Severe acute respiratory syndrome and its lesions in digestive system

The Fatty Acid Lipid Metabolism Nexus in COVID-19

Enteric symptomology seen in early-stage severe acute respiratory syndrome (SARS)-2003 and COVID-19 is evidence of virus replication occurring in the intestine, liver and pancreas. Aberrant lipid metabolism in morbidly obese individuals adversely affects the COVID-19 immune response and increases disease severity. Such observations are in line with the importance of lipid metabolism in COVID-19, and point to the gut as a site for intervention as well as a therapeutic target in treating the disease. Formation of complex lipid membranes and palmitoylation of coronavirus proteins are essential during viral replication and assembly. Inhibition of fatty acid synthase (FASN) and restoration of lipid catabolism by activation of AMP-activated protein kinase (AMPK) impede replication of coronaviruses closely related to SARS-coronavirus-2 (CoV-2). In vitro findings and clinical data reveal that the FASN inhibitor, orlistat, and the AMPK activator, metformin, may inhibit coronavirus replication and reduce systemic inflammation to restore immune homeostasis. Such observations, along with the known mechanisms of action for these types of drugs, suggest that targeting fatty acid lipid metabolism could directly inhibit virus replication while positively impacting the patient's response to COVID-19.

Naturally Occurring Animal Coronaviruses as Models for Studying Highly Pathogenic Human Coronaviral Disease

Coronaviruses (CoVs) comprise a large group of positive stranded RNA viruses that infect a diverse host range including birds and mammals. Infection with CoVs typically presents as mild to severe respiratory or enteric disease, but CoVs have the potential to cause significant morbidity or mortality in highly susceptible age groups. CoVs have exhibited a penchant for jumping species barriers throughout history with devastating effects. The emergence of highly pathogenic or infectious CoVs in humans over the past 20 years, including severe acute respiratory syndrome CoV (SARS-CoV), Middle East respiratory syndrome CoV (MERS-CoV), and most recently severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), underscores the significant threat that CoV spillovers pose to humans. Similar to the emergence of SARS-CoV-2, CoVs have been devastating to commercial animal production over the past century, including infectious bronchitis virus in poultry and bovine CoV, as well as the emergence and reemergence of multiple CoVs in swine including transmissible gastroenteritis virus, porcine epidemic diarrhea virus, and porcine deltacoronavirus. These naturally occurring animal CoV infections provide important examples for understanding CoV disease as many animal CoVs have complex pathogenesis similar to SARS-CoV-2 and can shed light on the ongoing SARS-CoV-2 outbreak. We provide an overview and update regarding selected existing animal CoVs and their primary host species, diseases caused by CoVs, how CoVs jump species, whether these CoVs pose an outbreak risk or risk to humans, and how we can mitigate these risks.

Viral Pandemics of the Last Four Decades: Pathophysiology, Health Impacts and Perspectives

The twenty-first century has witnessed some of the deadliest viral pandemics with far-reaching consequences. These include the Human Immunodeficiency Virus (HIV) (1981), Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (2002), Influenza A virus subtype H1N1 (A/H1N1) (2009), Middle East Respiratory Syndrome Coronavirus (MERS-CoV) (2012) and Ebola virus (2013) and the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (2019-present). Age- and gender-based characterizations suggest that SARS-CoV-2 resembles SARS-CoV and MERS-CoV with regard tohigher fatality rates in males, and in the older population with comorbidities. The invasion-mechanism of SARS-CoV-2 and SARS-CoV, involves binding of its spike protein with angiotensin-converting enzyme 2 (ACE2) receptors; MERS-CoV utilizes dipeptidyl peptidase 4 (DPP4), whereas H1N1 influenza is equipped with hemagglutinin protein. The viral infections-mediated immunomodulation, and progressive inflammatory state may affect the functions of several other organs. Although no effective commercial vaccine is available for any of the viruses, those against SARS-CoV-2 are being developed at an unprecedented speed. Until now, only Pfizer/BioNTech's vaccine has received temporary authorization from the UK Medicines and Healthcare products Regulatory Agency. Given the frequent emergence of viral pandemics in the 21st century, proper understanding of their characteristics and modes of action are essential to address the immediate and long-term health consequences.

