Severe acute respiratory syndrome

Severe acute respiratory syndrome (SARS) is a viral respiratory infection that can progress to pneumonia and, eventually, death. The disease was first recognized in 2003 with outbreaks in China, Canada, Singapore, Taiwan, and Vietnam, with other countries — including the United States — reporting smaller numbers of cases.

Causes

SARS is caused by the SARS-associated coronavirus (SARS-CoV). Coronaviruses are a common cause of mild respiratory illnesses in humans, but researchers believe that a virus may have mutated, allowing it to cause this potentially life-threatening disease.

Close contact with a person who’s infected with SARS, including contact with infectious aerosolized droplets or body secretions, is the method of transmission. Most people who contracted the disease during the 2003 outbreak contracted it during travel to endemic areas. However, the virus has been found to live on hands, tissues, and other surfaces for up to 6 hours in its droplet form. It has also been found to live in the stool of people with SARS for up to 4 days. The virus may be able to live for months or years in below-freezing temperatures.

Signs and symptoms

The incubation period for SARS is typically 3 to 5 days but may last as long as 14 days. Initial signs and symptoms include fever, shortness of breath and other minor respiratory symptoms, general discomfort, headache, rigors, chills, myalgia, sore throat, and dry cough. Some individuals may develop diarrhea or a rash. Later complications include respiratory failure, liver failure, heart failure, myelodysplastic syndromes, and death.

Diagnosis

Diagnosis of severe respiratory illness is made when the patient has a fever greater than 100.4° F (38° C) or upon clinical findings of lower respiratory illness and a chest X-ray demonstrating pneumonia or acute respiratory distress syndrome.

Laboratory validation for the virus includes cell culture of SARS-CoV, detection of SARS-CoV ribonucleic acid by the reverse transcription polymerase chain reaction (PCR) test, or detection of serum antibodies to SARS-CoV. Detectable levels of antibodies may not be present until 21 days after the onset of illness, but some individuals develop antibodies within 14 days. A negative PCR, antibody test, or cell culture doesn’t rule out the diagnosis.

Treatment

Treatment is symptomatic and supportive and includes maintenance of a patent airway and adequate nutrition. Other treatment measures include supplemental oxygen, chest physiotherapy, or mechanical ventilation. In addition to standard precautions, contact precautions requiring gowns and gloves for all patient contacts and airborne precautions utilizing a negative-pressure isolation room and properly fitted N-95 respirators are recommended for patients who are hospitalized. Quarantine may be used to prevent the spread of infection.

Antibiotics may be given to treat bacterial causes of atypical pneumonia. Antiviral medications have also been used. High doses of corticosteroids have been used to reduce lung inflammation. In some serious cases, serum from individuals who have already recovered from SARS (convalescent serum) has been given. The general benefit of these treatments hasn’t been determined conclusively.

Special considerations

❑ Report suspected cases of SARS to local and national health organizations.

❑ Frequently monitor the patient’s vital signs and respiratory status.

❑ Maintain isolation as recommended. The patient will need emotional support to deal with anxiety and fear related to the diagnosis of SARS and as a result of isolation.

❑ Provide patient and family teaching, including the importance of frequent hand washing, covering the mouth and nose when coughing or sneezing, and avoiding close personal contact while infected or potentially infected. Instruct the patient and his family that such items as eating utensils, towels, and bedding shouldn’t be shared until they have been washed with soap and hot water and that disposable gloves and household disinfectant should be used to clean any surface that may have been exposed to the patient’s body fluids.

❑ Emphasize to the patient the importance of not going to work, school, or other public places, as recommended by the health care provider.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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