| BackgroundInfectious atypical pneumonia was first reported on November 16, 2002 in Guangdong province, China. It was named severe acute respiratory syndrome (SARS) by World Health Organization (WHO) and has spread throughout more than thirty countries and regions around the world, and seriously endangered the people's health. The cumulative number of reported cases of SARS has been up to 8089 and that of the death cases up to 774 by September 26, 2003 globally. In China, the relevant numbers were 5327 and 349 in mainland of China, 1755 and 299 in Hong Kong, 346 and 37 in Taiwan, respectively. There were 4 imported SARS cases in Hangzhou, Zhejiang Province, of whom one died. SARS is a acute, severe, highly contagious disease with high mortality. Three cases of SARS were retrospectively analysed to improve the recognition and management of SARS.Materials and methods1. MaterialsA clinical investigation was conducted on three SARS cases referred to the Zhejiang Province between April 19, 2003 and June 17, 2003. Epidemiology, clinical data, laboratory results and chest radiology were studied. All patients reported here were infected with SARS-associated coronavirus (SARS-CoV) by the same source. Patient 1 (male, 48-year-old) , patient 2 (female, 53-year-old) and patient 3 (female, 49-year-old) were 3 of 6 members of a family, without underlying diseases, and were clinically diagnosed according to the SARS diagnostic criterion issued by China's Ministry of Health.2. MethodsThe patients were isolated for treatment. Hemogram, blood biochemistry, blood gas analysis, chest radiograph, sputum culture and blood culture were analysed at one day's or two days' intervals after admission in advanced stage. At the same time, 5ml anti-coagulating venous blood samples were collected from the three patients to detect pathogen on the same day and at two days interval after admission. Reverse transcription-ploymerase chain reaction (RT-PCR) was used to quantify the SARS-Co V RNA in peripheral blood mononuclear cells (PBMC) , and the level of sepecific anti-SARS IgM and IgG were detected by enzyme-linked immunosorbent assay (ELISA). Tissue specimens of one dead case were obtained by percutaneous transthoracic needle biopsy to conduct pathological histology. Chest CT scan and pulmonary function testwere conducted at regular intervals after patients being discharged from hospital.ResultsBased on the results of epidemiological investigation, the latency in 3 patients was five days. The onset symptom was high fever in all patients, with shortness of breath and non-productive cough, without catarrh symptom or diarrhea. The initial count of leukocyte was normal or decreased, and the level of serum alanine aminotransferase (ALT) was elevated. After the 15th day of the course the patient's sputum culture was available. The SARS-CoV RNA in PBMC was detected within 1-13 days after onset of the disease, and the serum viral antibodies were not detectable until the seventh day of the course. In the early phase of SARS, the main abnormal appearance was single or bilateral localized patchy clouding opacity on roentgenography, which progressed and expanded very rapidly. Five days later, patients experienced diffuse pathological changes in both lungs similar to those seen with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) . With artificial ventilation, glucocorticoid , and antibiotics therapy, etc., two patients had a clinical recovery while the other patient died. Histopathological examination of one death patient showed that alveolar edema, hyaline-membrane formation in some alveoli spaces, apparent fibrinous exudation within the alveolar cavity, and proliferation of type II epithelial cells of alveoli in the lungs. Dynamic follow-up observation to two SARS patients in recovery stage on chest CT scanning and pulmonary function test showed extensive lung fibrosis, restrictive ventilation disturbance and diffusion disturbance.ConclusionSARS is a acute onset, rapidly progressive and critica...
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