临床研究有关SARS的初步临床描述

MMWR Morb Mortal Wkly Rep 2003 Mar 28;52(12):255-6
Preliminary clinical description of severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) is a condition of unknown etiology that has been described in patients in Asia, North America, and Europe. This report summarizes the clinical description of patients with SARS based on information collected since mid-February 2003 by the World Health Organization (WHO), Health Canada, and CDC in collaboration with health authorities and clinicians in Hong Kong, Taiwan, Bangkok, Singapore, the United Kingdom, Slovenia, Canada, and the United States. This information is preliminary and limited by the broad and necessarily nonspecific case definition.


在加拿大确认SARS
N Engl J Med 2003 Apr 10; [epub ahead of print]

Identification of Severe Acute Respiratory Syndrome in Canada.

Poutanen SM, Low DE, Henry B, Finkelstein S, Rose D, Green K, Tellier R, Draker R, Adachi D, Ayers M, Chan AK, Skowronski DM, Salit I, Simor AE, Slutsky AS, Doyle PW, Krajden M, Petric M, Brunham RC, McGeer AJ.

Background Severe acute respiratory syndrome (SARS) is a condition of unknown cause that has recently been recognized in patients in Asia, North America, and Europe. This report summarizes the initial epidemiologic findings, clinical description, and diagnostic findings that followed the identification of SARS in Canada. Methods SARS was first identified in Canada in early March 2003. We collected epidemiologic, clinical, and diagnostic data from each of the first 10 cases prospectively as they were identified. Specimens from all cases were sent to local, provincial, national, and international laboratories for studies to identify an etiologic agent. Results The patients ranged from 24 to 78 years old; 60 percent were men. Transmission occurred only after close contact. The most common presenting symptoms were fever (in 100 percent of cases) and malaise (in 70 percent), followed by nonproductive cough (in 100 percent) and dyspnea (in 80 percent) associated with infiltrates on chest radiography (in 100 percent). Lymphopenia (in 89 percent of those for whom data were available), elevated lactate dehydrogenase levels (in 80 percent), elevated aspartate aminotransferase levels (in 78 percent), and elevated creatinine kinase levels (in 56 percent) were common. Empirical therapy most commonly included antibiotics, oseltamivir, and intravenous ribavirin. Mechanical ventilation was required in five patients. Three patients died, and five have had clinical improvement. The results of laboratory investigations were negative or not clinically significant except for the amplification of human metapneumovirus from respiratory specimens from five of nine patients and the isolation and amplification of a novel coronavirus from five of nine patients. In four cases both pathogens were isolated. Conclusions SARS is a condition associated with substantial morbidity and mortality. It appears to be of viral origin, with patterns suggesting droplet or contact transmission. The role of human metapneumovirus, a novel coronavirus, or both requires further investigation.

Notice: Because of possible public health implications, this article was
published at www.nejm.org on March 31, 2003. It will appear in the May 15 issue of the Journal. Click on "PDF of this article" for the full text. Copyright 2003 Massachusetts Medical Society