Ischemic gastrointestinal complications of COVID-19: a systematic review on imaging presentation

Background

Limited data is available addressing gastrointestinal (GI) ischemia in coronavirus disease 2019 (COVID-19). We reviewed the clinical and radiologic features of GI ischemia and its related complications in thirty-one COVID-19 patients reported in literature.

Methods

A systematic literature review was performed using a search strategy on all studies published from January 1, 2020, to June 13, 2020, and updated on September 6, 2020, on databases from PubMed, Scopus, Embase, Web of Science, and Google Scholar. Every study with at least one presentation of COVID-19-related GI ischemia complication and one GI imaging finding was included.

Results

In total, twenty-two studies and thirty-one patients with the mean age of 59 ± 12.7 (age range: 28–80) years old were included, of which 23 (74.2%) patients were male, 7 (22.5%) female, and one unknown gender. The significant GI imaging findings include mesenteric arterial or venous thromboembolism, followed by small bowel ischemia. Nine patients (29%) presented with arterial compromise due to superior mesenteric thromboembolism, resulting in bowel ischemia. Also, 6 patients (19.3%) demonstrated occlusive thrombosis of the portal system and superior mesenteric vein. More than two-thirds of patients (20, 64.5%) required laparotomy and bowel resection. Eventually, five (16.1%) patients were discharged, of whom four cases (12.9%) readmitted. Five (16.1%) patients remained ICU hospitalized at the report time and 12 (38.7%) patients died.

Conclusion

Macrovascular arterial/venous thrombosis is identified in almost half of COVID-19 patients with bowel ischemia. Overall mortality in COVID-19 patients with GI ischemia and radiologically evident mesenteric thrombotic occlusion was 38.7% and 40%, retrospectively.

Gynecological Endoscopic Society of Malaysia Statement and Recommendations on Gynecological Laparoscopic Surgery during COVID-19 Pandemic

Objectives:

While the issue of aerosolization of virus from the blood occurs during usage of energy sources scare practitioners, there have been no reported instances of healthcare workers (HCWs) being infected. COVID-19 virus is primarily transmitted via respiratory droplets and contact routes. Therefore, the ultimate decision for surgery, should be based on which is the safest, quickest route and concurrently ensuring that HCWs are protected during these surgeries. During the time of crisis, HCWs need to concentrate and channel resources to the care of those affected by the coronavirus hence judicious allocation of resources is mandatory. We present the guidelines and recommendations on gynecological laparoscopic surgery during this COVID-19 outbreak in Malaysia.

Materials and Methods:

Thorough search of articles and recommendations were done to look into the characteristics of the virus in terms of transmission and risks during surgery. Smoke plume characteristics, composition and risk of viral transmission were also studied. Search includes The WHO Library, Cochrane Library and electronic databases (PubMed, Google scholar and Science Direct).

Conclusion:

We concluded that there is no scientific basis of shunning laparoscopic approach in surgical intervention. Ultimately, the guiding principles would be of reducing the anesthetic and surgical duration, the availability of full protective gear for HCWs during the surgery and the status of the patient. It is mandatory for viral swab tests to be done within the shortest window period possible, for all cases planned for surgery.

