Thin-Section CT in Patients with Severe Acute Respiratory Syndrome Following Hospital Discharge: Preliminary Experience

Antonio, Gregory E.; Wong, Kin Fai Ellick; Hui, David S.; Wu, Alan; Lee, Nelson; Yuen, Edmund H.Y.; Leung, Chi‐Bon; Rainer, Timothy Hudson; Cameron, Peter; Chung, Sydney S.C.; Sung, Joseph J.Y.; Ahuja, Anil T.

doi:10.1148/radiol.2283030726

Cited by 245 publications

(225 citation statements)

References 8 publications

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“…In contrast, some adult patients have developed pulmonary fibrosis despite recovery from the primary illness. 24 The diffuse thinning and shedding of hair among two fifths of children was self-limiting, although it was initially distressing for some older girls. We do not consider the phenomenon to be drug-related.…”

Section: Discussionmentioning

confidence: 99%

Severe Acute Respiratory Syndrome Among Children

Leung¹,

Kwan²,

et al. 2004

Pediatrics

118

152

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ABSTRACT. Objective. To study the epidemiologic, clinical, laboratory, and radiologic features, prognostic indicators, and short-term to medium-term outcomes for children with severe acute respiratory syndrome (SARS) and to validate the performance characteristics of a clinical case definition, calculated with respect to SARSassociated coronavirus (SARS-CoV) seroconversion.Methods. Children <18 years of age, from a singlesite outbreak, who satisfied a clinical case definition for SARS, with subsequent serologic confirmation, were treated according to a standard protocol and prospectively monitored.Results. Forty-four children were included. The median age was 12 years. Forty-two children (95.5%) demonstrated an epidemiologic link. Fever, cough, malaise, coryza, sputum production, headache, myalgia, lymphopenia, and elevated lactate dehydrogenase levels were common presenting features. Radiographic findings were nonspecific, but high-resolution computed tomography of the thorax was an early diagnostic aid. A specific reverse transcription-polymerase chain reaction assay for SARS-CoV yielded positive results for <50% of children. Of 9 children who developed hypoxemia, 8 were treated with methylprednisolone. Of 5 children who received intensive care, 3 required assisted ventilation. All children recovered, and serious adverse events in response to treatment were not observed. The outcomes at 3 to 6 months after disease onset, including exercise tolerance, pulmonary functions, and psychologic status, were favorable. An age of >12 years was associated with methylprednisolone therapy for severe illness. After exclusion of the only infant, an age of >12 years was associated with oxygen requirements. Sore throat, high neutrophil count at presentation, and peak neutrophilia were independent factors predicting severe illness. The clinical case definition demonstrated good sensitivity, specificity, and positive and negative predictive values (97.8%, 92.7%, 88%, and 98.7%, respectively) for diagnostic accuracy.Conclusions. 1 Although the majority were adults, 121 children (6.9%) Ͻ18 years of age were registered, yielding an age-specific attack rate of 8.9 cases per 100 000 persons Ͻ18 years of age and a case fatality rate of 0%. A total of 89 hospitalized children in Hong Kong demonstrated serologic evidence of infection by the SARS-associated coronavirus (SARS-CoV) (e-SARS database, Hospital Authority, Hong Kong Special Administrative Region, data on file).Published articles on pediatric SARS have focused on reporting the demographic, clinical, laboratory, and radiologic characteristics. Definitive virologic data, prognostic indicators, and short-term to medium-term follow-up information were lacking in those preliminary reports. [2][3][4] We prospectively monitored a cohort of 44 children with laboratory confirmation of SARS who were treated at a referral center for pediatric infectious diseases that admitted the largest number of pediatric patients with SARS in Hong Kong. Their epidemiologic links; clinical, laboratory,...

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Section: Discussionmentioning

confidence: 99%

Severe Acute Respiratory Syndrome Among Children

Leung¹,

Kwan²,

et al. 2004

Pediatrics

118

152

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“…In humans, SARS-CoV causes diffuse alveolar damage and deposition of fibrin with macrophage and giant cell infiltration in lung tissue [75,76]. Acute hepatitis has been widely reported and may be a result of immune-mediated, rather than direct, SARS-CoV viral damage [27,77,78].…”

Section: Pathogenesismentioning

confidence: 99%

SARS: clinical presentation, transmission, pathogenesis and treatment options

2006

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SARS (severe acute respiratory syndrome) appeared as the first emerging infectious disease of this century. It is fortunate that the culprit virus can be grown without much difficulty from a commonly used cell line, allowing an unlimited supply of isolates for further molecular studies and leading to the development of sensitive diagnostic assays. How the virus has successfully jumped the species barrier is still a mystery. The superspreading events that occurred within hospital, hotel and high-density housing estate opens a new chapter in the mechanisms and routes of virus transmission. The old practice of quarantine proved to be still useful in controlling the global outbreak. Despite all the available sophisticated tests, alertness with early recognition by healthcare workers and prompt isolation of suspected cases is still the most important step for containing the spread of the infection. Although the rapidly evolving outbreak did not allow the conducting of systematic clinical trails to evaluate treatment options, the accumulated experience on managing SARS patients will improve the clinical outcome should SARS return. Although SARS led to more than 700 deaths worldwide, the lessons learnt have prepared healthcare systems worldwide to face future emerging and re-emerging infections.

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“…Residual deficits in the structural and physiological functions of the respiratory system might occur in patients with such severe pneumonias. Although there have been reports on short term radiological outcomes, [2][3][4][5] the long term outcome of SARS survivors has not been reported. We present the results of lung function tests and high resolution computed tomography (HRCT) of the thorax in these patients 6 months after their initial hospital admission with SARS.…”

mentioning

confidence: 99%

Six month radiological and physiological outcomes in severe acute respiratory syndrome (SARS) survivors

2004

Thorax

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Background: The long term physiological and radiological outcomes of SARS survivors and their possible determinants are uncertain. Methods: SARS survivors in a follow up clinic in a regional hospital underwent high resolution computed tomography (HRCT) of the thorax and lung function tests 6 months after admission to hospital. The associations between the clinical and demographic data of the patients and the physiological and radiological outcomes were examined. Results: Fifty seven patients took part in the study. Lung function abnormalities were detected in 43 patients (75.4%), with restrictive defects (n = 16) being most common (28.1%). Radiological abnormalities of any degree were detected in 43 patients (75.4%). Only the use of pulse corticosteroids was associated with the presence of CT abnormalities (p = 0.043, OR 6.65, 95% CI 1.06 to 41.73). Conclusions: Physiological and radiological abnormalities are still present in a considerable proportion of SARS survivors at 6 months.

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Thin-Section CT in Patients with Severe Acute Respiratory Syndrome Following Hospital Discharge: Preliminary Experience

Abstract: Pulmonary fibrosis may develop early in patients with SARS who have been discharged after treatment. Patients who are older and have more severe disease during treatment are more likely to develop thin-section CT findings of fibrosis.

Cited by 245 publications

References 8 publications

Severe Acute Respiratory Syndrome Among Children

Severe Acute Respiratory Syndrome Among Children

SARS: clinical presentation, transmission, pathogenesis and treatment options

Six month radiological and physiological outcomes in severe acute respiratory syndrome (SARS) survivors

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