A cluster of cases of severe acute respiratory syndrome in Hong Kong
A cluster of cases of severe acute respiratory syndrome in Hong Kong
复制标题
DOI：
10.1056/nejmoa030666
复制
发表时间：
2003-05-15
影响因子：
158.5
通讯作者：
Lai, KN
中科院分区：
文献类型：
--
作者：
Tsang, KW;Ho, PL;Lai, KN
[背景]有关严重急性呼吸综合征(SARS)临床特征的信息将对护理疑似SARS患者的医生有价值。方法我们摘录了2003年2月22日至2003年3月22日在香港的医院确诊的10例SARS患者的临床表现和病程数据，其中5名男性和5名女性年龄在38岁到72岁之间。潜伏期为2~11天。所有患者都有发热(体温38摄氏度，持续24小时以上)，大多数患者表现为僵硬、干咳、呼吸困难、乏力、头痛和低氧血症。身体检查发现胸部有爆裂和敲击迟钝。在9名患者中观察到淋巴细胞减少，大多数患者的转氨酶水平轻度升高，但血清肌酐水平正常。连续胸片显示进行性空隙疾病。两名患者死于进行性呼吸衰竭；他们的肺部组织学分析显示弥漫性肺泡损伤。没有肺炎支原体、肺炎衣原体或嗜肺军团菌感染的证据。所有患者在症状出现后平均(+/-SD)9.6+/-5.42天接受糖皮质激素和利巴韦林治疗，8例患者早期使用β-内酰胺类药物和大环内酯类药物联合治疗4+/-1.9天，均无临床或放射学疗效。发烧伴随着快速进行性的呼吸损害是该综合征得名的关键体征和症状复合体。SARS的微生物学起源仍不清楚。
BACKGROUNDInformation on the clinical features of the severe acute respiratory syndrome (SARS) will be of value to physicians caring for patients suspected of having this disorder.METHODSWe abstracted data on the clinical presentation and course of disease in 10 epidemiologically linked Chinese patients (5 men and 5 women 38 to 72 years old) in whom SARS was diagnosed between February 22, 2003, and March 22, 2003, at our hospitals in Hong Kong, China.RESULTSExposure between the source patient and subsequent patients ranged from minimal to that between patient and health care provider. The incubation period ranged from 2 to 11 days. All patients presented with fever (temperature, >38 degreesC for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed crackles and percussion dullness. Lymphopenia was observed in nine patients, and most patients had mildly elevated aminotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive air-space disease. Two patients died of progressive respiratory failure; histologic analysis of their lungs showed diffuse alveolar damage. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy a mean (+/-SD) of 9.6+/-5.42 days after the onset of symptoms, and eight were treated earlier with a combination of beta-lactams and macrolide for 4+/-1.9 days, with no clinical or radiologic efficacy.CONCLUSIONSSARS appears to be infectious in origin. Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name. The microbiologic origins of SARS remain unclear..