Expression of prothrombinase/fibroleukin gene fg12 in lung impairment in a murine severe acute respiratory syndrome model

To evaluate the role of murine fibrinogen like protein 2 (mfgl2) /fibroleukin in lung impairment in Severe acute respiratory syndrome (SARS), a murine SARS model induced by Murine hepatitis virus strain 3 (MHV-3) through trachea was established. Impressively, all the animals developed interstitial pneumonia with extensive hyaline membranes formation within alveoli, and presence of micro-vascular thrombosis in the pulmonary vessels. MHV-3 nucleocapsid gene transcripts were identified in multiple organs including lungs, spleen etc. As a representative proinflammatory gene, mfgl2 prothrombinase expression was evident in terminal and respiratory bronchioles, alveolar epithelia and infiltrated cells in the lungs associated with fibrin deposition and micro-vascular thrombosis. In summary, the established murine SARS model could mimic the pathologic characteristics of lungs in patients with SARS. Besides the physical damages due to virus replication in organs, the up-regulation of novel gene mfgl2 in lungs may play a vital role in the development of SARS associated lung damage.

Symptom combinations associated with outcome and therapeutic effects in a cohort of cases with SARS

Severe acute respiratory syndrome (SARS) is an infectious disease and some of its symptoms were clinically indistinguishable of those from similar diseases. This study aimed to find the symptom combinations associated with adverse outcome and the therapeutic effects in a cohort of patients with probable SARS retrospectively. In 2003, 123 SARS cases in Beijing were subjected to a strictly western medicine (WM) treatment, or a combined treatment (WM plus Herba houttuyniae injection, addition of individualized herbal treatments when necessary), of which 115 were followed till death or discharge; 8 were transferred and lost to follow-up. In both treatment groups, clinical manifestations were evaluated daily; development of signs and symptoms, and their possible relationship with outcome, were assessed. The relationships between these sign/symptom complexes and outcome under two treatment protocols were evaluated and differences were noted. Dynamic symptom combinations, dividing into the early, the medium-term and the durational symptom clusters, were identified as likely being related to the adverse outcomes of SARS (p < 0.05, p < 0.01). Compared with a strictly WM treatment, the combined treatment resulted in a longer hospital stay (p = 0.028), a non-statistically significant mortality rate decrease (combined treatment: 9.6% versus WM: 11.1%), and a significant improvement of arthralgia and myalgia (p < 0.05) in the early symptom cluster. Additionally, the combined protocol improved arterial oxyhemoglobin saturation significantly at day 22 (p < 0.05). In conclusion, the progress and outcome of SARS may be associated with specific temporal patterns of development in combination of several non-specific signs and symptom complexes, which are also helpful for evaluating the therapeutic effects on SARS patients.

Experimental infection of macaques with the human reovirus BYD1 strain: an animal model for the study of the severe acute respiratory syndrome

Experimental studies were performed to determine the role of a newly isolated reovirus (ReoV) from a severe acute respiratory syndrome (SARS) patient in the etiology of this newly described serious respiratory syndrome. Four cynomologus macaques were inoculated with this reovirus (BYD1) in an attempt to replicate the infection and pathology observed in SARS. The body temperature of the infected monkeys was monitored three times a day, and blood and fecal samples were periodically collected for specific immunology determinations. On days 7 and 33 after inoculation, necropsies for pathological accessment and pathogen isolation were performed. The four infected macaques developed a fever on days 3 and 4 after inoculation, and maintainted a febrile state for 4-6 days. The highest temperature in the animals recorded was 40.4 degrees C. After a recovery phase, the macaques developed a second febrile condition. Antibody titers against the reovirus injected by the intravenous route occurred in higher number than those in the nasal cavity. Four macaque monkeys demonstrated diffuse alveolar damage, characterized by hemorrhagic pneumonia, serosanguineous exudates, formation of hyaline membranes, and type II pneumocyte hyperplasia, which were similar to those that have been noted in SARS patients. Lymphocytes decreased in the cortex of the lymph node and in the white pulp of the spleen. ReoV was detected in pneumonic tissue by virus isolation and RT-PCR. The macaques infected with the newly isolated reovirus developed a fever, diffuse alveolar damage and pulmonary interstitial inflammation similar to that noted in SARS patients. This evidence demonstrates that ReoV might have a primary role in the etiology of SARS.

