- Partners AIDS Research Center, Brigham and Women's Hospital, Department of Medicine (Microbiology and Molecular Genetics), Harvard Medical School, Boston, Massachusetts 02115, USA
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3147
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Manocha S, Walley KR, Russell JA. Severe acute respiratory distress syndrome (SARS): a critical care perspective. Crit Care Med 2003; 31:2684-92. [PMID: 14605542 DOI: 10.1097/01.ccm.0000091929.51288.5f] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the epidemiology, clinical features, etiology, diagnosis, and management of severe acute respiratory syndrome (SARS) from a critical care perspective. DATA SOURCES A MEDLINE search was performed using the following terms: severe acute respiratory syndrome and SARS virus. Additional information and references were obtained from the Web sites for the Centers for Disease Control and Prevention, World Health Organization, and Health Canada. STUDY SELECTION Recent case series were used to develop a review of the epidemiology, clinical features, outcomes, and management of patients with SARS from an intensive care unit (ICU) perspective. This was supplemented by epidemiology information obtained from other Web-based sources. Recent published studies describing the etiology of SARS were also included. DATA SYNTHESIS SARS has rapidly spread from Southeast Asia to numerous countries, including Canada and the United States. A new coronavirus has been isolated and detected from many affected patients. The mortality rate worldwide is approximately 10.5%. From five cohorts, the ICU admission rate ranged from 20% to 38%. Fifty-nine percent to 100% of the ICU patients required mechanical ventilatory support. The mortality rate of SARS patients admitted to the ICU ranged from 5% to 67%. The most common clinical symptoms and signs are fever, cough, dyspnea, myalgias, malaise, and inspiratory crackles. Common laboratory abnormalities included mild leukopenia, lymphopenia, and increased aspartate transaminase, alanine transaminase, lactic dehydrogenase, and creatine kinase. The chest radiograph pattern ranged from focal infiltrates to diffuse airspace disease. Management consisted of isolation, strict respiratory and contact precautions, ventilatory support as needed, empiric broad-spectrum antibiotics, ribavirin, and corticosteroids. Predictors of mortality included advanced age, the presence of comorbidities, and a high lactic dehydrogenase or high neutrophil count at admission. CONCLUSIONS SARS is a highly contagious, infectious process that can advance to significant hypoxemic respiratory failure requiring ICU monitoring and support. Early recognition is critical for effective management and containment of this disease.
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Affiliation(s)
- Sanjay Manocha
- Department of Medicine, University of British Columbia, Vancouver, Canada
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3148
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Hui JYH, Cho DHY, Yang MKW, Wang K, Lo KKL, Fan WC, Chan CC, Chu CM, Loke TKL, Chan JCS. Severe Acute Respiratory Syndrome: Spectrum of High-Resolution CT Findings and Temporal Progression of the Disease. AJR Am J Roentgenol 2003; 181:1525-38. [PMID: 14627568 DOI: 10.2214/ajr.181.6.1811525] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Joyce Y H Hui
- Department of Diagnostic Radiology and Organ Imaging, United Christian Hospital, 130 Hip Wo St., Kwun Tong, Hong Kong.
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3149
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Abstract
Severe acute respiratory syndrome is a newly emerged infectious disease with moderately high transmissibility. Nosocomial outbreaks were responsible for the propagation of the epidemic worldwide. Health care workers (HCW) are at particular high risk because of their close contact with patients, involvement in medical procedures, and handling of excreta/fomites. Good hospital organization and appropriate infection control strategies are essential to prevent/interrupt disease transmission from patients to HCWs (and vice versa) and among inpatients and HCWs themselves. Education and training should target broadly to all HCWs.
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Affiliation(s)
- Nelson Lee
- Department of Medicine and Therapeutics, 9/F Clinical Science Building, Prince of Wales Hospital, Hong Kong.
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3150
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Xue-zhe Z, Wu W, Yan L, Zhen-guo H, Wen H, Yan-ning S, An R. CT manifestations of lung changes and complications in patients with severe acute respiratory syndrome. Chin J Integr Med 2003. [PMCID: PMC7089444 DOI: 10.1007/bf02838608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: To investigate the role of CT scanning in diagnosing severe acute respiratory syndrome (SARS).Methods: One hundred and twelve times of spiral CT scanning, 106 times on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females) of SARS.Results: Bilateral shadows showed in 66 patients (80.48%) and unilateral shadow in 16 (19.52%). The lung CT findings were sub-pleural focal consolidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large area consolidation in 9 (10.97%), ground-glass blurry shadow in 31 (37.80%), alveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51%). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesions tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub-pleural focal consolidation, flaky cloudy shadow, large area consolidation, ground-glass blurry shadow, and often accompanied with signs of broncho-inflation. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid progressions or changes on the size, amount, and distribution of the lesions likely to be found in dynamic observation of chest X-ray and CT scanning, i.e., markedly dynamic changes found within 24 to 48 hrs. Lesions with these characteristics may be recognized as pulmonary changes possibly induced by SARS. Complications were found in 6 patients (7.31%), including tuberculosis of lung and brain accompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SARS, by which more accurate assessment of the abnormal changes of lung and occurrence of complications in SARS patients can be made.
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Affiliation(s)
- Zhang Xue-zhe
- Department of Radiology, China-Japan Friendship Hospital, 100029 Beijing
| | - Wang Wu
- Department of Radiology, China-Japan Friendship Hospital, 100029 Beijing
| | - Lu Yan
- Department of Radiology, China-Japan Friendship Hospital, 100029 Beijing
| | - Huang Zhen-guo
- Department of Radiology, China-Japan Friendship Hospital, 100029 Beijing
| | - Hong Wen
- Department of Radiology, China-Japan Friendship Hospital, 100029 Beijing
| | - Shang Yan-ning
- Department of Radiology, China-Japan Friendship Hospital, 100029 Beijing
| | - Ren An
- Department of Radiology, China-Japan Friendship Hospital, 100029 Beijing
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