Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study.
Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study.
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DOI：
10.1016/s0140-6736(03)13412-5
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发表时间：
2003-05-24
期刊：
影响因子：
--
通讯作者：
HKU/UCH SARS Study Group
中科院分区：
文献类型：
--
作者：
Peiris JS;Chu CM;Cheng VC;Chan KS;Hung IF;Poon LL;Law KI;Tang BS;Hon TY;Chan CS;Chan KH;Ng JS;Zheng BJ;Ng WL;Lai RW;Guan Y;Yuen KY;HKU/UCH SARS Study Group
我们调查了一起社区暴发的严重急性呼吸系统综合征（SARS）的临床、放射学和病毒学变化的时间进展。我们对75例患者进行了为期3周的随访，采用利巴韦林和皮质类固醇的标准治疗方案，并评估了临床疾病的模式、病毒载量、不良临床结果的危险因素以及病毒学诊断方法的有效性。发热和肺炎最初得到改善，但64例（85%）患者在平均8.9 （SD 3.1）天后出现复发性发热，55例（73%）患者在7.5（2.3）天后出现水样腹泻，60例（80%）患者在7.4（2.2）天后放射学恶化，34例（45%）患者在8.6（3.0）天后呼吸道症状恶化。在34例（45%）患者中，初始肺部病变的改善与其他部位新放射学病变的出现有关。第3周出现自发性纵隔气肿9例（12%），急性呼吸窘迫综合征（ARDS） 15例（20%）。14例患者（4例合并急性呼吸窘迫综合征）鼻咽分泌物定量逆转录酶（RT） PCR结果显示，第10天病毒载量达到峰值，第15天病毒载量低于入院时。年龄和拉米夫定治疗的慢性乙型肝炎病毒感染是进展为ARDS的独立显著危险因素（p=0.001）。在第14天，67例患者中有65例（97%）在粪便中发现了与sars相关的冠状病毒。平均到血清转化时间为20天。一致的临床进展、转移的放射学浸润和倒V病毒载量谱表明，第2周的恶化与不受控制的病毒复制无关，但可能与免疫病理损伤有关。2003年5月9日在线发布http://image.thelancet.com/extras/03art4432web.pdf
We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS). We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods. Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8.9 (SD 3.1) days, 55 (73%) had watery diarrhoea after 7.5 (2.3) days, 60 (80%) had radiological worsening after 7.4 (2.2) days, and respiratory symptoms worsened in 34 (45%) after 8.6 (3.0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3. Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission. Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0.001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at day 14. The mean time to seroconversion was 20 days. The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage. Published online May 9, 2003 http://image.thelancet.com/extras/03art4432web.pdf
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DOI：
10.1016/s0140-6736(03)13077-2
发表时间：
2003-04-19
期刊：
Lancet (London, England)
影响因子：
--
作者：
Peiris JS;Lai ST;Poon LL;Guan Y;Yam LY;Lim W;Nicholls J;Yee WK;Yan WW;Cheung MT;Cheng VC;Chan KH;Tsang DN;Yung RW;Ng TK;Yuen KY;SARS study group
通讯作者：
SARS study group
影响因子：
2.6
作者：
OLLIFF, JFC;WILLIAMS, MP
通讯作者：
WILLIAMS, MP
影响因子：
6.4
作者：
TURNER, RB;FELTON, A;MESCHIEVITZ, CK
通讯作者：
MESCHIEVITZ, CK
影响因子：
8.8
作者：
KNAUS, WA;DRAPER, EA;ZIMMERMAN, JE
通讯作者：
ZIMMERMAN, JE
DOI：
10.1165/rcmb.4891
发表时间：
2003-02-01
影响因子：
6.4
作者：
Majeski, EI;Harley, RA;London, L
通讯作者：
London, L