Clinical significance of hepatic derangement in severe acute respiratory syndrome

AIM: Elevation of alanine aminotransferase (ALT) level is commonly seen among patients suffering from severe acute respiratory syndrome (SARS). We report the progression and clinical significance of liver derangement in a large cohort of SARS patient.

METHODS: Serial assay of serum ALT was followed in patients who fulfilled the WHO criteria of SARS. Those with elevated ALT were compared with those with normal liver functions for clinical outcome. Serology for hepatitis B virus (HBV) infection was checked. Adverse outcomes were defined as oxygen desaturation, need of intensive care unit (ICU) and mechanical ventilation and death.

RESULTS: Two hundred and ninety-four patients were included in this study. Seventy (24%) patients had elevated serum ALT on admission and 204 (69%) patients had elevated ALT during the subsequent course of illness. Using peak ALT > 5×ULN as a cut-off and after adjusting for potential confounding factors, the odds ratio of peak ALT > 5×ULN for oxygen desaturation was 3.24 (95%CI 1.23-8.59, P = 0.018), ICU care was 3.70 (95%CI 1.38-9.89, P = 0.009), mechanical ventilation was 6.64 (95%CI 2.22-19.81, P = 0.001) and death was 7.34 (95%CI 2.28-24.89, P = 0.001). Ninety-three percent of the survived patients had ALT levels normalized or were on the improving trend during follow-up. Chronic hepatitis B was not associated with worse clinical outcomes.

CONCLUSION: Reactive hepatitis is a common complication of SARS-coronavirus infection. Those patients with severe hepatitis had worse clinical outcome.

Eight-month prospective study of 14 patients with hospital-acquired severe acute respiratory syndrome

OBJECTIVE

To define the clinical characteristics and clinical course of hospital-acquired severe acute respiratory syndrome (SARS).

PATIENTS AND METHODS

This 8-month prospective study of 14 patients with hospital-acquired SARS in Taipei, Taiwan, was conducted from April through December 2003.

RESULTS

The most common presenting symptoms in our 14 patients with hospital-acquired SARS were fever, dyspnea, dizziness, malaise, diarrhea, dry cough, muscle pain, and chills. Lymphopenia and elevated serum levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were the most common Initial laboratory findings. Initial chest radiographs revealed various pattern abnormalities and normal results. Five of the 14 patients required mechanical ventilation. The need for mechanical ventilation was associated with bilateral lung involvement on the initial chest radiograph and higher peak levels of LDH and CRP. Clinical severity of disease varied from mild to severe. At 8 months after disease onset, patients with mild or moderate SARS had normal findings or only focal fibrosis on chest high-resolution computed tomography. However, bilateral fibrotic changes remained in the 4 patients who had recovered from severe SARS, 1 of whom had mild restrictive ventilatory impairment. One patient with severe SARS died; she was elderly and had other comorbidities. Five additional patients had reduced diffusing capacity.

CONCLUSION

The clinical picture of our patients presenting with hospital-acquired SARS revealed atypical pneumonia associated with lymphopenia, elevated serum levels of LDH, rapid clinical deterioration, and lack of response to empirical antibiotic therapy. Substantially elevated levels of LDH and CRP correlated with severe illness requiring mechanical ventilatory support. In those receiving mechanical ventilation, pulmonary function was only mildly reduced at 6 to 8 months after acute illness, consistent with the natural history of acute respiratory distress syndrome due to other causes.

Diarrhea in medical care workers with severe acute respiratory syndrome

BACKGROUND AND GOAL

Several known coronavirus species cause a variety of diseases, including respiratory or enteric diseases. The purpose of this study was to investigate the interesting enteric symptoms of the medical care workers who were evidently infected with SARS by means of respiratory transmission.

STUDY

Between May 1 and June 16, 2003, we enrolled 16 medical care workers who fulfilled the definition of probable SARS. Samples used for the detection of coronavirus RNA by RT-PCR were collected from throat and rectal swabs during acute phase. Serum anti-SARS IgG was checked by enzyme-linked immunosorbent assays at the convalescent phase.

