Sars

SEVERE ACUTE RESPIRATORY SYNDROME
(SARS)
- Communicable Viral disease caused by a new strain of
corona virus which differs considerably in genetic structure
of previously discovered corona virus.
- Most common symptoms are fever, malaise, chills,
myalgia, dizziness, cough, sore throat and running nose.
- Chest X-ray findings typically begin with a small, unilateral
patchy shadowing, and progress over 1-2 days to become
bilateral and generalized, with interstitial/confluent
infiltration.
- The incubation period has been estimated to be 2 to 7
days, commonly 3 to 5 days.
MODE OF TRANSMISSION:
 Direct or indirect contact of mucous membrane of eyes, nose or mouth

with respiratory droplets or fomites.
 Use of aerosol-generating procedures(Like nebulization) in hospitals.
 Virus is shed in stools but role of faecal-oral transmission in unknown.
 The natural reservoir is horseshoe bat.
 The virus can survive for hours on common surfaces outside the human
body and at least 24 hours on a plastic surface.
Case definition for notification of SARS under the
International Health Regulation (2005):
- A notifiable case of SARS is defined as an individual with

laboratory confirmation of infection with SARS coronavirus
(SARSCoV) who either fulfils the clinical case definition of SARS or
has worked in a laboratory handling live SARS-CoV or storing
clinical specimens infected with SARS-CoV.
Clinical case definition of SARS
1. A history of fever, or documented fever
AND
2. One or more symptoms of lower respiratory tract illness (cough,

difficulty in breathing, shortness of breath)
AND
3. Radiographic evidence of lung infiltrates consistent with

pneumonia or acute respiratory distress syndrome (ARDS) or autopsy
findings consistent with the pathology of pneumonia or ARDS
without an identifiable cause
AND
4. No alternative diagnosis fully explaining the illness.

Diagnostic tests required for laboratory
confirmation of SARS:
(a) Conventional reverse transcriptase PCR (RT-PCR) and
real-time reverse transcriptase PCR (real-time RT-PCR)
assay detecting viral RNA present in:
1. At least 2 different clinical specimens (e.g. nasopharyngeal and stool

specimens)
OR
2. The same clinical specimen collected on 2 or more occasions during
the course of the illness (e.g. sequential nasopharyngeal aspirates)
OR
3. A new extract from the original clinical sample tested positive by 2
different assays or repeat RT-PCR or real-time RT-PCR on each occasion of
testing
OR
4. Virus culture from any clinical specimen.
(b) Enzyme-linked immunosorbent assay (ELISA) and

immunofluorescent assay (IFA)
1. Negative antibody test on serum collected during the acute phase of illness,
followed by positive antibody test on convalescent-phase serum, tested
simultaneously
OR
2. A 4-fold or greater rise in antibody titre against SARS-CoV between an acute-
phase serum specimen and a convalescent-phase serum specimen (paired
sera) , tested simultaneously.
 In the absence of known SARS-CoV transmission to humans, the positive predictive

value of a SARS-CoV diagnostic test is extremely low; therefore, the diagnosis should
be independently verified in one or more WHO international SARS reference and
verification network laboratories. Every single case of SARS must be reported to
WHO.
EPIDEMOLOGICAL ASPECT:
Health Care workers especially those involved in procedures

generating aerosols – account for 21 percent of all cases,
Maximum virus excretion from the respiratory tract occurs on
about day 10 of illness and the declines.
Children are rarely affected by SARS.
International flights have been associated with the transmission of
SARS from symptomatic probable cases to passengers or crew.
COMPLICATIONS:
Pulmonary decompensation is the most feared promblem

Sequelae of intensive care include infection with nosocomial
pathogens, tension pneumothorax from ventilation at high peak
pressures, and non cardiogenic pulmonary edema.
TREATMENT:
Intensive care is required.
Number of different agents like Ribavirin (400-600 mg/d and 4
g/d), lopinavir/ritonavir (400 mg/100 mg). interferon type 1,
intravenous immunoglobulin, and systemic cortiocosteroids were
used to treat SARS patients during the 2003 epidemic.
Subsequent studies with ribavirin show no activity against the
virus in vitro, and a retrospective analysis of the epidemic in
Toronto suggests worse outcomes in patients who receive the drug.
Prevention:
As there is no vaccine against SARS, the preventive measures for SARS
control are appropriate detection and protective measures which include:
1. Prompt identification of persons with SARS, their
movements and contacts;
2. Effective isolation of SARS patients in hospitals;
3. Appropriate protection of medical staff treating these
patients;
4. Comprehensive identification and isolation of
suspected SARS cases;
5. Simple hygienic measures such as hand-washing after
touching patients, use of appropriate and well-fitted masks,
and introduction of infection control measures;
6. Exit screening of international travellers;
7. Timely and accurate reporting and sharing of
information with other authorities and/or governments.

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SEVERE ACUTE RESPIRATORY SYNDROME

 Direct or indirect contact of mucous membrane of eyes, nose or mouth

- A notifiable case of SARS is defined as an individual with

Clinical case definition of SARS

1. A history of fever, or documented fever

2. One or more symptoms of lower respiratory tract illness (cough,

3. Radiographic evidence of lung infiltrates consistent with

4. No alternative diagnosis fully explaining the illness.

1. At least 2 different clinical specimens (e.g. nasopharyngeal and stool

(b) Enzyme-linked immunosorbent assay (ELISA) and

 In the absence of known SARS-CoV transmission to humans, the positive predictive

Health Care workers especially those involved in procedures

Pulmonary decompensation is the most feared promblem

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