Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 9, Number 9—September 2003
Letter

Mild Severe Acute Respiratory Syndrome

On This Page
Article Metrics
21
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: Severe acute respiratory syndrome (SARS) is a recently recognized infectious disease caused by a novel human coronavirus (SARS-CoV) (1). The first case of SARS, diagnosed as communicable atypical pneumonia, occurred in Guangdong Province, China, in November 2002. Thousands of patients with SARS have been reported in over 30 countries and districts since February 2003.

SARS is clinically characterized by fever, dry cough, myalgia, dyspnea, lymphopenia, and abnormal chest radiograph results (13). According to the World Health Organization (WHO) (4), the criteria to define a suspected case of SARS include fever (>38°C), respiratory symptoms, and possible exposure during 10 days before the onset of symptoms; a probable case is defined as a suspected case with chest radiographic findings of pneumonia and other positive evidence.

Although most reported patients with SARS met the WHO criteria, we found two SARS case-patients who did not exhibit typical clinical features. Case 1 was in a 28-year-old physician. He had close contact with three SARS patients on February 1, 2003. After 10 days, he had mild myalgia and malaise with a fever of 37.3°C. He had no cough and no other symptoms. Leukocyte and lymphocyte counts were normal. The chest radiograph showed no abnormalities. He did not receive any treatment except rest at home. His symptoms disappeared after 2 days. He completely recovered and returned to work 4 days after onset of symptoms. After 12 weeks, his serum was positive for immunoglobulin (Ig) G against SARS-CoV in an indirect enzyme-linked immunosorbent assay (ELISA) with inactivated intact SARS-CoV as the coated antigen.

Case 2 was in a 13-year-old boy whose mother had been confirmed to have SARS on February 4, 2003. Fever developed in the boy 20 days after his mother’s onset of the disease. He did not come into contact with other confirmed SARS patients during this period. He had a mild headache and diarrhea with a fever from 37.2°C to 37.8°C for 3 days. No other symptoms and signs developed, and a chest radiograph showed no abnormalities. He completely recovered after 5 days. After 12 weeks, his serum was positive for IgG against SARS-CoV, detected with an ELISA.

In both case-patients, SARS had been initially excluded in spite of their close contacts with SARS patients because their symptoms could be explained as a common cold, and no specific diagnostic approaches were considered when they were sick since the causative agent of SARS was not identified until March 2003 (5). However, their serum specimens were positive for IgG against SARS-CoV by ELISA. Those results strongly indicate that both patients had been infected with SARS-CoV, although their signs and symptoms did not meet the criteria for the SARS case definition. Mild SARS-CoV infection may not easily be defined clinically, and such patients may potentially spread the disease if they are not isolated.

Top

Gang LiComments to Author , Zhixin Zhao, Lubiao Chen, and Yihua Zhou
Author affiliations: Sun Yat Sen University, Guangzhou, Guangdong Province, China

Top

References

  1. Peiris  JSM, Lai  ST, Poon  LLM, Guan  Y, Yam  LY, Lim  W, Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003;361:131925. DOIPubMedGoogle Scholar
  2. Tsang  KW, Ho  PL, Ooi  GC, Yee  WK, Wang  T, Chan-Yeumg  M, A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:197785. DOIPubMedGoogle Scholar
  3. Booth  CM, Matukas  LM, Tomlinson  GA, Rachlis  AR, Rose  DB, Dwosh  HA, Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003;289:28019. DOIPubMedGoogle Scholar
  4. World Health Organization. Case definitions for surveillance of severe acute respiratory syndrome (SARS). (Revised 1 May 2003). [Accessed June 6, 2003] Available from: URL: http://www.who.int/csr/sars/casedefinition/en/
  5. Stohr  K. A multicentre collaboration to investigate the cause of severe acute respiratory syndrome. Lancet. 2003;341:17303. DOIGoogle Scholar

Top

Cite This Article

DOI: 10.3201/eid0909.030461

Related Links

Top

Table of Contents – Volume 9, Number 9—September 2003

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

G. Li, Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat Sen University, NO. 600, Tianhe Lu, Guangzhou, 510630, Guangdong Province, P.R.China; fax: 86-20-87536401

Send To

10000 character(s) remaining.

Top

Page created: January 03, 2011
Page updated: January 03, 2011
Page reviewed: January 03, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external