Severe acute respiratory syndrome: clinical features

Lee, Po Oi; Tsui, Ping; Tsang, Tak Yin Owen; Chau, Tai Nin; Kwan, Chi Pong; Yu, Wai Cho; Lai, Sik To

doi:10.1007/3-7643-7339-3_3

Cited by 2 publications

(1 citation statement)

References 47 publications

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“…Though a satisfactory serum inhibitory concentration of lopinavir may not be achieved with the oral LPV/r combination [28], a sufficient level may be reached at the intestinal mucosa, since 20% of the drug is found excreted unchanged in the stool [29]. This is significant because severe watery diarrhea is a marked feature in 20.4-76.0% of SARS patients [12,25,30,31] and the gastrointestinal mucosa could be an important reservoir for viral replication and fecal-oral transmission [32]. In an open trial of the use of the LPV/r combination together with ribavirin in 41 patients compared with 111 historical controls, it was shown that patients in the LPV/r group had fewer 21-day adverse clinical outcomes (death/acute respiratory distress syndrome) and their disease course was milder with regard to diarrhea, fever recurrence, and worsening of chest radiographs.…”

Section: Antiviral Agentsmentioning

confidence: 99%

Treatment of severe acute respiratory syndrome

St¹

2005

Eur J Clin Microbiol Infect Dis

112

108

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The best treatment strategy for severe acute respiratory syndrome (SARS) is still unknown. Ribavirin and corticosteroids were used extensively during the SARS outbreak. Ribavirin has been criticized for its lack of efficacy. Corticosteroids are effective in lowering the fever and reversing changes in the chest radiograph but have the caveat of encouraging viral replication. The effectiveness of corticosteroids has only been suggested by uncontrolled observations, and the role of these agents in therapy remains to be established by randomized controlled studies. Both ribavirin and corticosteroids have very significant side effects. The lopinavir/ritonavir combination has been shown to reduce the intubation rate and the incidence of adverse clinical outcomes when used with ribavirin. When patients deteriorate clinically despite treatment with ribavirin and corticosteroids, rescue treatment with convalescent plasma and immunoglobulin may be beneficial. Noninvasive positive pressure ventilation is a sound treatment for SARS patients with respiratory failure if administered with due precaution in the correct environment. Interferons and other novel agents may hold promise as useful anti-SARS therapies in the future. The experience with traditional Chinese medicine is encouraging, and its use as an adjuvant should be further investigated.

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Section: Antiviral Agentsmentioning

confidence: 99%

Treatment of severe acute respiratory syndrome

St¹

2005

Eur J Clin Microbiol Infect Dis

112

108

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An overview on Severe Acute Respiratory Syndrome (SARS)

Hui

2005

Monaldi Arch Chest Dis

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Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease that has caught the medical profession by surprise in 2003. The major clinical features include persistent fever, chills/rigor, myalgia, malaise, dry cough, headache and dyspnoea but diarrhea occurs in 40-70% of patients after hospital admission. Respiratory failure is the major complication of SARS; at least half of the patients require supplemental oxygen during the acute phase whereas about 20% of patients progress to acute respiratory distress syndrome requiring invasive mechanical ventilatory support. In contrast, the severity is generally mild in infected young children. Due to our limited understanding of this new disease, treatment of SARS was empirical in 2003. Protease inhibitor (Lopinavir/ritonavir) in combination with ribavirin may play a role as antiviral therapy in the early phase whereas nelfinavir is a promising alternative. The role of interferon and systemic steroid in preventing immune-mediated lung injury deserves further investigation. In addition, other anti-viral treatment, RNA interference, monoclonal antibody, synthetic peptides, and vaccines are being developed. Rapid diagnosis, early isolation, and good infection control measures are important in preventing spread of the infection.

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Severe acute respiratory syndrome: clinical features

Abstract: Chest radiography can serve as a screening tool in the correct clinical setting. In a prospective study conducted in a SARS screening clinic for hospital staff, patients and their relatives, chest radiological changes were

Cited by 2 publications

References 47 publications

Treatment of severe acute respiratory syndrome

Treatment of severe acute respiratory syndrome

An overview on Severe Acute Respiratory Syndrome (SARS)

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