RESULTS

The incidence of watery diarrhea was 18.8% (3 of 16). The RT-PCR of coronavirus was positive in three (18.8%) of 16 throat swabs and in none (0%) of seven rectal swabs. Serum anti-coronavirus IgG was positive in 13 of the 15 patients (86.7%). The mortality rate was 6.25% (1 of 16). The diarrhea rate in our hospital was significantly lower in comparison with the 73% (55 of 75) of the Amoy Gardens outbreak in Hong Kong (P = 0.000073), and similar to the 19.6% (27 of 138) of the hospital-acquired outbreak in the Prince of Wales Hospital in Hong Kong (P = 0.798). In contrast to the high positive rate of feces RT-PCR (97%) in Amoy Gardens, our positive rate in rectal swab RT-PCT (0%) was significantly lower (P = 0.00000002).

CONCLUSIONS

Hospital-acquired SARS cases infected mainly by respiratory route less commonly presented with diarrhea. Lower intestinal viral load, when the virus spread by respiratory route, may be contributive to lower diarrhea rate and lower positive rate in rectal swab RT-PCR.

Phylogenomics and bioinformatics of SARS-CoV

Tracing the history of molecular changes in coronaviruses using phylogenetic methods can provide powerful insights into the patterns of modification to sequences that underlie alteration to selective pressure and molecular function in the SARS-CoV (severe acute respiratory syndrome coronavirus) genome. The topology and branch lengths of the phylogenetic relationships among the family Coronaviridae, including SARS-CoV, have been estimated using the replicase polyprotein. The spike protein fragments S1 (involved in receptor-binding) and S2 (involved in membrane fusion) have been found to have different mutation rates. Fragment S1 can be further divided into two regions (S1A, which comprises approximately the first 400 nucleotides, and S1B, comprising the next 280) that also show different rates of mutation. The phylogeny presented on the basis of S1B shows that SARS-CoV is closely related to MHV (murine hepatitis virus), which is known to bind the murine receptor CEACAM1. The predicted structure, accessibility and mutation rate of the S1B region is also presented. Because anti-SARS drugs based on S2 heptads have short half-lives and are difficult to manufacture, our findings suggest that the S1B region might be of interest for anti-SARS drug discovery.

Clinical characteristics and staging of SARS: A report of 801 cases in Beijing

AIM: To identify the clinical characteristic and stages of SARS.

METHODS: The data derived from 801 cases of patients with SARS (moderate type) were analyzed and the stages of SARS were classified by the respiratory symptoms, WBC and lymphocyte count, and chest radiography.

RESULTS: Three days after onset of SARS, the major clinical symptoms were fever (88.1%), fatigue, headache,myalgia, arthralgia (25-36%), and so on. Decrease of WBC (22.6 %), lymphocyte (70.3%), and CD₃, CD₄,and CD₈ positive T cells (70%) was found. From 4 to 7 days, the unspecific symptoms became weak, however, the positive rates of respiratory tract symptoms, such as cough (24.2%), pectoration (14.3%), chest distress (21.0%) and shortness of breath(9.2%) went up, so did the abnormality on chest radiograph or CT. The counts of WBC, lymphocyte and CD₃,CD₄, and CD₈ positive T cells touched bottom. From 8 to 16 days,the patients presented progressive cough (30%),pectoration (13.1%), chest distress (35.3%) and shortness of breath (20.4%). 100% patients had infiltrates on chest radiograph or CT, even multi-infiltrates. From 17 to 24 days, patients respiratory symptoms started to alleviate,the infiltrates on the lung began to absorb gradually, the counts of WBC, lymphocyte and CD₃, CD₄, and CD₈ positive T cells got back normality. From 5 to 8 weeks, the patients symptoms almost disappeared, and the infiltrates in lung were completely or mainly absorbed.

