SEVERE ACUTE RESPIRATORY SYNDROME

Márcio Lança, M.D., Pneumology. Medical Residency in Internal Medicine and Pneumology, Catholic University São Lucas Hospital (PUC-RS).

Alternative name: SARS

What is it?

It is a severe viral respiratory disease that first appeared in Guangdong, China. Other cases cases have also been reported in other parts of Asia, in addition to North America and Europe. The cases reported outside Asia occurred in individuals that had traveled to that continent, or amongst people having hat contact with such individuals (relatives or health-care providers having assisted infected individuals). Major risk areas include China, hanoi, Taiwan, Vietnam, Cingapura and Canada. Generally, the onset of the disease is marked with a fever above 38°C in addition to other flu-like symptoms. A fews days afterwards it can evolve to respiratory failure (very impaired breathing).

Usually, the disease begins with fever above 38º C and other symptoms similar to those of flu. After a few days it can progress into respiratory insufficiency (insufficient oxygen).

What does one experience?

The illness begins with fever that can be associated or not to chills and other alterations. The individual may experience general discomfort, joint and muscle pains, sore throat and headache – symptoms similar to those of a flu. More seldom, diarrhea can occur.

After a few days the individual with SARS will present dry cough and shortness of air, entailing hospitalization at an Intensive Care Unit in some cases, in order to be subjected to mechanical ventilation – an equipment that helps the individual breathe.

How is it acquired?

Two to seven days (it may take as long as 10 days) after the contact with a SARS-infected individual, fever and subsequent symptoms begin. The first mode of contagion is through contaminated droplets disseminated in the environmental air when the diseased individual sneezes or coughs. When doing so, the virus is expelled. When a healthy individual, sharing the same environment with the diseased person, starts breathing the contaminated air, the virus is taken to the lungs, and the disease is acquired.

The virus is believed to be able to survive in the environment for as long as 3 hours.

It’s also possible that contamination occurs through objects that had been contaminated by the diseased individual. For instance, the diseased individual that had touched his own nose with the hands starts using a comb without having washed the contaminated hands before, then another person uses the contaminated comb and puts his hand on the nose, getting infected as well.

How long the SARS-infected individual can contaminate other people?

According to information from the Atlanta’s Center for Disease Control (USA), it’s more likely that the individual may infect other people during the period in which he exhibits the disease symptoms – fever and coughs, e.g. However, it remains unknown how long before or after the disease onset the contagion may take place.

What’s the cause of the disease?

Laboratory evidence suggests that the disease is caused by a virus (coronavirus) that underwent some changes to its structure. A recent report in medical literature associates the new coronavirus as the cause of SARS cases around the world. The name coronavirus Urbani has been proposed for these SARS-associated cases.

How does the doctor diagnose it?

He must take into account signs and symptoms compatible with the disease, associated to the fact that the individual traveled in places where SARS cases have taken place (mostly in China). It’s important that the individual tell the physician about this.

People that had contact with suspect or confirmed cases of the disease must mention this at the medical visit.

There are no specific tests for SARS thus far. Investigators are working on this.

Laboratory tests are of little help for the diagnosis. Lung radiographs may look normal either throughout the disease course or only at its onset.

How is it treated?

Currently, patients suspected of SARS have been treated as any other severe pneumonia case of unknown cause acquired in the community. Antibiotics have been used. Antiviral and corticoid drugs can be used, though there’s no consensus over their help in these cases. Treatment is mostly supportive, that is, better conditions are provided so that the infected individual’s organism can defend itself from the infection.

How is it prevented?
 

measures for infection control must be maintained in SARS patients up to 10 days after fever and further changes disappear;
health-care professionals have advised people and handed out health alert cards in airports and ships;
individuals that had contact with people in suspicion of being infected must seek medical care in case they begin experiencing SARS symptoms;
individuals with SARS mustn’t leave their homes. They mustn’t go to school, work, or other public places for 10 days after the cure;
for 10 days, people who shared the same house with a patient will have to carefully and frequently wash the hands or rub them with an alcohol-containing solution;
diseased individuals must cover their nose and mouth when sneezing or coughing;
surgical masks must be used by SARS patients in recovery, or people in contact with these;
wear disposable gloves when in contact with body fluids (sweat, urine, etc,) from the patient (important to health-care professionals). Subsequently, wash your hands;
don’t share household appliances with the patient. Separate cutlery, dishes, glasses, towels and bed sheets;
keep the diseased individual’s home clean;
people living with SARS suspects don’t have to restrict their activities outside home, unless they develop symptoms of the disease.

Questions you can ask your doctor about:

Why can a virus that usually causes respiratory infections without greater severity change and cause a severe disease like this?

What antiviral drugs have been used to fight the disease?

Will the individual traveling with a condition suggestive of the disease be prevented from continuing his trip?

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