The spectrum of severe acute respiratory syndrome-associated coronavirus infection
The spectrum of severe acute respiratory syndrome-associated coronavirus infection
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DOI：
10.7326/0003-4819-140-8-200404200-00008
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发表时间：
2004-04-20
影响因子：
39.2
通讯作者：
Cameron, P
中科院分区：
文献类型：
--
作者：
Rainer, TH;Chan, PKS;Cameron, P
背景：严重急性呼吸综合征（SARS）是否出现亚临床或非典型表现，以及临床判断在检测 SARS 时是否准确尚不清楚。目的：描述大规模暴发中 SARS 冠状病毒感染的谱系，并将基于临床判断的诊断与 SARS 冠状病毒测试进行比较。设计：对前瞻性收集的临床数据和存档血清进行二次分析。设置：A 香港新界一所大学医院的SARS筛查诊所。患者：2003年3月12日至2003年5月12日期间到诊所就诊的1221名患者。测量：SARS冠状病毒血清学。结果：553名患者中有145名（26%）有SARS冠状病毒感染的血清学证据。在 910 名无需住院治疗的患者中，只有 6 名有 SARS 血清学证据。六名患者中有五名胸片正常，四名患者出现肌痛、发冷、咳嗽和发烧等症状。以 SARS 冠状病毒血清学检测为金标准，住院时临床诊断疑似 SARS 的敏感性为 0.96（95% Cl，0.91 至 0.98），特异性为 0.96（Cl，0.92 至 0.97）。 局限性：几乎一半的患者因拒绝进一步检测而未能获得后续血清学样本。社区中一些被感染但症状较轻或没有症状的人可能没有去过诊所。结论：几乎没有证据表明存在广泛的亚临床或轻度 SARS 冠状病毒感染。疫情爆发期间的临床诊断是合理的，并进行了适当的分诊。
Background: Whether subclinical or atypical presentations of severe acute respiratory syndrome (SARS) occur and whether clinical judgment is accurate in detecting SARS are unknown.Objectives: To describe the spectrum of SARS coronavirus infection in a large outbreak and to compare diagnoses based on clinical judgment with the SARS coronavirus test.Design: Secondary analysis of prospectively collected clinical data and archived serum.Setting: A SARS screening clinic of a university hospital in the New Territories of Hong Kong.Patients: 1221 patients attending the clinic between 12 March 2003 and 12 May 2003.Measurements: SARS coronavirus serology.Results: 145 of 553 (26%) patients had serologic evidence of SARS coronavirus infection. Of 910 patients who were managed without hospitalization, only 6 had serologic evidence of SARS. Five of the six patients had normal chest radiographs, and four had symptoms such as myalgia, chills, coughing, and feeling feverish. With the SARS coronavirus serologic test as the gold standard, the clinical diagnosis of probable SARS at hospitalization had a sensitivity of 0.96 (95% Cl, 0.91 to 0.98) and a specificity of 0.96 (Cl, 0.92 to 0.97).Limitations: Follow-up serologic samples were not obtained from almost half of the patients because they declined further testing. Some people living in the community who were infected but who had minor or no symptoms might not have visited the clinic.Conclusions: There is little evidence of widespread subclinical or mild forms of SARS coronavirus infection. Clinical diagnoses during the outbreak were reasonable and resulted in appropriate triaging.