CONCLUSION: The course of SARS can be divided into five stagess, namely the initial, progressive, fastigium, remittence and convalescence.

Characteristics of 1 062 patients with SARS in early stage in Beijing

AIM: To sumarize the clinical features of patients with SARS in early stage.

METHODS: The clinical data of patients with SARS who were admitted to hospitals in the periods of 1 to 7 days after onset of illness. The early stage of SARS was identified by the syndromes and signs of lungs, oxygenation index and the examination of imaging.

RESULTS: The positive rates of the reference parameters were similar in the 1st day and 2nd to 3rd day, but changed obviously in the later days. The period of 1 to 3 days was therefore considered as the early stage of SARS. The study showed that 88.7 percent of patients got fever, 98.8 percent of patients had reported fever and 16.3 % patients with chilly, 4.3 percent of patients even shiver. 20 percent of patients had the unspecific syndrome, such as fatigue, headache, myalgia, and arthralgia. 16.1% patients had congestion in throat and 8.4% patients with pharyngalgia. Rhinorrhea, sneezing, skin rash and tumefaction of tonsil or lymph nodes were rare (the rates were 3.4%, 2.5%, 0.9% and 0.3% respectively). 4.3 percent of patients occurred dianrrhea, but no hematenesis and hematochezia. Nausea, vomiting and other positive signs of abdumen were not common. About one third patients presented cough, 14.6% expectoration, 7% chest distress and suffocated. The sign of lung was usually lacked, and the rate of moist rales were only 4.9%. 71.4% patients artery pressure of oxygen decreased, 20.9% and 27. 8% patients oxygenation index and oxygen satureation also went down slightly. The reducing rate of WBC, lymphocyte and PLT were 22.5%, 36.4% and 13.4% respectively, but there were 6.4% patients with high WBC count. The mean counts of CD₃, CD₄, and CD₈ cells decreased obviously and their positive rates were more than 90%. Most patients of SARS (about 80% to 90%) had inflammatory shadow in chest films, majority had one lungfield shadow and minority with multi-lungfields, but some patients had normal films of chest X-ray (19.9%) and CT (9.1%). 10-15% patients liver and renal functions were abnormal. 13-16% patients with high values of creatinine kinase, but that of CK-MB was only 5.9%.

CONCLUSION: In early stage of SARS (1 to 3 days), almost all the patients get fever, some have the unspecific symptom, but the sign of catarrh and tumefaction of lymph nodes are rare. About one third patients have cough and 14.6% expectoration, and present mild hypoxemia, but usually lack the sign of lung. In 22.5% and 36.4% patients WBC and lymphocyte reduce, and also the mean counts of CD₃, CD₄ and CD₈ cells reduce significantly, the positive rates are more than 90%. About 80% (X-ray) to 90% (CT) patients show abnormal chest films in radiologic examination, but someones have the normal results of chest X-ray (19.9%) and CT (9.1%). About 10-16% patients suffer the damage of the liver, kidney and heart.

Influence of factors on production of IgG antibody in SARS patients

AIM: To study the affecting factors on the production of antibodies in SARS patients.

METHODS: In a total of 104 clinically diagnosed SARS patients, the relations among IgG antibody titer, patients age, duration and the dosage of cortiscosteroids therapy were investigated.

RESULTS: Eighty-three (79.8%) patients were positive for SARS-Cov antibody. The range of time for the occurrence of the antibody was 8 to 32 d; the percentage for the occurrence of the antibody in the periods of 0-7, 8-14, 22-28, 29-35, 36-42, 43-56 and 57-63 d were 0, 50% (21/42, 63.6%) 42/62, 73.3% (44/60), 88.1%(37/42), 81%(17/21), 92.6% (25/27) and 50% (2/4) respectively. The titer of antibody also increased from 0.14±0.05 in 0-7 d to 0.69±0.10 (43-56 d) and started to reduce after 8 wk. The positive percentage and titers of antibody grew when the dosage of cortiscosteroids was added. The positive percentage of antibody in severe patients and mild patients were 95.7% (22/23) and 75.3% (61/81) respectively, and the titers of antibody in the severe patients were higher than that of the mild patients (P > 0.05) and the same change was also found between 19-14 age group and 46-52 age group.

