Snapshot A 43-year-old female presents to a hospital in Singapore with a five-day history of fever and headache, and a three-day history of a dry cough. She recently travelled to China on business. Temperature is 99.7°F (37.6°C). Physical exam shows a lethargic patient. Chest is clear to auscultation. Chest radiograph shows patchy consolidation of the the right upper and lower lobes. Blood cultures were negative. Tests for Legionella, Mycoplasma, and Chlamydia were all negative. Immunofluorescence for influenza A and B, adenovirus, and RSV were all negative. The patient had a poor response to IV ribavirin, IV levofloxacin, and corticosteroids. She was placed on respiratory support. Introduction Classification linear, enveloped (+) ssRNA coronavirus severe acute respiratory syndrome (SARS) Contagious viral respiratory disease Epidemiology 2002-2003 pandemic started in South China 8,273 cases and 775 deaths worldwide (9.6% fatality) risk factors those > 65 years of age had greater than 50% fatality rate virus can be isolated from palm civets Transmission respiratory droplets Presentation Symptoms initial non-specific flu-like symptoms muscle aches headache fever 2-10 days later cough dyspnea pneumonia Evaluation Diagnosis ELISA detects antibodies to SARS only works within 21 days of onset of symptoms immunofluorescence detects antibodies after 10 days of onset of disease PCR detects genetic material of SARS virus uses blood, tissue, mucous, and stool samples specific but not very sensitive test Labs leukopenia tendency towards lymphopenia thrombocytopenia Imaging CXR no pathognomonic features for SARS can commonly have patchy infiltrates in any part of the lung Differential Atypical pneumonia Treatment Supportive antipyretics supplemental O2 ventilation as needed Pharmacology no specific antiviral or steroid interventions have been found to be clinically beneficial still, corticosteroids and ribavirin are most commonly used Prognosis, Prevention, and Complications Prognosis worse in older persons co-morbidities such as diabetes mellitus elevated serum LDH Prevention frequent hand washing suspected cases should be isolated in negative pressure rooms no vaccines or specific treatments are yet available