Use of quarantine to prevent transmission of severe acute respiratory syndrome--Taiwan, 2003.
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On July 5, 2003, Taiwan was removed from the World Health Organization (WHO) list of severe acute respiratory syndrome (SARS)-affected countries. As of July 9, a total of 671 probable cases of SARS had been reported in Taiwan. On February 21, the first identified SARS patient in Taiwan returned from travel to Guangdong Province, mainland China, by way of Hong Kong. Initial efforts to control SARS appeared to be effective; these efforts included isolation of suspect and probable SARS patients, use of personal protective equipment (PPE) for health-care workers (HCWs) and visitors, and quarantine of contacts of known SARS patients. However, beginning in mid-April, unrecognized cases of SARS led to a large nosocomial cluster and subsequent SARS-associated coronavirus transmission to other health-care facilities and community settings. In response to the growing epidemic, additional measures were taken to limit nosocomial and community transmission of SARS, including more widespread use of quarantine. By the end of the epidemic, 131,132 persons had been placed in quarantine, including 50,319 close contacts of SARS patients and 80,813 travelers from WHO-designated SARS-affected areas. This report describes the quarantine measures used in Taiwan and discusses the need for further evaluation of quarantine and other control measures used to prevent SARS. (+info)
Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS).
(66/980)
BACKGROUND: Severe acute respiratory syndrome (SARS) was diagnosed in Hong Kong in over 1700 patients between March and early June 2003. METHODS: 115 patients diagnosed with SARS were admitted to Queen Elizabeth Hospital, a large regional hospital in Hong Kong, from March 2003, of whom 100 were either discharged or were dead at 31 May. The patients were prospectively studied after admission to assess their short term outcomes and the risk factors associated with adverse outcomes, defined as death or the need for mechanical ventilation RESULTS: At the time of writing 18 patients had died, with a crude mortality rate of 15.7% and a 21 day mortality of 10% (standard error 3%). Thirty nine patients (34%) were admitted to the intensive care unit, 30 of whom (26%) required mechanical ventilation. Multivariate analysis showed that age above 60 (hazards ratio (HR) 3.5, 95% CI 1.2 to 10.2; p=0.02), presence of diabetes mellitus or heart disease (HR 9.1, 95% CI 2.8 to 29.1; p<0.001), and the presence of other comorbid conditions (HR 5.2, 95% CI 1.4 to 19.7; p=0.01) were independently associated with mortality. However, only the presence of diabetes mellitus and/or cardiac disease (HR 7.3, 95% CI 3.1 to 17.4; p<0.001) was associated with adverse outcomes as a whole. CONCLUSION: SARS is a new disease entity that carries significant morbidity and mortality. Specific clinical and laboratory parameters predicting unfavourable outcomes have been identified. (+info)
The chest X-ray image features of patients with severe SRAS: a preliminary study.
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OBJECTIVE: To study the chest X-ray image features of patients with severe SARS. METHODS: Chest X-ray image features in 36 patients with severe SARS were retrospectively analyzed. The image characteristics were compared with those of 224 patients with common SARS. RESULTS: The important chest X-ray imaging features of 36 patients with severe SARS included small patch of infiltration (n = 27, 75.0%), large patch of infiltration (n = 22, 61.1%), large area of lung consolidation (n = 10, 27.3%), interstitial lung lesion (n = 26, 72.2%), ground-glass shadow (n = 28, 77.8%), irregular linear opacity (n = 15, 41.7%), diffuse lung lesion (n = 12, 33.3%), with single lung involved (n = 9, 25.0%), and both lungs involved (n = 32, 88.9%). The rates of large patch of infiltration, large area of lung consolidation, ground-glass shadow, diffuse lung lesion and involvement of both lungs in patients with severe SARS were significantly higher than those in patients with common type of SARS (all P < 0.01). Out of the 11 severe SARS patients who died, nine had large area of ground-glass shadow with air bronchogram in both lungs before death. CONCLUSIONS: Large patch of infiltration, large area of consolidation, ground-glass shadow, diffuse lung lesion and involvement of both lungs were the main X-ray image characteristics of patients with severe SARS. Large area of ground-glass shadow with air bronchogram in both lungs indicated a bad prognosis. (+info)
Chest X-ray imaging of patients with SARS.
(68/980)
OBJECTIVE: To investigate the chest X-ray manifestations of SARS cases. METHODS: A retrospective study was conducted among 52 clinically confirmed SARS patients from February 9 to May 10, 2003. Chest X-ray scanning was performed at a interval of 1 - 3 days according to the requirements. The manifestations and special features of SARS in X-ray were analyzed. RESULTS: Small or large patchy shadows with intensive density in both lungs were observed in 31 cases, ground-glass like opacification in 16, small patchy shadows in one lung lobe or one lung segment in 18, nodular shadows in one lung segment in 1, and increased lung marking in lung interstitial tissues in 2. Rapidly changing consolidations revealed in chest X-ray images were found to be associated with SARS infections, and they were not affected by treatment with antibiotics. CONCLUSION: Chest X-ray provides a sensitive and specific method for the diagnosis and treatment of SARS, and those present with symptoms and signs should undergo chest X-ray scanning every 1 - 3 days. (+info)
Pathological study on severe acute respiratory syndrome.