CONCLUSION: 79.8% of SARS patients are positive for SARS-Cov antibody. The positive percentage and the titer of antibody grow gradually while the duration prolongs, but declines after 8 wk. It is positively related to the clinical condition, but not affected by the dosage of cortiscosteroids and the age of the patient.

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Current status of severe acute respiratory syndrome in China

Severe acute respiratory syndrome (SARS), also called infectious atypical pneumonia, is an emerging infectious disease caused by a novel variant of coronavirus (SARS-associated coronavirus, SARS-CoV). It is mainly characterized by pulmonary infection with a high infectivity and fatality. SARS is swept across almost all the continents of the globe, and has currently involved 33 countries and regions, including the mainland China, Hong Kong, Taiwan, North America and Europe. On June 30, 2003, an accumulative total reached 8450 cases with 810 deaths. SARS epidemic was very rampant in March, April and May 2003 in the mainland of China and Hong Kong. Chinese scientists and healthcare workers cooperated closely with other scientists from all over the world to fight the disease. On April 16, 2003, World Health Organization (WHO) formally declared that SARS-CoV was an etiological agent of SARS. Currently, there is no specific and effective therapy and prevention method for SARS. The main treatments include corticosteroid therapy, anti-viral agents, anti-infection, mechanical ventilation and isolation. This disease can be prevented and controlled, and it is also curable. Under the endeavor of the Chinese Government, medical staffs and other related professionals, SARS has been under control in China, and Chinese scientists have also made a great contribution to SARS research. Other studies in developing new detection assays and therapies, and discovering new drugs and vaccines are in progress. In this paper, we briefly review the current status of SARS in China.

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SEVERE ACUTE RESPIRATORY SYNDROME

Severe acute respiratory syndrome (SARS) is a form of atypical pneumonia that apparently originated in Guangdong Province of the People’s Republic of China in late 2002. This first came to the world’s attention in late February 2003, and has since spread worldwide. As of June 23rd 2003, the disease had been reported from 32 countries or regions globally, affecting 8459 people; 805 individuals (9.5 % of the total affected) have died of the disease. A novel coronavirus, the SARS-associated coronavirus (SARS-CoV) has been found in various specimens taken from patients with SARS. Although there has been rapid development of tests to detect SARS Co-V, these tests presently have certain limitations. Definitions of suspected, confirmed and probable cases have been formulated. Measures currently used for the management of patients with SARS include isolation, ribavirin, corticosteroid therapy and mechanical ventilation. Unfortunately, almost 10 % of affected patients succumb to their illness, underlying the need for developing more effective therapy. It remains to be seen how long it will take to bring this epidemic under control.

Severe acute respiratory syndrome

Severe acute respiratory syndrome (SARS) is a form of atypical pneumonia that apparently originated in Guangdong Province of the People's Republic of China in late 2002. This first came to the world's attention in late February 2003, and has since spread worldwide. As of June 23rd 2003, the disease had been reported from 32 countries or regions globally, affecting 8459 people; 805 individuals (9.5 % of the total affected) have died of the disease. A novel coronavirus, the SARS-associated coronavirus (SARS- CoV) has been found in various specimens taken from patients with SARS. Although there has been rapid development of tests to detect SARS Co-V, these tests presently have certain limitations. Definitions of suspected, confirmed and probable cases have been formulated. Measures currently used for the management of patients with SARS include isolation, ribavirin, corticosteroid therapy and mechanical ventilation. Unfortunately, almost 10 % of affected patients succumb to their illness, underlying the need for developing more effective therapy. It remains to be seen how long it will take to bring this epidemic under control.