Identification of severe acute respiratory syndrome in Canada
Identification of severe acute respiratory syndrome in Canada
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DOI：
10.1056/nejmoa030634
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发表时间：
2003-05-15
影响因子：
158.5
通讯作者：
McGeer, AJ
中科院分区：
文献类型：
--
作者：
Poutanen, SM;Low, DE;McGeer, AJ
严重急性呼吸系统综合征（SARS）是一种病因不明的疾病，最近在亚洲、北美和欧洲的患者中被发现。这份报告总结了最初的流行病学调查结果，临床描述，并随后在加拿大SARS的识别诊断结果。METHODSSARS首次确定在加拿大于2003年3月初。我们前瞻性地收集了前10例病例的流行病学、临床和诊断数据。所有病例的标本被送往当地、省、国家和国际实验室进行研究，以确定病原体。只有在密切接触后才会传播。最常见的表现症状是发热（100%）和不适（70%），其次是干咳（100%）和呼吸困难（80%），与胸部X线片上的浸润有关（100%）。淋巴细胞减少症（89%的数据可用），乳酸脱氢酶水平升高（80%），天冬氨酸转氨酶水平升高（78%）和肌酐激酶水平升高（56%）是常见的。经验性治疗最常见的包括抗生素、奥司他韦和静脉注射利巴韦林。5例患者需要机械通气。3名患者死亡，5名患者临床症状改善。实验室检查结果均为阴性或无临床意义，但9名患者中有5名患者的呼吸道标本中的人偏肺病毒扩增，以及9名患者中有5名患者的新型冠状病毒分离和扩增。在4例中，两种病原体均被分离。它似乎是病毒来源，模式表明飞沫或接触传播。人类偏肺病毒、一种新型冠状病毒或两者的作用需要进一步研究。
BACKGROUNDSevere acute respiratory syndrome (SARS) is a condition of unknown cause that has recently been recognized in patients in Asia, North America, and Europe. This report summarizes the initial epidemiologic findings, clinical description, and diagnostic findings that followed the identification of SARS in Canada.METHODSSARS was first identified in Canada in early March 2003. We collected epidemiologic, clinical, and diagnostic data from each of the first 10 cases prospectively as they were identified. Specimens from all cases were sent to local, provincial, national, and international laboratories for studies to identify an etiologic agent.RESULTSThe patients ranged from 24 to 78 years old; 60 percent were men. Transmission occurred only after close contact. The most common presenting symptoms were fever (in 100 percent of cases) and malaise (in 70 percent), followed by nonproductive cough (in 100 percent) and dyspnea (in 80 percent) associated with infiltrates on chest radiography (in 100 percent). Lymphopenia (in 89 percent of those for whom data were available), elevated lactate dehydrogenase levels (in 80 percent), elevated aspartate aminotransferase levels (in 78 percent), and elevated creatinine kinase levels (in 56 percent) were common. Empirical therapy most commonly included antibiotics, oseltamivir, and intravenous ribavirin. Mechanical ventilation was required in five patients. Three patients died, and five have had clinical improvement. The results of laboratory investigations were negative or not clinically significant except for the amplification of human metapneumovirus from respiratory specimens from five of nine patients and the isolation and amplification of a novel coronavirus from five of nine patients. In four cases both pathogens were isolated.CONCLUSIONSSARS is a condition associated with substantial morbidity and mortality. It appears to be of viral origin, with patterns suggesting droplet or contact transmission. The role of human metapneumovirus, a novel coronavirus, or both requires further investigation.