(69/980)
OBJECTIVE: To study the pathological characteristics of severe acute respiratory syndrome (SARS) and its relationship to clinical manifestation. METHODS: Tissue specimens from 3 autopsies of probable SARS cases were studied by microscope, and the clinical data was reviewed. RESULTS: The typical pathological changes of lungs were diffuse hemorrhaging on the surface. A combination of serous, fibrinous and hemorrhagic inflammation was seen in most of the pulmonary alveoli with the engorgement of capillaries and detection of micro-thrombosis in some of these capillaries. Pulmonary alveoli thickened with interstitial mononuclear inflammatory infiltrates, suffered diffuse alveolar damage, experienced desquamation of pneumocytes and had hyaline-membrane formation, fibrinoid materials, and erythrocytes in alveolar spaces. There were thromboembolisms in some bronchial arteries. Furthermore, hemorrhagic necrosis was also evident in lymph nodes and spleen with the attenuation of lymphocytes. Other atypical pathological changes, such as hydropic degeneration, fatty degeneration, interstitial cell proliferation and lesions having existed before hospitalization were observed in the liver, heart, kidney and pancreas. CONCLUSION: Severe damage to the pulmonary and immunological systems is responsible for the clinical features of SARS and may lead to the death of patients. (+info)
The relationship between serum interleukins and T-lymphocyte subsets in patients with severe acute respiratory syndrome.
(70/980)
OBJECTIVES: To observe the changes of serum interleukins (IL), T-lymphocyte subsets, and white blood cell (WBC) count in patients with severe acute respiratory syndrome (SARS), and to investigate the relationship between injured immune function, immune response and disturbed immune adjustment in SARS patients. METHODS: The levels of serum IL-2, IL-10, IL-12 and T-lymphocyte subset counts were measured in 35 clinically diagnosed SARS patients by using enzyme linked immunosorbant assay (ELISA). The relationship between the measured results and WBC count was further analyzed. RESULTS: The level of serum IL was increased to a great extent in the 35 SARS patients, and the levels of serum IL-2, IL-10 and IL-12 were 242.53 (92.69) pg/ml, 77.43 (63.37) pg/ml and 65.94 (43.21) pg/ml, respectively. The level of serum IL-2 increased markedly (P < 0.01). The peripheral blood CD(3)(+), CD(4)(+) and CD(8)(+) counts were lower than normal in 23 patients (67.7%), 26 patients (74.3%) and 15 patients (42.9%), respectively. The peripheral blood WBC counts were lower than 4.0 x 10(9)/L in 10 patients, and their CD(3)(+), CD(4)(+) and CD(8)(+) counts were 583.90 (315.58) x 10(6)/L, 272.00 (94.13) x 10(6)/L and 209.00 (72.21) x 10(6)/L, respectively. The peripheral blood WBC counts were (4.0 - 10.0) x 10(9)/L in 20 patients, and their CD(3)(+), CD(4)(+) and CD(8)(+) counts were 700.00 (502.96) x 10(6)/L, 347.00 (247.58) x 10(6)/L and 322.05 (228.47) x 10(6)/L, respectively. The peripheral blood WBC counts were higher than 10.0 x 10(9)/L in 5 patients, and their CD(3)(+), CD(4)(+) and CD(8)(+) counts were 1466.00 (630.86) x 10(6)/L, 783.00 (311.14) x 10(6)/L and 640.00 (294.40) x 10(6)/L, respectively. The decreased CD(3)(+), CD(4)(+) and CD(8)(+) counts were consistent with the decreased WBC counts. The level of IL in SARS patients was significantly higher than that in patients with chronic hepatitis B (P < 0.01). CONCLUSIONS: The level of serum IL is closely related to cell immunity in SARS patients. The level of serum IL is increased evidently while CD(3)(+), CD(4)(+) and CD(8)(+) counts decrease. Both serum IL and CD are associated with injury of immune function, and thus they could be regarded as a monitoring index for judging the condition of SARS patients and prescribing immune therapy. (+info)
Rapid loss of both CD4+ and CD8+ T lymphocyte subsets during the acute phase of severe acute respiratory syndrome.
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OBJECTIVE: To study the alteration of peripheral lymphocyte subsets in severe acute respiratory syndrome (SARS) patients and to help improve the early diagnosis of the disease. METHODS: Anti-coagulating blood samples from 98 SARS patients in the acute phase, 56 normal healthy blood donors, and from patients infected by HIV, CMV and EBV were collected. The T lymphocyte subsets were counted by flow cytometry using fluorescence-labeled specific monoclonal antibodies. RESULTS: A significant decrease was observed in all SARS patients in their peripheral CD4(+) and CD8(+) T lymphocyte absolute counts [256 (104) x 10(6)/L and 256 (117) x 10(6)/L, respectively], which were also lower than those of the patients infected with HIV, CMV and EBV. All patients infected with HIV, CMV and EBV had significantly higher CD8(+) T lymphocyte counts in comparison with normal controls. CONCLUSIONS: Decrease of both CD4(+) and CD8(+) T lymphocytes of patients is related to onset of SARS. T lymphocyte subset analysis would help improve the early diagnosis of the disease. (+info)
Establishment of a fluorescent polymerase chain reaction method for the detection of the SARS-associated coronavirus and its clinical application.
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OBJECTIVE: To establish a fluorescent polymerase chain reaction (F-PCR) method for detecting the coronavirus related to severe acute respiratory syndrome (SARS) and to evaluate its value for clinical application. METHODS: The primers and the fluorescence-labeled probe were designed and synthesized according to the published sequence of the SARS-associated coronavirus genes. A F-PCR diagnosis kit for detecting the coronavirus was developed, and 115 clinical nasopharyngeal gargling liquid samples were tested. RESULTS: The sequence of PCR amplified products completely matched the related sequence of the SARS-associated coronavirus genome. Forty-nine out of 67 samples from identified SARS patients and 8 of 18 samples from persons having close contact with SARS patients showed positive results. All 30 samples from healthy controls were negative. CONCLUSION: The F-PCR method established may be a rapid, accurate and efficient way for screening and for the early diagnosis of SARS patients. (+info)